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SlitLamp provides illuminating e-news for Colorado ophthalmologists. It keeps you in the know on the evolving Colorado health care scene by detailing the latest legislative and regulatory happenings. It also spotlights the information and resources you need for your practice.

 

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Top tags: advocacy  health plans  practice management  2014 legislative session  Avastin  MACRA  AAO  Coffman  compounding  CSEPS Connect  FDA  health advisory alert  HIPAA  IPAB  legislator  Medicaid  Medicare  member meeting  mergers  MIPs  pay issues  payer issues  payment reform  PDMP  QPP  reimbursement  repackaged drugs  US Congress 

Low vision: There is something you can do

Posted By Chet Seward, Saturday, December 24, 2016
A new resource from the American Academy of Ophthalmology can help you with patients with low vision. There Is Something Else You Can Do is a new video that emphasizes the impact of vision loss on individuals and the responsibility of eyeMDs to refer or provide vision rehabilitation. With advances in technology, modern vision rehabilitation can help most patients with any degree of vision loss. Providing or referring patients to vision rehabilitation is now the standard of care for all who experience vision loss. Be sure to review this video and other resources at the Academy’s ONE Network.

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Health advisory alert: Request for cases of adverse reactions to ocular Avastin injections

Posted By Chet Seward, Saturday, December 24, 2016

The following is an important health advisory alert from the Colorado Department of Public Health and Environment (CDPHE).

  • CDPHE is investigating a cluster of adverse outcomes following intravitreal injections with Avastin to treat macular degeneration. The investigation is ongoing.
  • The patients experienced inflammatory reactions, including clouded vision, decreased vision and floaters within a few days after intravitreal injection with Avastin. All patients recovered following treatment with topical steroids.
  • CDPHE requests any cases of inflammatory reactions following ocular Avastin use be reported to the Communicable Disease Branch by contacting Devra Barter at 303-692-2706 or devra.barter@state.co.us. You also may contact Devra Barter for more information.

Tags:  Avastin  health advisory alert 

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Don't forget to revalidate with Medicare

Posted By Chet Seward, Tuesday, December 6, 2016

Medicare requires that enrolled providers and suppliers revalidate per the Affordable Care Act. Revalidation are due on the last day of the month according to your revalidation schedule. The local Medicare Administrative Contractor Novitas should send you a revalidation notice about two-three months prior to your due date. If you're curious about what your date is then search here.

Find out all you need to know about provider revalidation here. Avoid holds on your Medicare payment or deactivation of your Medicare billing privileges by keeping your provider revalidation up to date. Contact Novitas if you have any questions.

Tags:  practice management 

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Physicians must post notices of non-discrimination by Oct. 17, 2016

Posted By Chet Seward, Tuesday, December 6, 2016

Under new HHS rules implementing the ACA nondiscrimination provision, covered entities (which includes most health care providers) must post and publish new mandatory nondiscrimination statements and taglines by October 17, 2016. The final rule coordinates existing federal nondiscrimination laws, regulations, and policy regarding race, color, national origin, age, and disability as they apply to health care coverage and care. The rule codifies HHS’s long-standing policy guidance on language assistance for individuals with Limited English Proficiency (LEP), and incorporates provisions of the Americans with Disability Act (ADA) to prohibit disability-based discrimination in health programs and activities.

The rule applies to those who provide or administer health-related services or insurance coverage and receive “federal financial assistance.” Federal financial assistance includes Medicare, Children’s Health Insurance Program, Medicaid, meaningful use incentive payments, HHS grants, Centers for Medicare and Medicaid Services gain-sharing demonstration projects, federal premium and cost-sharing subsidies, etc.

The rule does not apply to physicians who only receive payments from Medicare Part B (traditional Medicare), unless they are also receiving meaningful use incentive payments.

Covered physicians must:

  • By October 17th post a notice of nondiscrimination and taglines in the top 15 languages in the state.
  • Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees).
  • Covered entities are encouraged to develop and implement a language access plan.

For more information and sample documents click here.

Tags:  practice management 

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Ready for MACRA and value-based payment? TCPi can help

Posted By Chet Seward, Tuesday, December 6, 2016

Without some help doing two things at once is often a prescription for failure. With the looming implementation of Medicare’s Quality Payment Program and accelerating efforts by commercial health plans to pay for your care in different ways, you may be wondering how you can keep your practice running in the so called “old way” while simultaneously enhancing your systems and practices in pursuit of “new” value-based payment models.  This is hard work. 

Luckily as a practicing ophthalmologist in Colorado you have access to free quality improvement and practice transformation coaching and other resources through the Transforming Clinical Practices Initiative(TCPi) funded by the federal government. The initiative offers:

  • Business process development for new models of payment;
  • Change management and skills development for practice champions;
  • Efficient and effective referral processes – right patient in the chair with the right information;
  • Reporting and using data to drive improvements and to demonstrate the value of care;
  • Tools and training to develop effective care coordination and manage transitions in care; and
  • CME and credit for part IV of Maintenance of Certification.

With TCPI you can do two things at once. Get the help you need to make the necessary practice changes to thrive under new payment models, while surviving in current models as the system transformation occurs over time. Limited slots are left. Read more about TCPi here and sign up today. 

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Health plan pain points: eyeMDs identify top priorities

Posted By Chet Seward, Tuesday, December 6, 2016

Almost 30 Colorado ophthalmologists and their staff met on August 24, 2016, in Denver to discuss the challenges that they are facing in doing business with commercial health plans. CSEPS called the meeting in order to understand what some of the current, pressing issues that ophthalmology practices are struggling with so that CSEPS can devise appropriate advocacy strategies to address them.

It didn’t take long for the group to warm up and soon the room was bursting with stories demonstrating the growing frustration with increased bureaucracy and inefficient systems that are increasing costs. Cataloguing these concerns comes at a pivotal time as CSEPS opposes the Anthem-Cigna and Aetna-Humana mega mergers, and as the Colorado Division of Insurance is in the process of crafting new regulations on health plan network adequacy along with convening a new Physician Advisory Group. Key pain points identified include ineffective provider representatives, too many audits resulting in withheld or inappropriate payments, no access to renegotiate contracts and faulty designation formulas and programs. Review the full report here. The CSEPS board will take up these identified priorities during their November board meeting in advance of making an operational plan for the upcoming year. Members are encouraged to review the report and share what currently “hurts most” for them with commercial health plans.

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(i)mmersion Day: Rep. Ginal

Posted By Chet Seward, Monday, August 8, 2016
Updated: Sunday, August 7, 2016

Rep. Joann Ginal, PhD, (D- Fort Collins) is no stranger to health care given her deep background in bioscience and pharmaceuticals, and as member of both the Colorado House of Representatives Health, Insurance and Environment Committee and the House Public Health and Human Services Committees. She’s also no stranger to ophthalmology as she worked with her ex-husband for years in his ophthalmology practice. Even with all of that experience, Rep. Ginal learned something new during a visit in July to the Eye Center of Northern Colorado to see CSEPS board of directors member Kent Bashford, DO, perform a cataract surgery. She remarked that surgery has become more sophisticated and intense over the years since she had last seen one.


Kent Bashford, DO, (right) explains details of a surgery with Rep. Ginal (front left).

The visit was part of the CSEPS (i)mmersion Day project that connects legislators with local ophthalmologists to witness a surgery, get a first hand look at what it takes to run a practice and importantly build some lasting relationships. Are you interested in hosting a legislator at your practice? CSEPS is setting up more meetings for the fall so if you’re willing then please contact Chet Seward in the CSEPS offices.

CSEPS is grateful to Rep. Ginal for her time and leadership. A big thanks also goes out to Dr. Bashford and his great team at the Eye Center of Northern Colorado. “I am so proud of ophthalmology and the way this profession does wonderful things for people,” concluded Rep. Ginal.

Tags:  advocacy  legislator 

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DOJ sues to block health plan mega mergers

Posted By Chet Seward, Monday, August 8, 2016
Updated: Sunday, August 7, 2016

In July the U.S. Department of Justice (DOJ) issued lawsuits to block the proposed mega-mergers between Anthem and Cigna and Aetna and Humana. The Colorado Society of Eye Physicians & Surgeons joined numerous other physician-driven organizations in efforts to oppose these planned mergers. CSEPS opposition hinged upon the adverse effects that such mergers would have on care quality, patient access and insurance premiums given the mergers’ anti-competitive nature. Aetna and Anthem are opposing the DOJ suit. The DOJ action represents an important step and CSEPS will continue our vigorous advocacy on your behalf to ensure that your patients can get the eye care they need and that your practice can remain viable in a competitive marketplace.

Tags:  health plans  mergers 

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CSEPS positions on November ballot initiatives: ColoradoCare and tobacco tax

Posted By Chet Seward, Monday, August 8, 2016
Updated: Sunday, August 7, 2016

Coloradans will vote on a number of important constitutional amendments in this fall’s general election. CSEPS has taken official positions on two of these proposed changes including ColoradoCare and the tobacco tax increase.

CSEPS is opposed to ColoradoCare (Amendment 69). The initiative would create a universal health care coverage program for Colorado, essentially replacing all commercial coverage but not Medicare and Veterans coverage, paid for by 10% tax on all payroll and non-payroll income along with existing government funding. A 21-member board would be empowered to set provider rates, administer the benefits package and determine how other parts of the unprecedented program would work. Much about the program is unknown as the yet to be elected board has not decided many, important details. You can learn more about the program here (proponents), here (opponents) and here (non-partisan analysis). CSEPS opposition focuses on the sweeping, expensive and yet to be determined nature of the initiative that will be effectively locked into the state constitution should it pass. The current health care system is plagued with many problems but ColoradoCare is not the solution.

CSEPS supports the proposed tobacco tax increase that would raise about $315 million a year by increasing the existing tax on cigarettes by $1.75 and increasing the tax on other tobacco products by 22%.  Proceeds from the tax would be used to fund research on cancer treatment, lung disease and mental health, provide physical and behavioral health for 500,000 Colorado veterans, increase funding for prevention, education and tobacco cessation programs, and decreasing student debt for medical professionals in rural and underserved areas of the state. Learn more about the initiative that, as of press time, has yet to be certified for the November ballot here

 

Tags:  advocacy 

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CSEPS events: Staying local and going lean

Posted By Chet Seward, Monday, August 8, 2016
Updated: Sunday, August 7, 2016



From left, Drs. Ryan Rich, John Burroughs and Ron Pelton.
CSEPS regularly sponsors cutting edge educational programming and the past few months highlighted some outstanding local and national expertise. 

In May Drs. John Burroughs, Ryan Rich and Ron Pelton presented to Colorado Springs colleagues. While the presentations on blethroplasty, AMD anti-veg drugs and informed consent were great, some attendees thought the location at Johnny Martin’s Car Club was amazing. Check out pictures of some of the beautiful automobiles on display here

Not to be outdone, AAO Senior Secretary for Ophthalmic Practice Robert Wiggins, MD, MHA, came to Denver in July with a keen focus on helping to optimize Colorado ophthalmology practices through Lean Management. The essence of Lean thinking is to eliminate waste through understanding the value to the patient, using a value stream to deliver that value, creating an efficient and waste-free continuous flow system built on a pull approach, and continually pursuing perfection. Using stories from his practice in North Carolina, Dr. Wiggins both demonstrated and coached attendees on how eyeMDs and their team can excel in tomorrow’s health care system. Review pictures of the event here.

Tags:  CSEPS Connect  member meeting 

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