InBrief

CXL receives approval

The FDA has approved a riboflavin ophthalmic solution (Photrexa, Avedro), which treats progressive keratoconus with corneal collagen crosslinking (CXL). Photrexa uses an electronic device (KXL System), which irradiates the riboflavin ophthalmic solution using ultraviolet A light once applied to the cornea. The treatment could prevent the need for a corneal transplant.

New cataract surgery sedative

Imprimis’ midazolam-ketamine-ondansetron conscious sedation sublingual tablet — or the MKO Melt — is a new sedative option for cataract patients. Rather than use IV needles, MKO Melt dissolves over a period of about two minutes, peaking about 15 minutes later. It is composed of 3 mg midazolam, 25 mg ketamine and 2 mg ondansetron.

Oculus product update

The Oculus BIOM ready received a U.S. patent. The BIOM ready is the first single-use wide angle viewing system for vitreo-retinal surgeons. Also, a new tomographic keratoconus classification/staging display is available on the Oculus Pentacam. The Belin ABCD Keratoconus Staging, a free update for users, independently grades the anterior corneal surface, posterior corneal surface, and corneal thickness.

CLARIFICATION

Our March/April 2016 cover photograph depicted an injection procedure where the doctor was not wearing gloves. The photo was of a simulated patient encounter, not an actual encounter, where the presence of a photographer, lights, and other equipment might affect patient care or compromise patient confidentiality. Therefore, infection control precautions were not necessary. That said, the editors of Ophthalmic Professional apologize for not catching this oversight.

If you were Jess, what would you do?

Robert M. Kershner, MD, replies:

This scenario is all too familiar. Physicians today need a deck of tarot cards to see what new regulatory hurdles they will have to jump. Ophthalmic practices of the past decade were not burdened with the complex compliance and regulatory requirements that are a daily part of today’s offices. According to The Practice Profitability Index, physicians spend 70% more time on administrative paperwork than they did just a few years ago.

In 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HiTech) Act, which provided financial incentives to eligible professionals (EPs) who adopted and showed meaningful use of certified Electronic Health Records (EHRs). Despite this incentive, a recent survey of the members of the American College of Surgeons Board of Governors showed that 22% do not use an office EHR.

A recent RAND Health report cited physician dissatisfaction with EHRs, including time-consuming data entry, interfaces that do not match clinical workflow, interference with face-to-face care, information overload, mismatch between meaningful use criteria and clinical practice, negative effects on practice finances, the need to perform lower-skilled work, and template-based notes degrade the quality of clinical documentation. The Centers for Medicare and Medicaid Services (CMS) data show a 20% meaningful use dropout rate in 2013. In February 2015, Medical Economics reported that 256,000 physicians were penalized for failure to show meaningful use. And that is just the beginning.

Although most practices will not likely undergo an audit for violations of the Health Insurance Portability and Accountability Act (HIPAA), the threat of an audit lurks over every practice. Consider meaningful use attestation, HIPAA, and the impact of the Affordable Care Act (ACA) on claim denials, which requires manpower to sort out the reasons for denial and forces the practice to collect the multiple co-pays and deductibles.

Physician Quality Reporting System (PQRS) and the Merit Based Payment System will gradually shift reimbursement from fee-for-service to value-based payments. Practices will face penalties for not reporting PQRS data to CMS. Someone in the practice will be strapped with these responsibilities.

Jess should listen to her gut — and heed the advice of her husband. If she accepts this role, she should ask her boss if she can delegate some responsibilities. She should also request that she be granted the power to hire additional outside help if necessary. Most importantly, Jess’ new job should grant her enough time to prepare for the onslaught of even more regulatory intervention. It’s in the cards.