8 Ways the ACA Could Affect Your Ophthalmology Practice

Leigh Page


September 11, 2013

In This Article

You Might Work More Closely With Other Physicians

3. Referral relationships may change

Ophthalmologists tend to have relatively little contact with other specialties, but ACOs and other arrangements promulgated by the new healthcare law could bring them into much closer contact, according to Shachar Tauber, MD, chairman of Mercy Clinic Eye Specialists, an 8-member ophthalmology practice in Springfield, Missouri, that is owned by Mercy, a multistate health system with 31 hospitals.

Dr. Tauber is part of a very rare breed of ophthalmologist who is employed by a hospital and actively involved in an ACO. Mercy's Springfield-based Medicare ACO was approved in January.[3] Dr. Tauber said that his group will participate in "holistic" care involving new relationships that emerged 8 years ago. In 2005, Mercy-Springfield physicians, then part of St. John's Health System, started operating in the Medicare Physician Group Practice (PGP) demonstration,[4] a federal initiative that was the basis for developing the ACO.

In the PGP demonstration, one of St. John's goals was to improve care for diabetes by providing eye exams for diabetic retinopathy, Dr. Tauber said. Only about half of the targeted population had been getting eye exams, so to improve the rate, St. John's provided primary care physicians with non-mydriatic retinal cameras to photograph their patients' eyes. They took pictures of 800 eyes that had never been examined, and when St. John's ophthalmologists reviewed the images, they found that 20% had disease.

Just as other Mercy physicians help Mercy ophthalmologists identify eye patients, the ophthalmologists, in turn, help colleagues by ordering labs, imaging, or referrals for illnesses that ophthalmologists don't typically treat. "Our goal is to make ourselves indispensable to primary care," Dr. Tauber said.

4. You may be reimbursed under new methodologies

Although most ophthalmologists will continue to be paid fee-for-service rates even in ACOs, they could eventually gravitate to new payment methodologies that could improve ophthalmic care.

The federal Center for Medicare & Medicaid Innovation (CMMI), created by the ACA, is experimenting with strategies like bundled payments, where all aspects of care for a particular procedure are brought together under one overall payment.

Dr. Rich said that a bundled payment for cataract surgery could take advantage of lower reimbursement in an ophthalmic surgery center relative to a hospital. The bundle would include the surgery center's facility fee, the surgeon's fee, the intraocular lens (IOL), preoperative drugs, and other costs over 6 months. He suggested another bundled payment to cover the total costs of treatment for wet age-related macular degeneration (AMD) over a year, including surgery, drugs, visits, and images. "There is a lot of variation among practices here," he noted.

In addition, Dr. Rich said that new payment models could reimburse ophthalmologists for putting patients on home monitors for conditions such as AMD, glaucoma, and diabetic retinopathy. Medicare currently does not cover such arrangements, even though they are much less costly than office visits.

Dr. Rich said that he has proposed bundled payments for ophthalmologists to federal officials several times but has not received a response. Gustafson, who used to work at HHS, said that it might take a while for officials at CMMI to study these suggestions, but they probably would be interested. "CMMI has only so many people, and they need to prioritize," he said.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.