Eyeworld Daily News

EW SHOW DAILY 18 ASCRS News Sunday, April 15, 2018 by Lauren Lipuma EyeWorld Contributing Writer silicone tip prevents any metal from coming into contact with the cap- sule, is good at polishing the posteri- or capsule, and can flip the epinucle- us out of the bag and safely aspirate it, according to Dr. Davidson. Dr. Davidson's surgical unit started using a pre-formed silicone tip handpiece in December 2015 and analyzed rates of PCR 1 year later. They reported only nine cases of PCR during that time, none of which occurred while using the silicone tip handpiece. Dr. Davidson concluded that while the silicone tip handpiece reduced incidences of PCR to zero in her center, randomized controlled trials are needed to determine whether this technique has a statisti- cal advantage over others. EW Editors' note: Dr. Davidson has fi- nancial interests with Bausch + Lomb (Bridgewater, New Jersey). U sing a preoperative form to assess a patient's risk of posterior capsule rupture (PCR) during cataract sur- gery significantly reduces incidences of PCR and vitreous loss, according to research presented yesterday. A study of more than 27,000 cataract surgery cases shows scoring patients with the form reduced inci- dences of PCR by more than 20% at two surgery centers in the U.K. The risk score allows surgeons to bet- ter predict complex cases and take appropriate precautions to minimize incidences of PCR, said Amelia Davidson, MB, ChB, Aylesbury, U.K., who presented results of the research study at a poster session. The reasons for the reduction of PCR incidences are multifactorial but are due in part to the surgery centers' decision to reserve low risk cases for residents and assign high risk cases only to experienced sur- geons, Dr. Davidson said. PCR with vitreous loss during cataract surgery is associated with higher rates of infection, retinal detachment, and poor visual out- comes. Physicians have recently focused on risk stratification systems for cataract patients, which gives them the opportunity to counsel patients on the potential risks prior to surgery, modify surgical strategies in high risk or complex cases, and ensure novice surgeons only operate on the lowest risk patients, accord- ing to Dr. Davidson. In the study, Dr. Davidson and her colleagues analyzed whether a risk scoring form introduced in 2011 reduced rates of PCR for cataract patients at two surgery centers in the U.K. The researchers looked at PCR incidences in more than 27,000 eyes operated on between 2008 and 2016, before and after surgeons began using the form. Surgeons completed the form at the patient's preop listing appoint- ment. The form scored patients' risk for PCR on a scale of 1 to 21. The surgery centers then assigned cases to surgeons based on the patients' risk scores. Junior residents operated only on patients scoring less than 3; senior residents and fellows operated on patients scoring between 3 and 5; and attending surgeons operated on patients scoring 5 or higher. Dr. Davidson and her colleagues found the relative risk of PCR with vitreous loss dropped from 1.1% to 0.8% after the form was intro- duced, a reduction of more than 20%. The incidence of vitreous loss for resident surgeons also dropped steeply after introduction of the form; resident involvement in cases with PCR dropped from 50 to 11, Dr. Davidson said. While residents performed more low risk surgeries than before, the number of surgeries residents performed did not change after the form was introduced, she said. The form enabled Dr. Davidson's surgery center to better plan their operating lists, she added. "There was always some form of risk stratification, but it was done on the day of surgery, not pre-planned," she said. The researchers also looked at whether using a silicone tip irri- gation/aspiration (I/A) handpiece reduced incidences of PCR. The Scoring patients according to risk reduces incidences of posterior capsule rupture and patient interactions, which in turn impact compliance. Technicians also shine as audi- tors due to their knowledge of the primary areas on which reimburse- ment is based: the care needed and provided; patient indications and medical necessity; and chart docu- mentation. All of those roles require the knowledge of ophthalmology that technicians have. Technicians' specific clinical knowledge can improve the accura- cy of the billing examined through audits. Expertise in the practice's electronic health record (EHR) system can help them ensure it supports the payment requests that have been submitted. Insights of a technician-auditor can help find an incomplete note, repeated errors on certain charts, services that were charted but not billed, and noted misfiled on the EHR. The technicians' role and ex- perience can help them as auditors determine whether the billing issue they found was caused by staffing, processes, or training. Then they can use that knowledge to begin formulating workable solutions, Ms. Johnson said. "Compliance is an every day activity," Ms. Johnson said. Among the benefits for tech- nicians from taking on auditing is the opportunity to learn something new, finding challenges beyond their core role in producing patient workups, and an expansion of their expertise beyond clinical roles, Ms. Johnson said. The practice can benefit from a technician-auditor through improved patient satisfaction, improved patient flow, improved compliance in charting and claims, and possibly enhanced revenue. However, she noted that tech- nicians cannot fill the role alone but need the support of a billing office representative and physician contact. EW How continued from page 14

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