InFocus WAEPS Member Newsletter - December 2019

President's Corner

Rebecca Dale, MD,

WAEPS President 2019-20

Last month, I had the opportunity of joining 20,000 runners for a marathon in Las Vegas. I don't run quickly, so this provided me a lot of time to think. I realized that there were a few powerful lessons the marathon could teach ophthalmologists.

First, training matters. I don't need to belabor this point to this audience. But it's clear to me that the hours spent carefully training, building experience, and learning from mini-injuries, fatigue and set-backs are key to successful completion of a marathon. And the more than 18,000 hours of training ophthalmologists receive is both important for successful patient care, and something we should be proud of.

Second, persistence is key. It's easy to become discouraged with prior-authorizations, step-therapy hurdles, exorbitant drug costs, vanishing generics, scope of practice battles, and declining reimbursements. But if we refuse to stop, we can experience successes.

Third, our mental game is crucial to success as we persist against these frustrations. Once we believe our voice doesn't matter, it doesn't. But if we shush the voice that says to just quit, we'll find that we can exceed our own expectations. If we believe in our ability to make a difference against these frustrations and we take actions grounded in the belief we can succeed, we will.

Finally, we can go farther together. There is an African proverb about running that speaks to this. "If you want to go fast, go alone. If you want to go far, go together." We have some outstanding servant-leaders in WAEPS who have put in countless hours for advocacy for our profession. But the power of many is needed if we want to go the distance in advocating for our patients. Every one of us can and should be contributing to our Washington Physicians EyePac, the Washington Eye Foundation, the AAO surgical scope fund and Ophthpac. Even more gratifying, I ask that you also raise your hand and get involved. Our patients need fresh perspectives and many minds considering how to meet the eye care challenges of our future. It may just be your idea -- for a new collaborative practice model, a creative way to use technology, or a legal action to protect patients -- that brings a win for our patients. But if you don't slip into your sneakers and take the first step of getting involved, you'll never know how many marathons we could have completed together. Please reach out to me or any WAEPS board member, and we'll be happy to help you get involved.

Fall AAO Council Update

Mike Brush, MD

The Fall Council Meeting occurs every year during AAO. I encourage all WAEPS members to take the time to attend at least once to help understand some of the big issues facing our profession.

The morning session was dominated by discussion regarding the Academy’s relationship to organized optometry – AAO2AAO. This was in follow up to a summer council webinar that reviewed the history of this relationship and the question of where to go from here.

Although many of us have strong and collegial individual relationships with optometrists the two professions have spent over $250 million in legislative battles regarding scope of practice. While ophthalmology has won over 90% of these fights, currently 8 states have expanded scope of practice for optometry into the surgical realm.

The AAO2AAO initiative began in 2013 and has led to four successful joint symposia at each organizations Annual Meeting. Topics such as Cosmetic Contact Lenses and Prevention of Myopia Progression have resulted in collaborative statements.

In January 2020 all AAO members will receive a survey to help guide the council on the question of where to go from here, in regards to the status of optometry at our Annual Meeting. I encourage everyone to complete this as it will give voice to our opinions.

In our regional breakout sessions, the Washington delegation heard from other Pacific/Mountain states about the status of their state societies and any potential legislative battles that may be forthcoming. We continue to be one of the strongest state societies – this is only possible through active membership. If you know of colleagues that are not WAEPS members, please reach out and encourage them to join.

Finally, we received updates on several Council Advisory Recommendations (CAR). Of note, WAEPS sponsored a CAR that resulted in updating of the AAO’s sexual harassment policies.

Please feel free to contact me with any questions regarding the AAO Council.

Respectfully submitted,

Michael Brush MD

2020 WAEPS Annual Meeting

March 19 & 20, 2020

Paul Griggs, MD, Chair

Venue: Washington State Conference Center, Seattle, WA

Join your colleagues for another outstanding program with tracks specifically designed for ophthalmologists, their medical personnel, practice managers and administrative staff.

This year we return to the spacious Seattle Conference Center facility in downtown Seattle, WA.

Our Annual Meeting program includes the following components:

• All day Coding and Reimbursement Seminar - Thursday the 19th.
• Physician Program begins Thursday evening and continues all day on Friday the 20th.
• Ophthalmic Personnel Program for techs - Friday the 20th.
• Practice Management Seminar - Friday the 20th

The 2020 line-up of outstanding guest faculty for the physician program is as follows:

• Donald Bundenz MD, Glaucoma speaker, University of North Carolina, Chapel Hill, NC
• Mitchell Jackson, MD, cataract speaker, Jackson Eye Founder, Lake Villa, IL
• David Plager, MD, pediatric ophthalmologist speaker, Riley Hospital for Children, Indianapolis, IN
• Sunil Srivastava, MD, uveitis and retina speaker, Cole Eye Institute, Cleveland, OH
• Hans Bruhn, Risk Manager, OMIC, on malpractice prevention

Registration Fees:

The cost to participate in each program is based on whether participants are employees of a WAEPS member practice. In order to take advantage of the significant member discounts, the member’s 2020 dues must be paid prior to January 30, 2020. Some of the programs also have an early-bird registration discount. Check the individual program pages for details.

Overnight accommodations:

A room block at a discounted rate of $249.00 per night (single or double occupancy), plus tax including free wi-fi and discounted parking has been reserved at a convenient nearby hotel, the Seattle Sheraton Grand located one block from the Conference Center. You may book your room at the discounted rate by clicking this link.

The room block is limited so make your reservation today.

Registration for all components of the meeting will open in January. We encourage all participants to register themselves via their own personal profile. The exception is the coding program-where we prefer to have the practice managers register the entire group coming from their practices. More details will be coming in late January on the annual meeting page of the WAEPS website.

Level Up at Codequest 2020

Michael Gilbert, MD

2020 WAEPS Annual Coding Seminar with Sue Vicchrilli!  March 19, 2020

The best way to protect your practice from claim denials and audits.

Join the most knowledgeable coding experts in ophthalmology for a half-day of professional instruction in your area. We’ll map out the latest coding updates and steer you through the complex maze of payers’ rules, arriving at successful solutions for preventing claim denials and avoiding penalties.
 Save the date: Thurs. March 19, 2020.

Fundamentals of Ophthalmic Coding (3hrs)

• New cataract/glaucoma codes and criteria for the new codes for extended and subsequent ophthalmoscopy
• Additional 2020 updates:  Modifier -50, ICD-10, HCPCS, CCI, MUE, LCDs and payment changes.
• What happens to claims when you don’t follow and apply CCI edits
• Modifier mastery, Part One

• Implementation of the new E/M documentation guidelines
• For physicians and physician extenders
• Modifier mastery, Part Two
• Coding competency challenge
• Stop claim denials.  Causes and repairs
• MIPS reporting updates for 2020

BONUS: Each attendee will receive fact sheets on important topics:

• Testing bundling edits
• Frequency of testing
• Premium IOL Dos and Don’ts for out-of-pocket expenses
• Refractions
• A-scan and ultrasound billing
• Blepharoplasty and ptosis guide
• Cataract and complex cataract surgery
• Skilled nursing facility
• Strabismus add-on codes

Best of all, Codequest is ophthalmology-specific and region-specific to focus on the coding information you need most. Join us March 19, 2020 at the Washington State Conference Center.

Have a specific coding conundrum? Email questions to [email protected] before the course and get answers to your personal coding challenges. Registration will open in late January. Watch your email for registration information.

Public Information / Education:

 David Epley, MD

The public information committee is working on developing “pop up” eye clinics in Washington state, the first being in the Bellingham area. The idea is to partner with a local business, sports teams, or charities to host the clinic and to recruit volunteers to staff the clinic to provide eye exams for those in need. WAEPS Board Member Stephanie Cramer is organizing the development of this project, collaborating with the Department of Ophthalmology at UCLA to learn from their experience in doing these types of clinics.

WAEPS Board Member Matthew Weed, along with colleagues Jeffrey Colburn and David Epley (Chair of the Public Education Committee) collaborated with school nurses to survey how they have changed vision screening procedures following a change in the screening regulations several years ago. They found that many schools adopted instrument-based screening as a loophole in the language that allowed them to avoid having to do near vision screening which was added in the new regulations. School nurses view the technology positively because it is a time-saver. Unfortunately, this is leading to instrument-based screening of older children who can read a chart. As ophthalmologists, we know that the instruments can auto refract, and can detect anisometropia, some strabismus, anisocoria and asymmetric red reflexes, and sometimes ptosis, but do not test vision and can fail to catch some kids with posterior pathology who cannot see well (macular scar, optic nerve hypoplasia, etc.). You can read the abstract here or download the full poster here.

WAEPS, the Washington Eye Foundation (WEF), and local charity Violet Sees to explore having an ophthalmology presence in a “medical home” concept that Lowell Elementary is developing. Planning is in the early stages, but if you are interested in helping out on this project, or any of the other Public Information Committee Projects, please email David Epley at [email protected].

Payer Relations

Michael Gilbert, MD

NEW Medicare Recovery Audits Target Ophthalmology.

Medicare has announced that their Recovery Audit Contractors, RAC, will be uniquely targeting Ophthalmology as the specialty most frequently billing for a new patient exam incorrectly. New-patient exams pay at a higher margin than established patient exams at all levels of complexity. While the rules for describing a patient as “new” are straight forward, there are many nuances and situations which can lead to error. It is not apparent why ophthalmology has an error rate beyond other specialties. However, knowing this would encourage WAEPS members to conduct practice review of billing policies. Should errors be identified, it would be advisable to correct the error rather than hope it will go undetected.

Because ophthalmology practices somehow have a disproportionate error in determining new vs established WAEPS will add this as a focus of the upcoming WAEPS CodeQuest March 2020, below. RAC audits are disruptive and potentially expensive as these auditors work on a bounty system. It is time for a review of the basics!

Executive Summary When an established patient is submitted as new by claim: commercial payers deny an erroneous claim so it can be submitted with the appropriate level as established patient exam. Medicare pays as submitted, and then recoups going back three years through RAC audits.

Noridian Developing MIGS LCD Policy

Noridian has published a draft LCD, Local Carrier Determination, policy on MIGS. The content of the policy is in line with Medicare policies in other carrier regions. The proposed policy would cover only one stent of the newer iStent Inject technology. Should the policy be published and finalized in this form, the second stent, CPT 0376T, could by used in patient care however would require an ABN, Advanced Beneficiary Notification, and patient responsibility.

Find those Medicare/Noridian LCDs

To review or download Noridian LCD policies; Start with the disclosure/agreement page:

https://med.noridianmedicare.com/web/jfb

RVS Fairness, E/M & Surgical Codes

Since its inception the RVS, Relative Value System, was touted as a fair and equitable basis of compensation such that all specialties, medical and surgical ,would be treated fairly and equally. Currently Medicare CMS intends to change that uniformity choosing to apply different rates depending on whether the values are part of a surgical 10 or 90-day global compensation for the postop care. If implemented as proposed this will adversely impact reimbursement of surgical codes in addition to and compounding adverse revaluations in RVUs, Relative Value Units, such as the pending decrease in cataract reimbursement. Supporting your national organization PACs (AAO, ASCRS, etc) and your own contacts to Congress are our best chance to influence these changes.

Legislative Update

 Washington Medical Commission 

Edited to update incorrect links.

Dear Interested Party:

The Department of Health (department) has adopted amendments to WAC 246-918-990 Physician Assistant fees and renewal cycle and WAC 246-919-990 Physician and Surgeon fees and renewal cycle. These rules will increase the fees for license renewal and late renewal penalty. The amended fees were adopted on October 10, 2019 under WSR # 19-21-052 and become effective February 1, 2020. Attached you will find the adopted rules, the Concise Explanatory Statement, and other relevant documents as referenced below.

What has changed from the proposed rule filed April 2019?
The final adopted fees have decreased by the following:

	Physician			Physician Assistant
	Current	Initial proposal	Final Proposed	Current	Initial proposal	Final Proposed
Renewal (every 2 years)	$525	$880	$824	$70	$265	$247
Late Penalty	$262.50	$300	$300	$50	$130	$124

*Fees listed do not include University of Washington (UW) HEAL-WA annual surcharge of $16 or Washington Physician Health Program annual surcharge of $50.

How did the department and the Washington Medical Commission (WMC) respond to comments provided during the open public comment period and the hearing?
Attached is the Concise Explanatory Statement outlining the comments received and the department and WMCs response to those questions.

Where can I find out more information about the budget?
Attached is a document showing the financial forecast and costs that are driving the fee increase. This document has been updated from the proposal to reflect changes as a result of the final adopted rule.

Who has authority for setting fees?
The WMC does not have authority to establish fees or make recommendations for a fee change. The fees for every health profession fall under the jurisdiction of the Secretary of Health. (WAC 246-12-330). RCW 43.70.250 requires that each health profession’s budget must be self-sustaining and borne by the profession. Therefore, costs associated with the medical professions come directly from the profession’s budget. This applies to all health professions.

What factors have contributed to the need for the increase?
The main reason for the fee increase is high disciplinary and litigation costs for the medical professions. Costs associated with disciplinary spending include investigations, legal services, and attorney general services. Costs have also increased for credentialing, case management, and call center functions. You can find more detailed information about disciplinary actions in the 2015-2017 Uniform Disciplinary Act Biennial Report.

We hope this information is useful in understanding the necessity for a fee increase. The department has implemented procedures to avoid an even higher increase. In addition, the department and WMC have increased efforts to assist with finding ways to keep costs down.

The department and the WMC remain firmly committed to its mission and mandate of public protection. If you have any questions, you can contact Cori Tarzwell at [email protected] or 360-236-4981.

Any person may petition the adoption or amendment of these rules in accordance with RCW 34.05.330.

---

 Wenatchee's Dr. Brian Bowe connects with Sen. Brad Hawkins

WAEPS Board Member Dr. Brian Bowe with Sen. Brad Hawkins

"A fund raiser for Senator Brad Hawkins (R-12) was held in Wenatchee on Saturday, November 16, 2019. There was a large number of medical providers and administrators from Confluence Health in Wenatchee present. I was able to deliver a check to Sen. Hawkins from the WAEPS EyePAC personally. We had a interesting discussion of medical issues and it was a nice informal time to re-establish a connection with our representative in Olympia."

 Washington State Licensure: Ambulatory Surgical Facility 

State regulations overview and checklists from WAEPS legal counsel, Emily Studebaker

State Regulations Overview & Checklists

Monthly Meetings

Monthly Scientific Meeting Series 2019-20 – Yewlin Chee, MD, Chair

WAEPS members gather monthly for educational sessions in our award winning Monthly Scientific Meeting Series, co-presented by the University of Washington Department of Ophthalmology. These programs are presented by experts in a variety of ophthalmology sub-specialties. For those who are able to attend in person, the lectures are held in the auditorium at the Harborview Eye Institute on floor 7 in Seattle. In addition, the series is available to members throughout the state via live streaming webinar. Category 1 CME credit for the series is an exclusive WAEPS member benefit and is free of charge. Note that to earn credit you must sign-in to each session you attend and track your attendance and submit a credit claim form at the end of the series.

On December 18th, Dr. Matthew Zhang, MD Assistant Professor, Department of Ophthalmology at University of Washington will be presenting two lectures. The first will focus on thyroid eye disease: and the utilization of orbital radiotherapy. The second will provide a review canalicular injury and reconstruction.

To receive login instructions, be sure to register online on the Monthly Meeting page of the WAEPS website. Your automatic confirmation email will contain the webinar login information for that month's session. If you need assistance with registration or do not receive your confirmation, please contact the WAEPS office no later than 3 p.m. on the day of the session you plan to participate in. Contact [email protected].

Seattle / King County Clinic

Seattle/King County Clinic Needs Vision Care Volunteers February 13-16, 2020

 WAEPS invites all ophthalmologists and technicians to support the King County Clinic scheduled for February 13 – 16, 2020 at Seattle Center.

Seattle/King County Clinic reported that only 18% of the vision volunteer support has been filled. Can you help?

What is filled to date:

• 58% of Medical assignments
• 51% of General Support assignments
• 42% of Dental assignments
• 18% of Vision assignments
• 11% of Healthcare Resource assignments

Do you know someone who intends to volunteer? Have you asked your healthcare providers to participate? Have you signed up? Thursday and Sunday are the days we experience the most difficulty getting volunteers. Please help us with recruitment! You can find information and sign-up at seattlecenter.org/volunteers

Dr. Aaron Lee receives the AAO Secretariat Award!

The secretariat award recognizes special contributions to the Academy and to ophthalmology.  Dr. Lee has been selected for his outstanding support of Secretariat for State Affairs' Big Data efforts. Russell Van Gelder, MD, PhD, Professor and Chair of Ophthalmology at University of Washington and WAEPS Immediate Past President notes, “Dr. Lee has put his prodigious data analysis skills to use in mining databases such as IRIS to improve patient care throughout the country.  His work has revealed the current state of ophthalmic care in our state and our country, and highlighted the outstanding access to ophthalmic care available to the vast majority of the population.  Dr. Lee is highly deserving of the Secretariat Award of the AAO, and we are very fortunate to have him as a WAEPS member and ophthalmologist in our state."