2022 Physician Fee Schedule Implications, Personalizing Glaucoma Surgery, and More
Addressing the proposed 2022 Medicare Physician Fee Schedule and Quality Payment Program rules released by CMS, the American Academy of Ophthalmology (AAO) and the Surgical Care Coalition said that the proposal’s inaction on pending cuts to surgical care would threaten patient care and have a significant effect on ophthalmology practices.
With cuts coming as a result of a reduction that is necessary to keep Medicare payments budget neutral, the proposed cut to the Medicare conversion factor for 2022 would be 3.75%. As reported by Ophthalmology Times®, both AAO and the Surgical Care Coalition said that updates to the conversion factor have failed to keep up with inflation.
Notably, cuts had been scheduled to go into effect this year, but had been delayed by Congress for 1 year. If no additional changes are made to the proposal, the cuts will go into effect on January 1, 2022.
Current Progress in Personalized Glaucoma Surgery
In an article by Ophthalmology Times®, progress within microinvasive glaucoma surgery (MIGS) was spotlighted.
Trabeculectomy, the gold standard of glaucoma surgery, has evolved in terms of safety and efficacy. However, the surgery may be associated with a higher risk of failure or complications in some cases, particularly with the use of mitomycin-C or 5-fluorouracil. Notably, the article highlights that nonpenetrating surgery may be a reasonable alternative in these cases, an approach that is considered by few surgeons due to its surgical complexity/difficulty and the long learning curve in mastering the techniques.
When conducted, the surgery has been associated with significant reductions in postoperative complications and effective long-term intraocular pressure control. However, several unmet needs persist for MIGS, which include the lack of a clear definition, poorly established cost-effectiveness balance, and the quality of trials comparing these techniques with conventional surgeries.
Dual Imaging Linked With Reduction in Costs, Unnecessary Referrals
According to findings of a retrospective, comparative cohort study assessing spectral domain optical coherence tomography (SD-OCT) with ultrawide field (UWF) imaging in a diabetic retinopathy (DR) telemedicine screening program, the dual imaging approach was associated with substantially increased detection and reduced false positive assessments of diabetic macular edema and epiretinal membrane.
As reported by Modern RetinaTM, 211 patients were assessed in a free UWF image-based DR teleophthalmology program at Joslin Diabetes Center in Boston, Massachusetts, via Optos, which allows SD-OCT and UWF imaging in a single sitting.
Discussing implications of the study findings, use of integrated SD-OCT/UWF devices in large DR screening programs was noted to potentially reduce unnecessary referrals, in addition to substantially improving disease identification. As the study only evaluated 422 eyes, future research is warranted to determine the applicability of the findings.