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    New world order of glaucoma presenting strong challenges


    Reimbursement complexities

    Electronic health records (EHR) are another “pain in the neck,” Dr. Iwach opined. “My understanding is roughly 50% of practices don’t use EHR.”

    Not only is there an upfront cost, “you have to maintain it,” he said. “Then, you have to calculate the impact on your ability to see patients and to talk to them and to develop relationships.

    “Especially in glaucoma even if you do everything right, some things go wrong,” Dr. Iwach added. “That lack of relationship can end up biting you down the road.”

    The American Academy of Ophthalmology is working on tips to ease the burden. “For a glaucoma specialist’s office which does not have EHR but wants to avoid a penalty, there will be a little bit of a recipe because you have all these different options,” said Dr. Iwach.

    Likewise, negotiating the Centers for Medicare and Medicaid Service’s Merit-Based Incentive Payment System (MIPS) can be complicated, Dr. Iwach said. The system offers physicians incentives to show evidence that they are providing high-quality, efficient care.

    “The way I understand it is you can do a little bit and try to avoid the penalty,” Dr. Iwach explained. “You can do a little bit more to try to get the bonus. But the bonus is influenced by the amount of people who don’t do the minimum work. The more people who do the minimum, the smaller the pie for the potential bonus. So you really have to look at what are the economics that really make sense.”

    Dealing with private insurers can be just as difficult, he added. Dr. Iwach cited a recent letter from Aetna demanding that his practice pay a $3,000 refund based on an error that the insurer made a year ago.

    Ophthalmology goes online

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