EyeWorld Today is the official daily of the ASCRS Symposium & Congress. Each issue provides comprehensive coverage editorial coverage of meeting presentations, events, and breaking news
Issue link: https://daily.eyeworld.org/i/677598
3 EW SHOW DAILY ASCRS•ASOA Symposium & Congress, New Orleans 2016 semi-quantitative device would be something that would be useful,'" he said before showing an image of the first keratometer he built and going on to reveal later iterations all the way to his development of a keratoscopic lens. In addition to measuring astigmatism, Dr. Barrett said also of interest to him is the correc- tion of astigmatism at the time of surgery, particularly the impact of the incision and the issue of toric IOL alignment. Dr. Barrett discussed research involving different incision sizes and said he has found "there is some merit in smaller incisions." When it comes to positioning a toric IOL, Dr. Barrett highlighted his toriCAM app. "All you need is your iPhone and a felt-tipped marking pen," he said, demonstrating how the app helps determine the axis of corneal limbal marks for ideal IOL align- ment. Dr. Barrett conducted a prospec- tive study to evaluate the error in alignment when marking is done using a slit lamp, a slit lamp with toriCAM, free hand, and free hand with toriCAM. "Even with slit lamp marking, the app improves the accuracy by about 50%, and with free-hand marking it reduces the error … by about 68%," he said. "The bottom line is if you use the app and free- hand marking, it is more accurate than if you use slit lamp alone." His final concern with astig- matism is the prediction of it after cataract surgery. Dr. Barrett has developed many formulas to aid in IOL calculations. With his, and many other, calculators available as well as technologies to help measure astigmatism, Dr. Barrett said he be- lieves "astigmatism prediction with toric IOLs is just about as accurate as spherical power prediction." Bringing his lecture back to the idea of innovation itself, Dr. Barrett pulled out a newspaper clipping that he has carried around in his wallet for years. It's an article about Isaac Asimov, PhD, an author and biochemist who was approached by the U.S. government to work on a project during the Cold War that would, as Dr. Barrett put it, "en- courage innovation." Dr. Asimov declined, but this moment, Dr. Bar- rett said, stimulated him to write an essay on creativity, 1 that suggested creativity was not something that you could encourage in someone. "It's something that comes from inward reflection by people who are sometimes a bit odd and eccentric," Dr. Barrett said. Dr. Barrett said that a sense of curiosity fostered beyond child- hood into adulthood, coupled with inspiration not only from oneself but from mentors and friends, and persistence are the source of creativi- ty and innovation. "I am truly humbled by this honor. When you present among a big group like this and your slides go wrong, you get tense," he said, ref- erencing an earlier technical glitch with his presentation, "I'm not. I'm relaxed. I've enjoyed every moment of it … and really that's because I just feel I'm among friends." Preceding Dr. Barrett's highlight presentation were 5 other engaging topics. Stephen Pflugfelder, MD, Houston, spoke about an intranasal neurostimulation device called the Oculeve Tearbud (Allergan, Dublin) still under investigation, which stim- ulates natural tears as a management technique for dry eye disease. John Berdahl, MD, Sioux Falls, South Dakota, presented his theories on intracranial pressure being an over- looked factor in glaucoma patients and how he's exploring the use of goggles to create a small vacuum to balance a pressure gradient between IOP and intracranial pressure. David Chang, MD, Los Altos, California, discussed technologies still in the preclinical stage that could provide options for automated capsulotomies. Rohit Shetty, DNB, Bangalore India, described research that found tear samples could assist in kerato- conus diagnosis, while Raymond Stein, MD, Toronto, discussed topography-guided PRK combined with crosslinking as a more effective treatment for keratoconus from the treatment angle with topography- guided PRK and crosslinking. EW Editors' note: Dr. Barrett has finan- cial interests with Alcon (Fort Worth, Texas), Bausch + Lomb (Bridgewater, New Jersey), Haag Streit (Koniz, Swit- zerland), and MST (Redmond, Wash- ington). Dr. Pflugfelder has financial interests with Allergan and Shire (Lex- ington, Massachusetts). Dr. Berdahl has financial interests with Equinox (Sioux Falls, South Dakota). Dr. Chang has financial interests with Abbott Medical Optics (Abbott Park, Illinois) and Mynosys (Fremont, California). Drs. Shetty and Stein have no related financial interests. continued from page 1 doesn't currently fit nicely in the APM model. MIPS consolidates the current quality reporting programs (PQRS, VBPM, and Meaningful Use) and adds clinical practice improvement activities (CPIAs) into this new pro- gram. MIPS will begin in 2019, based on 2017 performance. She discussed MACRA compared to prior law. There are modest but positive updates for 5 years. The quality reporting programs are also consolidated with more flexibility, potential for significant bonuses, and lower maximum penalties. There's financial support for small practices, Ms. McCann added. With the MIPS program, physicians will receive a composite performance score (from 0–100) based on their performance in 4 categories: quality (making up 50% of the composite score), cost (10% of the composite score), advancing care information, previously called Meaningful Use (25% of the com- posite score), and clinical practice improvement activities (15% of the composite score). This composite score will then be compared to a performance threshold. The most important point is that existing penalties associated with the current programs end at the end of 2018, Ms. McCann said. Ms. McGlone went into detail on the 4 components of the MIPS composite score. Under the qual- ity portion of the MIPS program, physicians will need to report a minimum of 6 measures, with at least 1 cross-cutting measure and an outcome measure, if available. Oth- erwise, the provider would report 1 additional "high quality" measure. The cost aspect includes 2 of the cost measures previously used in the VBPM program: total per capita costs for all attributed beneficiaries and Medicare spending per ben- eficiary. The attribution method is unchanged, and episode-based measures will be used to evaluate resource use. Under the advancing care infor- mation, physicians will submit data for a full calendar year reporting period. This category is comprised of a score for participation and report- ing 6 objectives and their measures. There is also a score for reporting at various levels above the base score (a performance score of up to 80 points in objectives and measures for pa- tient electronic access, coordination of care through patient engagement, and health information exchange). Finally, with the clinical practice improvement activities, physicians will work toward a total of 60 points by selecting CPIAs. They will select activities from a list of more than 90 options, with medium level activi- ties worth 10 points and high-level activities worth 20 points. CPIA needs to be performed for at least 90 days during the performance period. Ms. McCann shifted to discuss the misvalued codes initiative, which was included in the ABLE Act, passed in late 2014. It accelerates an initiative previously included in an early SGR patch to revalue certain "misvalued" codes. This moved up the timeline to 2016–2018 and set a 1% target from misvalued savings for 2016 and a 0.5% target in sav- ings for 2017 and 2018. If the target is met, savings are redistributed to other services and excess savings carry forward; otherwise, across-the- board cuts apply. This sets screens to identify potentially misvalued codes. "That is why we saw significant retina and glaucoma cuts that were in the rule," Ms. McCann said. If we don't get this addressed now and get CMS to make changes, this has the possibility to impact all codes mov- ing forward, she added, and there could be even more of an impact because cataract codes will be up for reevaluation shortly. "It's important that we get input from all of you when we have to provide input to the federal agen- cies," Ms. McCann said. EW Editors' note: The speakers have no relevant financial interests. continued from page 1 Ms. McCann discusses legislative and regulatory issues.