Increasing cost of health care 2010 Prevalence of Cataract Patients: 24.4 M (NEI/NIH) of patients age 40+

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1 7/27/15 Comanaging Modern Cataract Surgery: Guiding patients through Advanced Technology and Optimizing Surgical Outcomes Disclosures: Robert S. Stutman, OD, MBA, FAAO Alcon Speaker s Alliance Select Eye Care Columbia, MD st Century Health Care Patient Demographics Aging population Medicare patients will almost double by 2030 (79 M vs 44 M) Increasing cost of health care 2010 Prevalence of Cataract Patients: 24.4 M (NEI/NIH) of patients age 40+ Reduction of reimbursement Access limitations By 2030: 38.7M Physician shortage By age 75, 50% of patients will have a cataract By 2050: 50.2 M Increased role for optometrists (and other non-md professions) 3 4 The Changing Face of Cataract Surgery The Baby Boomer Generation An Evolving Definition of Cataract - Large, rapidly growing demographic Average Age of US Cataract Patient is Declining - Educated, financially secure - Increased life expectancy - Longer working careers Today: earlier diagnosis & treatment before substantial vision loss - Demand high quality vision (reading, distance, night vision) In 2011, almost 800,000 cataract surgeries performed on patients years old New surgical approaches available to improve UCVA for many patients - New requirement for near vision (computers) Established LASIK market validates that patients will pay for surgically improved vision - Unwilling to compromise active lifestyle - Embracing demand driven healthcare 2 3 1

2 The Need for Improvement: Cataract surgery IS Refractive surgery! Key to Optometric Comanagment Know your surgeon Convey patient preferences, observations and conditions to your surgeon Inform your patient of your role in peri-operative care Successful comangement is the result of constant communication 5 8 Advanced Technology Baby Boomers and Cataracts PIOLs Toric Multifocal FS Laser This is your new refractive surgery patient The generation with the greatest buying power in the history of our country Account for a dramatic 40% of total consumer demand even in a recession Have more discretionary income than any other age group Source: babyboomer-magazine.com 9 10 Optometry s Role in Success Understanding Patient Needs We understand patient s needs We are best positioned to educate patients Prescribing from the exam lane: We do it for optical goods Educate on advantages/disadvantages Listen to your patients Believe in the technology Make the medical recommendation What area of vision is most important to you? Distance Intermediate Near All of the above

3 Goal of Advanced Technology Who are good multifocal candidates? Improve the quality of life of our cataract patients by increasing their spectacle freedom Monofocal at distance (need readers) Monofocal at near (need DVO) Monovision (if successful CL patient) Toric (monofocal) Multifocal Toric/Multifocal (coming soon!) Patient must have a cataract with demonstrable visual and functional symptoms Motivated to reduce dependence on glasses Active lifestyle Bilateral is ideal Realistic expectations Who are good multifocal candidates? Poor multifocal candidates Previous refractive surgery Previous cataract surgery in one eye Patients with astigmatism 0.50D 1.00D D >2.00D Want to wear glasses Poor visual perception Occupational drivers (esp night time) High astigmatism Unrealistic expectations Ocular pathology Astigmatism Patient Selection Realistic expectations Educate patients on the advantages AND the limitations of the multifocal lens 17 3

4 Importance of Astigmatic Treatment Ability to Treat Pre-Existing Astigmatism Impacts: Patient Satisfaction Premium IOL % Quality of Vision l Glare l Halo l Snellen Visual Acuity As little as 0.50D of residual cylinder may leave a patient symptomatic Refractive IOL surgeons must be willing and able to treat postoperative astigmatism to make patients happy postoperatively Astigmatism and Cataract Surgery 70% of patients have > 0.5 D of pre-op astigmatism 39% of patients have > 1.0 D of pre-op astigmatism 35% 30% 25% 20% 15% 10% 5% 0% 30% 31% 19% 10% Grabow and Martin N=1, D to 3.5 D = 20% 5% 2% 1% 1% 0% 0% 0% Astigmatism is Common in Patients Undergoing Cataract Surgery Astigmatism Prevalence 6,000 Patients Warren Hill MD 3.00 D or greater 2% 2.75 D or greater 3% 2.50 D or greater 5% 2.25 D or greater 6% 2.00 D or greater 9% 1.75 D or greater 12% 1.50 D or greater 18% 1.25 D or greater 26% 1.00 D or greater 38% 0.75 D or greater 53% 0.50 D or greater 72% 0.25 D or greater 89% Less than 0.25 D 10.95% Treatment options for Astigmatism FS with LRI (standard monofocal IOL) Toric IOL Multifocal IOL How much K cyl is ideal? How much is too much Other considerations Post refractive surgery Ocular pathology 22 Surgical Comanagement Clinical Post Op Management Pre-op evaluation Includes counseling on ATIOL options Peri-operative care Post op management POD#1 1 week PO 1 month PO

5 Management of VA limitations after surgery Basis of Optometric Comanagement Ocular surface disease PCO CME (or other retinal changes) IOL (dislocated or refractive surprise) High quality eye care Benefits to patient care Patient comfort Patient convenience Efficiency Cost effective Utilize skills and expertise of each practitioner AOA: Optometric Postoperative Care Suggested Guidelines AOA: Optometric Postoperative Care Suggested Guidelines The selection of an operating surgeon for patient referral should be based on providing the best potential outcomes for that patient. Financial relationships between providers should not be a factor The patient s right to choose the method of postoperative care should be recognized consistent with the best medical interest of the patient. Comanagement of postoperative care should be determined on a caseby-case basis and not prearranged. The transfer of postoperative care must be clinically appropriate and depend on the particular facts and circumstances of the surgical event Following surgery, transfer of care from the operating surgeon to an optometrist should occur when clinically appropriate at a mutually agreed upon time or circumstance; and such time should be clearly documented via correspondence and be included in the medical record AOA: Optometric Postoperative Care Suggested Guidelines Communication is the key to success The operating surgeon and the co-managing optometrist should communicate during the post-operative period to assure the best possible outcome for the patient. Compensation for care should be commensurate with the service provided. Cases involving Medicare beneficiaries should reflect proper use of modifiers and other Medicare billing protocol. Prior to surgery Referral request form Pertinent patient findings Consent for comanagement After surgery Transfer of care Post op notes

6 Billing for Comanagement -54 modifier: Surgical care only -55 modifier: Post op care only -24 modifier: unrelated evaluation in post op period -79 modifier: unrelated procedure in post op period Surgeon s NPI Diagnosis code: Procedure code: DOS and RT/LT Surgeon s relinquish care date 31 6