Quality measures approved in four areas of ophthalmology

If Congress should offer a financial bonus to physicians who participate in a voluntary Medicare physician-reporting program, ophthalmologists will be ready.

That's because a group of ophthalmologists and other stakeholders have developed eight initial measures for common ophthalmic procedures that can be used to establish a standard of care. These measures, approved by the Ambulatory Care Quality Alliance (AQA) in late October, outline specific treatment patterns for glaucoma, age-related macular degeneration (AMD), cataract, and diabetic retinopathy.

The American Medical Association's Physician Consortium for Performance Improvement and the American Academy of Ophthalmology's Eye Care Work Group worked since last spring to develop these guidelines. The Centers for Medicare and Medicaid Services (CMS) has said it might include ophthalmology measures in the Medicare Physician Voluntary Reporting Program beginning in 2007.

"The key here is that the Medicare program was discussing having measures that doctors can participate in as a way of getting a bonus or some payments for reporting performance," Dr. Lee said.

"The evidence suggests the people in ophthalmology do a really good job in providing care, so if there were going to be some differential payments, we wanted to make sure physicians had the opportunity to take advantage of these payments," Dr. Lee added.

The measures outline standards for four areas:

AMD

Cataract

Diabetic retinopathy

Glaucoma

Subspecialty associations contributed ideas and members to serve on the committee, with a public comment period in which opinions were solicited. Dr. Lee said the selected measures are viewed as a first step in the process, and the group will work to develop more measures over the coming months.

The group also was able to determine a potentially key policy when dealing with patients who may be seen by more than one ophthalmologist for various eye-care needs. The question arose: who is responsible for reporting these conditions?

"We came up with the notion that the doctor is charged with being aware of all the conditions a patient has, but if the doctor is a glaucoma specialist with a patient who has a cataract and diabetes, as long as the doctor indicates that the person's conditions are being cared for by another doctor, that satisfies the requirement," he said. "It was a keen insight."

Ophthalmology was among the first medical specialty areas to have its measures approved by the AQA, said Cathy G. Cohen, the American Academy of Ophthalmology's vice president of governmental affairs. She said the group was able to move quickly in determining the initial measures because of the established work done to identify preferred practice patterns.

Exactly how physicians would implement the reports still needs to be determined.

Priscilla P. Arnold, MD, FACS, chairwoman of the government relations committee at the American Society of Cataract and Refractive Surgery and a member of the Eye Care Work Group, hopes the reporting process improves areas of ophthalmology that may not be uniformly practiced or reported correctly. For example, she said, one measure for diabetic retinopathy indicates a need to communicate with the patient's primary-care physician.