Alabama Academy of Ophthalmology NewsletterAn Eye MD Organization

AN EYE M.D. ORGANIZATION

EyeCare Alabama

A Community Outreach Program of ALAO

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Alabama2014 Issue

S.E. Eye 2014 Annual Regional Meeting at Sandestin

The Alabama, Louisiana, Mississippi and Tennessee Academies of Ophthalmology co-hosted the S.E. 2014 Annual Regional Meeting July 24-26 at Sandestin. AAO President, Dr. Gregory Skuta, was a featured guest along with numerous other nationally recognized ophthalmic presenters. A special word of thanks to Meeting Chair, Dr. Kristin Bains, and Co-Chair, Dr. Priscilla Fowler for their efforts. S.E. Eye 2015 returns to Sandestin July 23-25, 2015. Mark Your Calendars!

Guest Speaker, Dr. Mitchell Weikert & Dr. Kristin Bains

AAO Coding Executive, Sue Vicchrilli, & ALAOPresident, Dr. Jim Izer

Stephen Clay, Kathey Bradford, Peggy Jones & Terri Mendez welcome attendees to SE Eye 2014

Dr. & Ms. Doug Owens

ALAO Vice-President, Dr. & Ms. Leonard Rich

Dr. Andrew Mays, Dr. Tom Friman, Dr. Sanders Benkwith, Dr. Jim Izer, Dr. Lindsay Rhodes & Dr. Priscilla Fowler

Dr. Janet Betchkal, AAO President, Dr. Gregory Skuta, Cathy Cohen & Dr. Connie McCaa

Fellow Ophthalmologists:

Greetings again from the Alabama Academy of Ophthalmology.

We just finished another excellent SouthEast Eye Regional Meeting in Destin with terrific speakers, educational forums and hopefully a little relaxation thrown in for the attendees. Thanks again to all the organizers who made it another very successful meeting. We are lucky to have such a fine tradition in this region. The

American Academy of Ophthalmology often holds our meeting up as a model for others to emulate.

The past year has been another interesting time for Alabama ophthalmologists. Your Alabama Academy of Ophthalmology has been busy representing you and your patients’ best interests in many arenas. Changes in both federal and private insurances have been challenging to many of us and the Academy is trying to keep every member abreast of your rights and responsibilities. No scope of practice bills were introduced this year, but we do not expect to be so fortunate in the future. Our colleagues in surrounding states such as Tennessee and Louisiana fought courageously against allowing surgery by non-surgeons, but to no avail. The remaining states in the SouthEast seem to be targets for this year.

The Alabama Academy of Ophthalmology has been actively educating state legislators about the dangers associated with untrained surgeons. We have been inviting representatives and senators from all around the state into our operating rooms to have them see first-hand the skill that surgery involves. We again ask all of our members to become involved in this process. If you can help to educate and inform those that ultimately make these decisions, please do so. Call your state representatives. Donate to the ALAO’s EyePAC and the AAO’s Surgical Scope fund. Involve your patients in the battle.

Do not wait until it is too late!

Sincerely,James D. Izer, M.D. Montgomery

ALAO President’s ColumnJames D. Izer, M.D.

ALAO Supports Congressional Candidates

Mike Merrill & U.S. Rep. Mike Rogers

ALAO Members at AAO 2014 Mid-Year Forum and Ambassador Advocacy Day in Washington

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It has been increasingly evident that there are a number of forces that continue to pressure our profession of medicine. Government mandates, liability concerns, patient access to health care, along with recent insurance company provider exclusions and the attempt of ancillary medical providers increasing their scope of practice legislatively are examples of these pressures. Although these issues are remote from the chief medical complaints we encounter in our exam rooms daily, we can’t ignore them or the very fabric our profession may be harmed. We are told by our legal counsels and professional societies that we must use caution in addressing the above issues for fear of anti-trust or trade restraint retributions. For example, telling a patient not to use an insurance carrier because a certain practice has been dropped as a provider by that company isn’t allowed by law. Telling a patient or a hospital not to use a provider because that provider isn’t a Board Certified MD is considered an anti-trust offense. So how does a Board Certified physician protect the integrity of his profession and practice with these legal roadblocks in place? Thinking you worked hard academically, that you were the “cream of the crop,” that you have a medical diploma and you passed your Boards, mean little in today’s health care environment. Very few patients know the differences between the myriad of health care providers. In my opinion, I believe there are limited but effective ways to differentiate ourselves from the numerous health care providers. First, keep current your professional knowledge base and bond emotionally and intellectually with your patients. Attend meetings, read journals, and communicate with your peers. The annual ALAO Meeting in Sandestin this past July was one of the best medical meetings I have attended. It gave me many tools to incorporate into my practice. Make an effort to communicate with your patients and leave them with a positive impression. Patients who sense you care about them and feel you are knowledgeable will always support you. In fact, patients will be your best advocate if an insurance company drops you as a provider. Second, contributing to medical society PAC’s must be considered a cost of doing business. If you stay on the sidelines, then other paramedical providers will fill the void. Increased scope of practice attempts legislatively by non-physicians can only be effectively countered by organized societies such as AAO, ALAO, and MASA. Attending the ALAO annual meeting and contributing $1000 to its EyePac is one of the only ways to counter the efforts of non-MD’s wanting to be an MD without attending medical school. These organization can and have effectively protected our profession by educating the public and lobbying legislators and insurance carriers regarding our outstanding qualities as medical school and residency trained physicians. Our profession of medicine has given you much to be grateful for….our profession of medicine needs your help…It’s time to give back…It’s time to show your gratitude and support. Thank you for considering this request. Leonard S. Rich, M.D. PS: Please have your office manager send your EyePac Contribution today (before you forget!) to the following address: Mike Merrill, ALAO Executive Director, 2012 Seaton Park-Sturbridge Commons, Montgomery, AL 36116

ALAO Vice President’s ColumnLeonard S. Rich, M.D.

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The Bagpiper

Time is like a river. You cannot touch the water twice, because the flow that has passed will never pass again. Enjoy every moment of life. As a bagpiper, I play many gigs. Recently, I was asked by a funeral director to play at a graveside service for a homeless man. He had no

family or friends, so the service was to be at a pauper’s cemetery in the Nova Scotia back country.

As I was not familiar with the backwoods, I got lost and, being a typical man, I did not stop to ask for directions.

I finally arrived an hour late and saw the funeral guy had evidently gone and the hearse was nowhere in sight. There were only the diggers and crew left and they were eating lunch. I felt badly and apologized to the men for being late.

I went to the side of the grave and looked down. The vault lid was already in place. I didn’t know what to do, so I started to play.

The workers put down their lunches and began to gather around. I played out my heart and soul for this man with no family or friends. I played like I’ve never played before for this homeless man.

As I played “Amazing Grace” the workers began to weep. They wept, I wept, we all wept together. When I finished, I packed up my bagpipes and started for my car. Though my head was hung low, my heart was full.

As I opened the door to my car, I heard one of the workers say, “I never seen anything like that before and I’ve been putting in septic tanks for twenty years.”

Apparently, I’m still lost...it’s a man thing.

Until next time, our goal remains,

To be the best and....

Ask for Directions!

Mike

ALAO Executive Director’s ColumnMike Merrill, Esq.

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Save the Date

S.E. Eye 2015 Returns to Sandestin

July 23-25, 2015

October 1, 2015 Set as Deadline forICD-10 Compliance

From NCG Medical, July 31, 2014

The U.S. Department of Health and Human Services (HHS) has issued a ruling finalizing October 1, 2015, as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. The deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business procedures are ready to go on October 1, 2015.

The ICD-10 codes on a claim are used to classify diagnoses and procedures on claims submitted to Medicare and private insurance payers. By enabling more detailed patient history coding, ICD-10 can help to better coordinate a patient’s care across providers and over time.

Using ICD-10, doctors can capture much more information, meaning they can better understand important details about a patient’s health than with ICD-9-CM. Moreover, the level of detail that is provided for by ICD-10 means researchers and public health officials can better track diseases and health outcomes.

The previous revision, ICD-9-CM, contains outdated, obsolete terms that are inconsistent with current medical practice, new technology and preventive services.

ICD-10 represents a significant change that impacts the entire health care community. As such, much of the industry has already invested resources toward the implementation of ICD-10. CMS has implemented a comprehensive testing approach, including end-to-end testing in 2015, to help ensure providers are ready.

For additional information about ICD-10, please visit http://www.cms.gov/ICD10

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ALAO to Offer Two ICD-10 Coding Seminars in 2015ALAO, in conjunction with the AAOE, will host two ICD-10 Coding Seminars in 2015. Both meetings will be conducted by Sue Vicchrilli, COT, OCS, AAOE Director of Coding & Reimbursement.

For Meeting Registration & Other Information See:http://www.aao.org/codequest-alabama.cfm and www.aao.org/codequest and www.aao.org/icd10

Questions: Contact Valerie Brown, AAOE at VBrown@aao.org

***ON-LINE REGISTRATION OPENS NOVEMBER 1, 2014***

Friday, May 29, 2015Marriott Hotel

3590 Grandview ParkwayBirmingham, Alabama

Tel: 205-968-3775 - Registration 7:00 A.M. Program Begins at 8:00 A.M.

Saturday, May 30, 2015Marriott Hotel

3101 Airport BoulevardMobile, AL

Tel: 251-476-6400 - Registration 7:00 A.M.Program Begins at 8:00 A.M.

ALAO NEWS

Louisiana Governor, Bobby Jindal, has signed a law (HB 1065) passed by his state Legislature allowing optometrists the authority to perform some surgeries. Governor Jindal’s decision makes Louisiana the third state in the nation to follow this dangerous and alarming trend of allowing surgical privileges to non-physicians.

HB 1065 allows optometrists to perform several laser procedures, including YAG capsulotomy, peripheral iridotomy and selective laser trabeculoplasty. Additionally, optometrists may perform procedures using multiple methods and instruments including scalpels, lasers, needles, ultrasound, ionizing radiation and by burning and freezing tissue.

It also states that the scope of optometry now includes the “use or prescription of vision therapy, ocular exercise, rehabilitation therapy, subnormal vision therapy, and ordering of appropriate diagnostic lab or imaging tests.”

With the Affordable Care Act’s Section 2706 - the “non-discrimination” clause forcing insurance companies to pay non-physicians at the same rate as physicians for the same procedures - mid-level providers or physician extenders like optometrists, physical therapists, CRNAs and others are scrambling in nearly every state capitol across the country with a renewed call to arms to advance scope of expansion legislation and regulations.

Retina doctors can expect to see significant cuts in 2015 Medicare payments for vitrectomy surgery due to reductions in the time required to perform the procedures. Earlier this year, CMS targeted several codes as potentially “misvalued.”

If CMS makes these work value revisions along with other proposals that impact ophthalmological payments in the final rule as expected, 2015 payments for these codes could see major reductions. The final rule is due out in November, 2014.

Louisiana Grants Optometrists Surgery PrivilegesFrom MASA and News Reports

Retina Payments to be Cut in 2015 Under CMS Misvalued Codes InitiativeFrom AAO

MASA to Stop Offering Healthcare Coverage to Thousands of MembersFrom WSFA-TV Reports

According to the Medical Association of the State of Alabama (MASA), about 5,000 members and their families will lose their healthcare coverage as a direct result of the Affordable Care Act.

“This is a situation where the Affordable Care Act said this plan is not going to work,” said Niko Corley, with MASA’s Government Relations.

Corley stated that MASA was informed that since the association negotiated the policy for members, but doesn’t technically employ them, the plan is non-compliant under the Affordable Care Act.

MASA provides health insurance to doctors, nurses, physician assistants and other medical professionals.

ALAO Welcomes New Board MembersALAO welcomes two new members to its Board of Directors. Dr. Tom L. Mitchell, Jr., of Montgomery and Dr. Ryan Burton of Birmingham. Dr. Burton will serve as the “UAB resident Member.”

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ALAO NEWS

Physicians should look for their confidential Medicare feedback reports in September. They will detail how the cost and quality of care physicians provided to their Medicare patients last year compares to that of other physicians. This is the first time the data will be used to adjust Medicare payments made to some physicians.

The reports, based on care provided in 2013, are scheduled to be made available through the Centers for Medicare & Medicaid Services’ (CMS) Enterprise Portal beginning in September.

In addition to the comparison data, physicians in large groups of 100 or more practitioners will learn whether their Medicare payments next year will be affected by the new Value Based Modifier (VBM), which will bring bonuses to some physicians and penalties to others. Smaller practices will get a preview of how they may

fare as the VBM is phased in over the next three years.

CMS is required by law to apply the VBM to some physicians in 2015 and to all physicians in 2017. The agency has chosen to apply the modifier to groups of 100 or more practitioners in 2015, groups of 10 or more practitioners in 2016, and all medical groups and solo physicians in 2017.

The process for gaining access to the reports is complicated and requires a user ID and password for the “Individuals Authorized Access to the CMS Computer Services” site, which must be renewed periodically. In preparation for the release of the 2013 reports, physicians should make sure their group has an up-to-date password.

Additional information about the reports and the VBM is available on the CMS’ website.

Presentations from the S.E. Eye 2014 Annual Meeting, July 24-26, in Sandestin, along with the Coding Seminar, have been posted at www.regonline.com/SEEye2014. Any presentations not posted were not provided by presenters to ALAO.

Medical Publishing, LLC, is proud to present the 2014 Alabama Hospital & Healthcare Guide. This complimentary copy is available at http://al-hospitals.com/

Medicare Quality Reports to Compare Doctors, Impact Payments From AMA Wire

S.E. Eye 2014 Presentations Posted

Alabama Hospital and Healthcare Guide Now Available On-line

Medicare Requirements for BlepharoplastyBy: Stephen J. Kelly, M.D., ALAO Third Party Carrier Advisor

On July 15, 2014, Cahaba Government Benefit Administrators hosted an open meeting to review proposed Local Coverage Determinations (LCDs). The purpose of an LCD is to provide uniform criteria for providers to receive payment from Medicare for their services. At this meeting, a draft LCD for blepharoplasty (DL30057) was presented for review and comments by those in attendance. Stephen J. Kelly, M.D., from Birmingham, was in attendance to represent the Alabama Academy of Ophthalmology (ALAO). The draft LCD contains the familiar requirements for blepharoplasty, including photographic documentation of the redundant eyelid skin as well as visual field results demonstrating improvement with taped eyelids. A written narrative interpretation of the visual fields must describe the defect and the reasoning for surgery. All of this needs to be included in the physician’s clinic chart as well as the chart of the facility where the procedure is performed. Details of the LCD can be found on the Cahaba GBA website and comments can be directed to: J10LCDComment@cahabagba.com. The comment period for this draft LCD closes on September 8, 2014.

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ALAO NEWS

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The California State Legislature adjourned recently without passing legislation that would have expanded optometry’s scope of practice in that state to include scalpel and laser eye surgery, in addition to injections.

In the closing weeks of the session, proponents of SB 492 - championed by the chairman of the powerful

California Senate Health Committee, a practicing optometrist - pulled the measure from further consideration after the Assembly Appropriations Committee passed a drastically amended version. The amendments removed all provisions that would have allowed optometrists to perform surgery.

California State Legislature Adjourns Without Considering Optometric Scope of Expansion LegislationFrom AAO

CMS to Resume Audit ProgramFrom AAO

UnitedHealthcare Information Available From MASAFrom MASA

CMS to Provide Three Opportunities for ICD-10 TestingFrom AAO

Federal officials have announced three periods when providers can participate in end-to-end ICD-10 testing. All providers must transition from ICD-9 to the new coding system by October 1, 2015. End-to-end tests will take place:

*November 17-21, 2014*March 2-6, 2015*June 1-5, 2015

More information is available at www.aao.org.

The Centers for Medicare and Medical Services plans to resume a limited version of the Recovery Audit Contractor program. CMS said in an

August 4, 2014, statement that recovery auditors whose contracts expired June 1, would be re-engaged beginning in August, 2014. Contractors will conduct

a limited number of Medicare fee-for-service claim reviews.

Information about the UnitedHealthcare Medicare Advantage Network Terminations is available at:http://www.masalink.org/

Click: “News and Publications”Under “MASA News” in left - hand column, Click “2014”UHC Information is the First Link

ALAO Hosts Regional Meetings for Alabama Legislatorsto View Eye Surgery and Discuss Ophthalmic Issues

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Florence

Montgomery Mobile

Dothan

UAB

EyeCare Alabama Continues Its Community Service

Free Eye Clinic-Frazer United Methodist Church in Montgomery

Free Eye Exams for Moldova Orphans in Montgomery

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Alabama Department of Revenue Addresses Sales Tax on Ophthalmologistsby Jeff Patterson*

Following the lead of the Alabama legislature in 2013, the Alabama Department of Revenue (ADOR) proposes to amend a sales tax regulation to include the taxation of ophthalmologists. Specifically, the amendment, if adopted, would require ophthalmologists to pay sales tax on their dispensing or transferring of ophthalmic materials.

Recap of Act 2013-333

Prior to May 23, 2013, the dispensing of ophthalmic materials to a patient by a licensed ophthalmologist was excluded from sales tax, because ophthalmologists, as doctors, were considered members of a “learned profession.” Thus, the dispensing of ophthalmic materials was merely incidental to the providing of professional services to a patient, and did not constitute a sale subject to sales tax. The “learned profession” doctrine had been recognized for decades by the Alabama Supreme Court, the ADOR, and the legislature.

Nevertheless, on May 23, 2013, the Alabama legislature reversed this long-standing position, and declared that the dispensing or transferring of ophthalmic materials to a patient does constitute a sale subject to state sales tax. See Act 2013-333, which was sponsored by Rep. McClendon. The Act took effect immediately upon Governor Bentley’s signature.

Act 2013-333 presented, and still presents, a number of problems for ophthalmologists. By far, though, the most punitive result of the Act is that, in situations where a patient is covered by insurance, ophthalmologists are required to pay the so-called sales tax out of their gross receipts, instead of adding the tax to patients’ bills and collecting it from the patients. This is so because, in a transaction covered by insurance, it is impossible for a doctor to collect any amount, including sales tax, in excess of the contractually-agreed upon insurance reimbursement and co-pay amounts. Thus, here, the “sales tax” imposed by the legislature cannot function as a true sales tax (which is meant to be passed on to the consumer), and instead must be paid by ophthalmologists out of gross receipts.

Details of the ADOR regulation

Now, the ADOR proposes to amend Regulation 810-6-1-.60 to include ophthalmologists with those who currently are responsible for sales tax on the dispensing of ophthalmic materials, i.e., opticians and optometrists. Other than this inclusion, the regulation contains two noteworthy points.

First, the proposed amendment would allow ophthalmologists to separately state their professional-service fee from their charge for ophthalmic materials on an invoice to the patient, and to then collect sales tax only on the charge for materials. Second, the proposed amendment states that, when ophthalmic materials are purchased by a patient covered by insurance, including Medicare, sales tax applies to the amount reimbursed to the ophthalmologist by the insurance company plus the co-pay amount paid by the patient.

The ADOR’s rule-making hearing was held on September 10, 2014, during which the public had the opportunity to comment on the proposal. There should be a decision within a few months as to whether the amendment has been adopted.

Contact Info:

JEFF PATTERSON, LLCPark Place CenterSuite 2048650 Minnie Brown RoadMontgomery, AL 36117(334) 215-4446 (office phone)(334) 462-8438 (cell)jeffpatterson@jeffpattersonlaw.com http://www.jeffpattersonlaw.com

Alabama Academy of Ophthalmology2012 Seaton ParkSturbridge CommonsMontgomery, AL 36116

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ALAO Promotes July as Fireworks Safety Month

Alabama Governor, Robert Bentley, signs an ALAO Proclamation declaring July as Fireworks Safety Month in Alabama.

ALAO Executive Director, Mike Merrill, appeared on WSFA-TV in Montgomery to promote July as National Fireworks Safety Month. Pictured with Mike is WSFA-TV reporter, Judd Davis.