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TIPS, TRENDS & NEWS YOU CAN USE
Congress Replaces SGR Formula With New Payment Systems
After undergoing 17 patch jobs since its creation in 1997, CMS’ sustainable growth rate (SGR) will be replaced by new payment systems through the Medicare Access and CHIP Reauthorization Act (MACRA), which President Obama signed into law late last month. Under SGR, a 21% pay cut was set to start April 1.
“I believe the ‘fix’ of Medicare’s flawed formula for determining new fee schedules will be good for all providers,” explains Charles Brownlow, O.D., F.A.A.O., founder of PMI, LLC, a consultancy for medical records and coding. “First, it ensures a small increase in reimbursements over the next several years. Second, and probably more importantly, it will eliminate all the annual uncertainty about Medicare’s fees that have left providers in doubt from November 1 of each year right up until Congress would step in to ‘fix’ the fee schedule in the first quarter of the new year.
“Third, providers won’t have to wait for the ‘corrections’ that each Medicare carrier had to make each year when the original changes — usually reductions — were set aside and corrected by Congress.”
Under the new law:
► MACRA will freeze Medicare payment rates at prior April levels until June when rates will escalate 0.5% and subsequently increase from 2016 until 2019. Payment rates for services on the physician fee schedule will remain at the 2019 level until 2025; however, payments to individual providers will be adjusted via one of two ways, depending on whether the provider chooses to participate in an Alternative Payment Model (APM) program or the Merit-Based Incentive Payment System (MIPS), which replaces provider payment incentives under Meaningful Use.
► Starting 2026, providers paid via APM will see a 0.75% annual payment rate increase, while payment rates for other providers will escalate 0.25% annually. In addition, those providers who participate in MIPS will get payment adjustments based on their performance compared with a threshold.
Further, from 2019 to 2024, $500 million will be given to MIPS providers whose performance is viewed as exceptional.
► Finally, from 2019 to 2024, providers who get a large portion of their revenue via APMs will pocket a lump-sum payment after each year that is equal to 5% of their Medicare payments for reimbursed services based on that year’s physician fee schedule. Providers who receive small revenue amounts from APMs don’t get an adjustment to their payments or the MIPS performance adjustment if measures and activities were reported via that program.
► In addition to the payment changes, the law extends the Children’s Health Insurance Program (CHIP) and Medicare Advantage plans through 2017 and permanently extends the Qualifying Individuals Program and Medicaid’s Transitional Medical Assistance program through several offsets.
Tips for Your Practice
■ “Today’s shopper sees, hears and smells with greater acuity. They form opinions through visual and symbolic information, such as colors, assortments and organization, much more readily than through words” – Kit Yarrow, author of “Decoding the New Consumer mind: How and Why We Shop and Buy”
■ “Asking for small initial commitments primes people to want to be consistent with them because doing so fulfills the fundamental motivation to been seen in a positive light.” – Robert B. Cialdini, author of “Influence: The Psychology of Persuasion”
■ “When presenting consumers marketing materials, use an easy-to-read font, such as Arial, vs. a ‘fancy’ font, such as Brushy. ‘Fancy’ fonts can make the marketing material seem time-consuming or complicated.” – Roger Dooley, author of “Brainfluence: 100 Ways to Persuade and Convince Consumers with Neuromarketing”
■ “. . .The more the salesperson understands the client’s needs, the better and more mutually beneficial the decisions become.” – Craig Christensen, author of “Closing: 5 Sales Skills for Achieving Win-Win Outcomes”
■ “Words are powerful. The subtle differences in the language and words we use are directly connected to how we feel, our attitude and, ultimately, our success. When you use positive language, whether talking to others or, in your own self-talk, your outlook tends to become positive.” – Jeb Blount, author of “People Buy You: The Real Secret to What Matters Most in Business”
New Mexico Scope of Practice Law Expands Prescription Authority
New Mexico passed a law that enables the state’s O.D.s to treat the eye and surrounding tissue with oral steroids/immunosuppressives, oral anti-fungal and oral glaucoma drugs and some Schedule II controlled drugs, such as all hydrocodone combination drugs. The law also gives the New Mexico Board of Optometry the authority to decide what constitutes scope of practice.
The legislation, which goes into effect July 1, received support from lobbyists from the New Mexico Academy of Ophthalmology, the American Academy of Ophthalmology and the New Mexico Medical Society.
“I think ophthalmology supported this legislation for a few reasons,” explains Robert Jarrell, III, O.D., president of the New Mexico Optometric Association. “First, several O.D.s in the state work hand-in-hand with ophthalmologists, so many already knew that we have both the education and skill needed to provide excellent care. Second, we educated those concerned about the legislation that our education and annual CE training. . . prepares us well for patient care. Finally, ophthalmology agreed that O.D.s were needed to help solve the problem of lack of eyecare access.”
Indeed. Eye Associates of New Mexico, a large ophthalmology practice, says, “We realize the challenges of providing eye care to the citizens of our state. Many live in rural and underserved areas and, in some cases, an optometrist is the sole eyecare provider . . . The changing demographics of our country and the increased demand for medical care, including eye care, requires all providers to practice at the highest level of their training.”
Low Vision Rehabilitation Pioneer Passes Away
Alfred A. Rosenbloom, O.D. M.A., D.O.S., a trailblazer in low vision services, passed away at age 94 in early April.
Dr. Rosenbloom was a former professor, dean and president of the Illinois College of Optometry as well as a writer and editor of a plethora of papers and books on the low vision field. In 1954, he helped create the Low Vision Clinic at the Chicago Lighthouse and most recently the Alfred and Sarah Rosenbloom Center on Vision and Aging at the Illinois Eye Institute. In addition, he received VOSH’s Humanitarian of the Year Award, the AOA’s Distinguished Service Award, the William Feinbloom Memorial Award for excellence in low vision services, the American Foundation for the Blind’s Migel Medal, and in 2010, the AOA inducted him into the National Optometry Hall of Fame.
Alcon Announces Color Squad to Promote AIR OPTIX COLORS
Alcon, a division of Novartis, has announced its new “Color Squad,” to help promote the company’s AIR OPTIX COLORS contact lenses, which were launched last year. The Squad, consisting of celebrity hair stylist Lacy Redway, makeup artist Scott Barnes and fashion stylist Ilaria Urbinati (see photo), recently spoke to the press and select style influencers about top Summer 2015 trends, including the following:
• ’70s inspired. The iconic 1970s are reimagined by way of colorful floral and bohemian prints and flowy peasant blouses.
• Laidback looks. Shirtdresses and sneakers plus minimalist makeup mix with low braids and a more carefree, undone beachy wave to let natural beauty shine through.
For more information on the latest trends, visit www.facebook.com/airoptixcolors, or contact your Alcon representative for in-office educational materials and support.
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