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01/08/2018

OOS Working on Your Behalf

President’s Message

 

Greetings. We wrapped up a very successful 2017 during which we hosted an Annual Meeting that drew more than 400 attendees, added a new residency position to our board as we keep an eye on the future of our profession, and effectively kept abreast of legislative and regulatory changes that would impact ophthalmology.

But the new year is upon us and a lot of work lies ahead. In this issue of our newsletter, you’ll learn about some of the legislative issues that could eventually challenge you as a practicing physicians – including MOC regulations, managing patient pain, and scope of practice challenges from optometrists in many states close to Ohio. All of which reminds me to encourage you to please support our PAC so that we are well-positioned to fight off any challenges in Ohio. To do so, simply go to our webpage www.ohioeye.org and select the PAC Donation button on the bottom right of the front page.
 
On a bright note, you’ll also learn that one of our own –John Stechschulte – was recognized with a well-deserved AAO Hall of Fame Award, just more evidence of the great work and leadership ophthalmologists in Ohio provide not only in our state but on the national stage.
 
Finally, I want to thank you for the honor of serving as your President the last two years. I look forward to seeing you at our Annual Meeting on February 24th and turning the presidency over to Dr. Joe Coney, our colleague from Northeastern Ohio.

 

- Walker Motley, M.D.

 

OOS Third Party Payer News

 
OOS Meets With Anthem on Modifier 25 Cut

On December 20th, representatives from the Ohio Ophthalmological Society, American Academy of Ophthalmology, Ohio State Medical Association and several other state specialty societies met with Anthem in Columbus to raise significant concern with some of its proposed policy change, most specifically its announcement to reduce payments by 50% for E&M services billed with CPT modifier 25 when reported with a minor surgical procedure code or a preventive/wellness exam. The changed was initially scheduled to become effective in Ohio on January 1.
 
Subsequent to the meeting, Anthem announced it was delaying implementation of this policy until March 1 and reducing the level of the reduction to 25% instead of 50%, as originally planned. While encouraged by these two changes the OOS, AAO and OSMA will continue to the dialogue with Anthem to make additional changes to the policy. Should you have any questions regarding the change or our advocacy efforts on this issue, please contact us at oos@ohioeye.org.

 
Bilateral Cataract

After hearing from several members, the OOS reached out to the our Medicare Contractor, CGS, to clarify coverage for bilateral cataract surgery. Below is the clarification we received from the medical director.

The following information can be located in our Cataract LCD:  https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33954&ContrId=238&ver=15&ContrVer=2&CntrctrSelected=238*2&Cntrctr=238&name=CGS+Administrators%2c+LLC+(15202%2c+MAC+-+Part+B)&DocType=Active&s=42&bc=AggAAAQAAAAAAA%3d%3d&

Bilateral cataract extraction performed on both eyes, on the same date of service is termed immediate sequential bilateral cataract surgery (ISBCS). ISBCS as an approach to bilateral cataract extraction may afford certain clinical benefits but carries with it, the possibility of bilateral visual loss. The decision to perform ISBCS should be an individual decision, made jointly by the patient and physician. The medical record must document the rationale for ISBCS and that the patient has been apprised of the risks and benefits of both this approach and of the available alternatives.

If the first cataract extraction is performed and a subsequent contralateral cataract extraction is considered, the criteria for coverage of the procedure in the contralateral eye are the same as the criteria for the first cataract extraction.

 
Coding Seminar Schedule Set

Once again this year, the OOS will be hosting Coding and Reimbursement seminars in March conducted by our consultant Joy Newby. Registration materials will be mailed to members next week. The course has already been approved for JCAHPO credits. Dates and locations are as follows:

Cincinnati - 3/7/2018 - Hilton Garden Inn

Cleveland 3/13/2018 - Holiday Inn Independence

Columbus 3/14/2018 - Conference Center at the OCLC

 
New Chairperson

Matthew Ohr, M.D. will be taking over from Tom Mauger, M.D. as the OOS Third-Part Payer Chair. The main responsibility of the chair is to serve as the OOS representative on the CGS Carrier Advisory Committee, a group of volunteer physicians that works with the CGS medical director to review Local Carrier Determination policies. Additionally, the chair works with OOS staff on other insurance related issues. We thank Dr. Mauger for his service and welcome Dr. Ohr to the Board.

 

OOS Legislative Update

 
MOC

The Ohio House has begun hearings on House Bill 273, a measure that could ban maintenance-of-certification (MOC) as a prerequisite for licensure, insurance plan participation, hiring, and hospital admission privileges. Ohio is now one of about a dozen states that have or is currently seeking to curtail the use of MOC as a tactic that could impact a physicians’ ability to practice medicine.

The impact of MOC in Ohio has divided many specialties with some outright opposed to it, others in favor of it, and many who are neutral. The OOS has taken a neutral stance and is watching for developments on the bill. Those who support the anti-MOC bill say requirements are becoming to frequent, redundant and expensive and have little to do with improving patient care. Those who support MOC say the requirements help distinguish their practice of medicine and keeps them apprised of new developments within their specialty.

The bill is still in a House committee and could receive more attention once legislators return from holiday break in January.

 
Scope of Practice

An underlying issue at the American Academy of Ophthalmology Annual Meeting in New Orleans in November was the battle optometrist in many states continue to wage as they seek authority to do more surgical procedures that are typically reserved for Ophthalmologists.

AAO officials said that its national PAC fund spent money and other resources in nearly a dozen states this year assisting with scope battles. The AAO said optometrists were largely successful in Alaska and Georgia where legislatively they were able to secure some additional roles over the objections of ophthalmologists. However, the AAO said its advocacy efforts were more successful in most other states, including Florida, North Carolina, and Pennsylvania.

While Ohio has not seen such challenges from optometrists, some officials at the AAO felt it was inevitable that Ohio will eventually be subject to a scope battle. This is a good time to remind OOS members that supporting the OOS’ PAC is critically important.

 
New Opioid Prescribing Rules

If you prescribe opioids the state pharmacy board has new rules you must follow. The pharmacy board, to better track which doctors are prescribing opioids and for what reason they are prescribing the painkillers, will now require ICD-10 codes to be included on the actual prescription that patients take to a pharmacy to be filled:

  • On Dec. 29, 2017, the first four-digits of ICD-10 codes must be included on opioid prescriptions. If your electronic systems cannot generate the proper codes, the codes can be handwritten on the prescription.
  • On June 30, 2018, the first four-digits of ICD-10 codes must be included on prescriptions for any controlled substance.

And, as a reminder, the state medical board implemented new rules that started on Aug. 31 for when prescribing opioid for acute pain conditions:

  • Physicians cannot prescribe more than a 7-day supply to adults for an initial opioid prescription.
  • Physicians cannot prescribe more than a 5-day supply to minors for an initial opioid prescription.
  • The drugs cannot exceed a 30-MED daily average and must be short-acting opioids.
  • Physicians do have the discretion to exceed these limits but must provide a documented reason in the patient’s medical records.
 
Price Transparency

With the state’s price transparency law still on-hold due to pending litigation, state Rep. Stephen Huffman (Tipp City-R) has introduced legislation that he says will give patients a clearer idea of what their doctor or hospital bill will be before a medical procedure is performed.

His proposal is a direct response to a state price transparency law that was set to go into effect in January 2017; however, multiple healthcare associations, including the Ohio State Medical Association (OSMA), sued the state claiming the new statute has unworkable provisions that could frustrate and harm patients. A hearing on that lawsuit has been postponed until March 2018.

“My legislation would address those concerns while still providing price transparency for patients,” Huffman said during a press conference in November at the Statehouse where he introduced his legislation. Huffman, a physician, said he believes the litigation could last another two years.

The law currently in litigation would require physicians and hospitals to tell patients in advance how much their medical services will cost and how much they will have to pay versus what their insurance will cover.  But healthcare organizations have argued it is impossible in many cases for a physician or hospital to provide that level of detail because insurance coverages vary so significantly from patient to patient. This information is also not always readily available to the provider. Therefore, the current law’s mandates are unrealistic to ask of providers and doing so would negatively impact the delivery of efficient health care.

 

OOS Annual Meeting Registration is Now Open

 

Registration for the Ohio Ophthalmological Society’s Annual Meeting, scheduled for Saturday, Feb. 24, 2018, is now open. The meeting will begin at 8 a.m. and again be held in Columbus at the Easton Hilton Hotel. Another terrific daylong program has been planned. Additionally, we have received both JCAHPO and nursing credits for the technician program so please encourage your staff to attend.
 
The physician education program will highlight two featured speakers. Neal Shorstein, MD, from Walnut Creek, CA will deliver a presentation entitled: “Prophylaxis Strategies for Cataract Surgery: What Works, What Doesn’t with Endophthalmitis and Macular Edema.” Later, Samuel Masket, MD, from Los Angeles, CA will deliver a presentation entitled: “Management of Malpositioned IOLs.”

Click here for more information about the program, to register, and to make overnight accommodations.

 

Membership News

 

Ohio Ophthalmologist Lauded with National Hall of Fame Award

Longtime Ohio Ophthalmological Society (OOS) member John R. Stechschulte, MD, has received the American Academy of Ophthalmology’s (AAO) Secretariat for State Affairs 2017 Hall of Fame Award. Dr. Stechschulte was the lone honoree for the prestigious recognition during the AAO’s annual meeting in New Orleans in November.

The AAO said it selected Dr. Stechschulte for his contributions to ophthalmology both on a state and national level over a distinguished three-decade career. The OOS submitted the following information in support of Dr. Stechschulte’s nomination:

stech

 

JOHN R. STECHSCHULTE, MD has enjoyed a long and distinguished career as a nationally recognized ophthalmologist. Dr. Stechschulte has been employed at Arena Eye Surgeons in Columbus, Ohio since 1985 where he specializes in refractive, corneal and cataract surgery. He is also an assistant clinical professor of Ophthalmology at The Ohio State University. He is a board member for the Central Ohio Lion’s Eye Bank and past chairman of Ophthalmology for Grant Medical Center.

Dr. Stechschulte has served in dozens of roles for both his state and national professional associations. He is a past president of the Ohio Ophthalmological Society (OOS), remains a member of its executive board, and has served as the society’s PAC chairman since 2008. His work on the national level has brought Dr. Stechschulte even greater recognition. He is a fellow of the American Academy of Ophthalmology. He has also been elected chair, vice chair, and trustee-at-large for the Academy’s Board of Trustees. He has also served on the Academy’s Council and as a member of its Executive Committee. His other Academy committee roles, include: membership, audits, bylaws & rules, awards, nominating, and governmental affairs.He received the Academy’s Senior Achievement Award in 2015.

Dr. Stechschulte earned an undergraduate degree from the University of Notre Dame and then received his medical degree from The Ohio State University. He completed an Ophthalmic Surgery Residence at Wills Eye Hospital in Philadelphia, where he served as co-chief resident. And received fellowship training in corneal and anterior segment surgery at Bascom Palmer Eye Institute at the University of Miami where was a clinical instructor. Dr. Stechschulte lives in Central Ohio with his wife Jodi. They have five children.

 

 

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