AE March/April 2018 Vol 27 No 2 - 20

RUNNING THE PRACTICE // REIMBURSEMENT
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EMBRACING CHANGE

TO THRIVE IN AN EVOLVING REIMBURSEMENT WORLD
Andrew Maller, MBA, COE

C

hange seems to be taking
place everywhere in the U.S.
healthcare system, particularly in the world of reimbursement. Practices know
that Medicare and commercial payers want to shift
reimbursement from volume to
value, meaning that physicians and
practices face increasing pressure to
adapt and accept more risk for the
quality of patient care they deliver.
Failure to meet quality measures
may result in Medicare penalties
and could, ultimately, impact a
practice's ability to remain a part of
commercial payer networks.
Currently, the most obvious representation of this shift is through
MACRA, but the reality is that we
have been moving in this direction
for years, with programs such as
Meaningful Use, PQRS, and the
Affordable Care Act. Commercial
payers are also signaling this shift in
many markets through value-based
contracts and quality data reporting
requirements that aim to engage
providers in sharing accountability
for lowering the cost and improving the quality of healthcare for
members. The result is added pressure from payers for providers to
improve patient care while lowering
the cost of healthcare delivery.
The ongoing changes in how
insurance payers reimburse practices for services will continue to

20

AE // Mar/Apr 18

have a dramatic impact on the
future viability of ophthalmology
practices. With change, practices
will have options but will need
to make important decisions
about how they plan to move
forward. Practices can be resistant to change (i.e., keep doing
things the way they have always
done them), or they can see the
changing landscape as an opportunity to adapt and prepare for
the future. Obviously, the option
to resist change is not feasible
or sustainable for future success.
Practices must take a creative and
strategic approach to these changing trends by modifying the way
they think about reimbursement.
Like any practice-wide initiative, success starts with a unified
commitment from the leadership
team (physicians and administration). There must be a cultural
shift in the way reimbursement is
approached, and an acceptance that
all team members play a role in the
process. More than ever, the entire
mindset of an organization must
be focused on providing superior,
quality-based patient care that is
consistent with the goals of CMS
and private health plans.
There is no specific, one-size-fitsall approach to thriving in this new
reimbursement world, but there are
several important areas ophthalmology practices can focus on when

charting their new path. This article
addresses four of these areas.
REDEFINE THE PAYER AND
PROVIDER RELATIONSHIP
Practices need to stop seeing commercial payers as adversaries and,
instead, see them as partners in
patient care. Due to the nature of
traditional fee-for-service contracts,
physician practices and health
plans are naturally at odds because
their priorities are not aligned.
However, this paradigm has shifted
to a point where physician practices and health plans must now
work collaboratively due to the
rising cost of providing healthcare
services and initiatives driving
value-based care and population
health improvement.
DETERMINE PAYER PRIORITIES
AND GOALS
Proactively developing relationships
with local marketplace payers is essential, especially those with many
covered lives. A practice needs
to determine which priorities are
important to each health plan and
work to meet those priorities.
HEDIS is a good example.
HEDIS is an acronym for "Health
Effectiveness Data and Information Set," which are healthcare
performance metrics that health
plans must report to demonstrate
quality and access to care, as well



Table of Contents for the Digital Edition of AE March/April 2018 Vol 27 No 2

How We Can Successfully Lead
Advanced Administration: Administrator Success Factors—Needing a Tune-Up Is Expected
Advice for New Administrators: Introducing the Administrator Beginners Circle—The Go-To Resource for New Administrators
Business Operations: Some Things to Know About Professional Liability Insurance
Customer Care: Making a Diffi cult Journey A Little Easier
Fast Practice: Breaking Down Practice Cliques
Human Resources: Recruiting Strategies for Ophthalmology—Where to Search for New Physicians
InfoTech: Cloud Computing— Storms or Blue Skies?
Reimbursement: Embracing Change to Thrive in an Evolving Reimbursement World
Technicians: Creating a “Feeder Program” to Staff Your Clinic
Washington Watch: MIPS in 2018—Key Changes for Ophthalmic Practices
Taking Your Practice to the Top
Use Podcasts to Increase Practice Visibility—and Thrive
Trailblazing— How to Implement Career Pathing in Your Practice
Ocular Surface Disease: Reimbursement Considerations for the Evaluation and Management of Dry Eye
Retina: Should Retinal Specialists Be Integrated Into a Multispecialty Practice?
Asked and Answered
ASOA News
Bookshelf: Off Balance On Purpose: Embrace Uncertainty and Create a Life You Love
COE Corner: Preparing for the COE Exam – Keep Your Eye on the Prize
Focus on a Practice: Ohio Valley Eye Physicians & Surgeons, PLLC, on Operating a Practice in Two States
Gamechanger: Karen Bachman, COE, COMT, OCS, ROUB
Advertisers’ Index
Peer to Peer: What’s Your Favorite Technique for Holding a Productive Staff Meeting?
AE March/April 2018 Vol 27 No 2 - Cover1
AE March/April 2018 Vol 27 No 2 - Cover2
AE March/April 2018 Vol 27 No 2 - 1
AE March/April 2018 Vol 27 No 2 - 2
AE March/April 2018 Vol 27 No 2 - 3
AE March/April 2018 Vol 27 No 2 - 4
AE March/April 2018 Vol 27 No 2 - How We Can Successfully Lead
AE March/April 2018 Vol 27 No 2 - Advanced Administration: Administrator Success Factors—Needing a Tune-Up Is Expected
AE March/April 2018 Vol 27 No 2 - 7
AE March/April 2018 Vol 27 No 2 - Advice for New Administrators: Introducing the Administrator Beginners Circle—The Go-To Resource for New Administrators
AE March/April 2018 Vol 27 No 2 - 9
AE March/April 2018 Vol 27 No 2 - Business Operations: Some Things to Know About Professional Liability Insurance
AE March/April 2018 Vol 27 No 2 - 11
AE March/April 2018 Vol 27 No 2 - Customer Care: Making a Diffi cult Journey A Little Easier
AE March/April 2018 Vol 27 No 2 - 13
AE March/April 2018 Vol 27 No 2 - Fast Practice: Breaking Down Practice Cliques
AE March/April 2018 Vol 27 No 2 - 15
AE March/April 2018 Vol 27 No 2 - Human Resources: Recruiting Strategies for Ophthalmology—Where to Search for New Physicians
AE March/April 2018 Vol 27 No 2 - 17
AE March/April 2018 Vol 27 No 2 - InfoTech: Cloud Computing— Storms or Blue Skies?
AE March/April 2018 Vol 27 No 2 - 19
AE March/April 2018 Vol 27 No 2 - Reimbursement: Embracing Change to Thrive in an Evolving Reimbursement World
AE March/April 2018 Vol 27 No 2 - 21
AE March/April 2018 Vol 27 No 2 - Technicians: Creating a “Feeder Program” to Staff Your Clinic
AE March/April 2018 Vol 27 No 2 - 23
AE March/April 2018 Vol 27 No 2 - Washington Watch: MIPS in 2018—Key Changes for Ophthalmic Practices
AE March/April 2018 Vol 27 No 2 - 25
AE March/April 2018 Vol 27 No 2 - Taking Your Practice to the Top
AE March/April 2018 Vol 27 No 2 - 27
AE March/April 2018 Vol 27 No 2 - 28
AE March/April 2018 Vol 27 No 2 - 29
AE March/April 2018 Vol 27 No 2 - 30
AE March/April 2018 Vol 27 No 2 - 31
AE March/April 2018 Vol 27 No 2 - 32
AE March/April 2018 Vol 27 No 2 - 33
AE March/April 2018 Vol 27 No 2 - Use Podcasts to Increase Practice Visibility—and Thrive
AE March/April 2018 Vol 27 No 2 - 35
AE March/April 2018 Vol 27 No 2 - 36
AE March/April 2018 Vol 27 No 2 - 37
AE March/April 2018 Vol 27 No 2 - Trailblazing— How to Implement Career Pathing in Your Practice
AE March/April 2018 Vol 27 No 2 - 39
AE March/April 2018 Vol 27 No 2 - 40
AE March/April 2018 Vol 27 No 2 - 41
AE March/April 2018 Vol 27 No 2 - Ocular Surface Disease: Reimbursement Considerations for the Evaluation and Management of Dry Eye
AE March/April 2018 Vol 27 No 2 - 43
AE March/April 2018 Vol 27 No 2 - Retina: Should Retinal Specialists Be Integrated Into a Multispecialty Practice?
AE March/April 2018 Vol 27 No 2 - 45
AE March/April 2018 Vol 27 No 2 - Asked and Answered
AE March/April 2018 Vol 27 No 2 - 47
AE March/April 2018 Vol 27 No 2 - ASOA News
AE March/April 2018 Vol 27 No 2 - 49
AE March/April 2018 Vol 27 No 2 - Bookshelf: Off Balance On Purpose: Embrace Uncertainty and Create a Life You Love
AE March/April 2018 Vol 27 No 2 - 51
AE March/April 2018 Vol 27 No 2 - COE Corner: Preparing for the COE Exam – Keep Your Eye on the Prize
AE March/April 2018 Vol 27 No 2 - 53
AE March/April 2018 Vol 27 No 2 - Focus on a Practice: Ohio Valley Eye Physicians & Surgeons, PLLC, on Operating a Practice in Two States
AE March/April 2018 Vol 27 No 2 - 55
AE March/April 2018 Vol 27 No 2 - Gamechanger: Karen Bachman, COE, COMT, OCS, ROUB
AE March/April 2018 Vol 27 No 2 - 57
AE March/April 2018 Vol 27 No 2 - Advertisers’ Index
AE March/April 2018 Vol 27 No 2 - 59
AE March/April 2018 Vol 27 No 2 - Peer to Peer: What’s Your Favorite Technique for Holding a Productive Staff Meeting?
AE March/April 2018 Vol 27 No 2 - Cover3
AE March/April 2018 Vol 27 No 2 - Cover4
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http://www.nxtbook.com/ygsreprints/ASOA/g77256_ae_mayjun17
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http://www.nxtbook.com/ygsreprints/ASOA/ae_novdec16
http://www.nxtbook.com/ygsreprints/ASOA/ae_septoct16
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http://www.nxtbook.com/ygsreprints/ASOA/asoa_mayjune2016
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http://www.nxtbook.com/ygsreprints/ASOA/asoa_sepoct15
http://www.nxtbook.com/ygsreprints/APTA/g52750_apta_25ada
http://www.nxtbook.com/ygsreprints/ASOA/asoa_julyaug2015
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http://www.nxtbook.com/ygsreprints/ASOA/asoa_sepoct14_AE
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http://www.nxtbook.com/ygsreprints/ASOA/ASOA_MayJunAE
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http://www.nxtbook.com/ygsreprints/ASOA/asoa_fall_2013
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http://www.nxtbook.com/ygsreprints/ASOA/asoa/asoa_summer_2013
http://www.nxtbook.com/ygsreprints/ASOA/ehr_cust_survey_Apr2013
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