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    MACRA changes are part of volume-to-value shift

    Clinicians need to understand system basics, reporting requirements; consider new models


    Retina-specific advanced APMs are a theoretical option to MIPS. They required evidence of downside risk-taking—typically greater than 3% of payments—as well as critical bundle size, such as 35% of Medicare revenue and patients in 2019 and 50% in 2021. Dr. Parke said that the Academy continues to model and investigate this approach because of advantages in bonus payments but has yet to define a model which it believes is clinically applicable.

    He also reminded physicians that commercial as well as federal payers are keenly interested in moving from volume to value and are exploring non-traditional payment systems including reference-based pricing, bundles, and two-sided risk arrangements.  

    Facing challenges from multiple directions, ophthalmologists and particularly retina specialists have to acknowledge that their chosen specialty and subspecialty make up a very small part of the “house of medicine,” Dr. Parke said. “As we try to move the payment needle in what we consider to be the appropriate and right direction, the key thing is to work together as a whole specialty. Retina alone constitutes less than 0.3% of American physicians.”

    More information about MIPS is available on the academy website.


    David W. Parke II, MD

    e: [email protected]

    This article was adapted from Dr. Parke’s presentation during Retina Subspecialty Day at the 2017 meeting of the American Academy of Ophthalmology. He does not have any relevant conflicts of interest.


    Nancy Groves
    Nancy Groves is a freelance medical writer.

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