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2014 ASCRS•ASOA Boston Daily News Tuesday

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EW SHOW DAILY 3 ASCRS•ASOA SYMPOSIUM & CONGRESS, BOSTON 2014 ASCRS News Today Innovator's continued from page 1 Ms. McCann continued from page 1 Dr. Hafezi highlighted his results from working with PACK CXL, which is crosslinking with photo-activated riboflavin. The 2014 Charles D. Kelman Innovator's Lecture was given by Warren E. Hill, MD, East Valley Ophthalmology, Mesa, Ariz., and was titled "Something Borrowed, Something New: Improved Accuracy for IOL Selection." Dr. Hill discussed the exchange and movement of technology from one field or many fields into oph- thalmology, which he said is a com- mon trend. He also spoke about the honor of giving the lecture and the contributions that Dr. Kelman made to the field. He thanked the other doctors he works with, calling them the "algorithm development dream team." Dr. Hill said the three most important questions for any research project to ask are why, how, and what. First, he discussed what the current predictability of refractive outcomes is, referencing several studies. For half diopter accuracy it's somewhere between 71% and 80% for plus or minus a half diopter. "One shortcoming of a lot of theoretical formulas is that they use a linear regression algorithm, and the relationships within the eye are often non-linear," Dr. Hill said. Radial basis function (RBF) takes as its basis the human neuron. The RBF is like a neural network but with a different activation function. It's good with multiple factor, non-linear relationships, and it gives robust outcomes with few input factors, he said. Dr. Hill shared some of his tests of the validation of this formula using an independent validation set. He also discussed results in compari- son to other formulas. RBF IOL power calculations represent a robust approach based on data interpolation, pattern recog- nition and a validating boundary model, Dr. Hill said. The response and the accuracy of this method are mostly driven by the quality and diversity of the database used to fit the RBF model. By using only 3 measured variables, the RBF model performs on par with the most advanced theoretical formulas. A similar process is underway to develop a method for eyes that have undergone prior keratorefractive surgery, like RK, PRK, and LASIK. This is only a first effort, Dr. Hill said, and additional work remains to be done before RBF IOL power calculations will be ready for prime time. He said there may come a time when calculating the power of an IOL may be as accurate as the meas- urement of the axial length. The future of IOL power calculations is bright, he said. EW Editors' note: Dr. Hafezi has financial interests with Peschke MediTrade, Schwind Eye-Tech Solutions, and Ziemer Ophthalmics Systems. Dr. Hill has no related financial interests. Ms. McCann focused on priority issues impacting ophthalmology. There are a number of principles for SGR reform, the first of which is repealing it. These principles also include a 5-year period of payment stability and positive updates; a choice of voluntary payment mod- els; allowing private contracting on a case-by-case basis; positive incen- tives instead of penalties for quality improvement; replacing the current PQRS, EHR and value-based pay- ment system programs; quality measures determined by physicians; legal protections for physicians fol- lowing guidelines and participating in quality programs; and a repeal of the Independent Payment Advisory Board (IPAB). Reductions as a result of the SGR began in 2002 when a 5.4% cut actually went into effect. Since then, Congress has been enacting short- term patches to avoid the subse- quent cuts created by the flawed SGR, Ms. McCann said. There was recently another short-term patch through March 31, 2015, despite agreement on policy to repeal and replace, due to the inability to agree on offsets, Ms. McCann said. She also discussed the effort made by Congress to repeal the SGR, comparing the bills from the com- mittees of jurisdiction—the House Energy and Commerce and Ways and Means Committees and the Senate Finance Committee. "As a result of our lobbying, we were able to get a pretty good bill," she said. The Medicare Provider Payment Modernization Act would repeal SGR immediately, provide 5 years of a positive update, and consolidate the three existing quality programs, as well as eliminating the penalties associated with them. Ms. McCann noted there was one very concern- ing provision in the legislation, which involves the misvalued codes section. But she said that there were so many good aspects of the bill that the entire medical community supported the legislation. Ms. McCann's session moved into a discussion of the PQRS, EHR and value-based payment modifier quality programs. "Again, 2014 is the last year that you can get an in- centive payment," Ms. McCann said regarding PQRS participation. Addi- tionally, to successfully report for 2014 providers have a choice of re- porting either the Cataract Measures Group via registry for 20 patients, 50% of which must be Medicare Part B patients or 9 individual measures from the relevant ophthalmology and general care measures in 3 NQS domains for 50% of the Medicare Part B fee-for-service patients they see during the reporting period. The value-based payment modi- fier is a program you really need to pay attention to, Ms. McCann said. Beginning in 2014, with the 2016 payment year being affected, prac- tices of 10 or more will have to have a majority of their eligible profes- sionals successfully participate in PQRS or risk being penalized. This will affect all physicians by 2017. She then spoke about EHR meaningful use, reminding those in attendance that 2014 is the last year to begin and qualify for incentive payments. Going forward, Ms. McCann said there will continue to be efforts for repeal of the SGR, positive updates, and a quality system that rewards physicians for meeting thresholds. She recom- mended actions individuals can take as well, including speaking to legis- lators, voicing concerns to them, and explaining the impact these proposals have on the practice and, most importantly, patients. "You need to get in the game because if you are not in it, you can't win it," she said. EW Based on what you have heard today, how important do you believe it is to use both NSAIDs and corticosteroids to block the inflammatory cascade after cataract surgery? Very important 69% Somewhat important 27% Neutral 2% Somewhat not important 2% Not important 0% 96% of attendees at the "Reducing the Impact of Cataract Surgical Stress by Mitigating Inflammation and Reducing Ultrasound Energy" symposium believe it is somewhat to very important to use both NSAIDs and steroids to block the inflammatory cascade after cataract surgery.

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