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  • 31 Oct 2012 8:47 AM | Arkady Yatskevich (Administrator)
    Reminder: Optometrists subject to $500+ fee for Medicare DMEPOS enrollment
    Optometrists who wish to provide eyeglasses for cataract patients under Medicare are subject to a new durable medical equipment prosthetics, orthotics and supplies (DMEPOS) registration fee every three years, according to the AOA Advocacy Group.  As reported in AOA publications previously, the fee was put in place in March 2011 over the objections of AOA and other physician organizations when the Centers for Medicare & Medicaid Services (CMS) decided to treat all DMEPOS suppliers as institutional fraud risks.
    Under a government initiative to screen out unscrupulous providers, all physicians who are now enrolled as health care practitioners or suppliers under Medicare will be required to re-enroll by March, 2015.   Optometrists should watch for letters to revalidate their Medicare enrollment, which verifies their enrollment records in the government health plan’s Provider Enrollment, Chain and Ownership System (PECOS).
    Optometrists and other health care physicians who wish to provide only professional services are not subject to any Medicare registration fees, the AOA Advocacy Group notes. However, those who wish to provide health care products, including eyeglasses, are subject to a new $500+ fee ($523 this year, indexed to increase annually with inflation) as well as stringent new screening requirements including site visits by inspectors.
    The Medicare DMEPOS registration fee is distinct from the health plan’s DMEPOS provider surely bond requirement, from which optometrists have been exempted unless they provide eyeglasses to the public without any sort of examination of the patient, and separate from the DMEPOS accreditation requirement, until the CMS decides to implement supplier standards for physicians.
    The AOA Advocacy Group has been lobbying to win exemption for optometrists from the DMEPOS registration fee as well. However, at this time, the registration fee remains applicable to eyewear providers and other physicians who furnish DMEPOS to their patients, AOA Advocacy Group staff note.
    Many optometrists have been receiving notifications to reenroll in Medicare over recent weeks, the AOA Advocacy Group reports.
    For additional information, see “HHS anti-fraud program to mean new scrutiny, fees for physicians" on the AOA News blog or the Medicare Learning Network (MLN) article “Further Details on the Revalidation of Provider Enrollment Information."


    Communication came from:

    Dr. Harvey Richman, FAAO, FCOVD
    Diplomate American Board of Optometry
    136 Main Street
    Manasquan, NJ 08736
    AOA Third Party Center Executive Committee
  • 30 May 2012 1:37 PM | Arkady Yatskevich (Administrator)

    Growing numbers of physicians are earning reporting bonuses, but hundreds of thousands still have not participated in a program that turns punitive in 2013.

    By Charles Fiegl, amednews staff. Posted May 28, 2012.


    Washington Absent a significant change in the trajectory of Medicare’s physician quality reporting system, a large majority of doctors will set themselves up for future rate cuts by failing to report enough quality measures to the federal government in 2013.

    A recent trends report from the Centers for Medicare & Medicaid Services shows that fewer than 200,000 physicians, out of the more than 600,000 who were eligible for the incentive program, reported PQRS measures in 2010. More than 125,000 physicians reporting as individuals met enough of the requirements to share a total of nearly $400 million in bonuses, but hundreds of thousands of eligible doctors did not attempt to meet the pay-for-reporting criteria. More than 50,000 tried for the bonuses but did not report enough quality measures to hit the minimum.

    The lack of participation has physician organizations concerned that a huge segment of those caring for Medicare patients soon will take a hit when CMS begins not only withholding bonuses from doctors who don’t participate in the PQRS but also cutting their pay rates. Physicians can consider 2012 to be their final year to try reporting risk-free: A 1.5% noncompliance penalty won’t be assessed until 2015, but that payment adjustment will be based on whether physicians report quality measures in 2013.

    Organized medicine groups, including the American Medical Association, have urged CMS not to base 2015 PQRS penalties on the 2013 reporting year. Physicians are facing several deadlines for penalties related to quality and health information technology initiatives, said AMA President Peter W. Carmel, MD. The programs would require doctors to meet substantial requirements to avoid the penalties.

    “While physicians may be aware of the 2015 PQRS deadline, many do not know that the penalty will be based on their performance in 2013,” Dr. Carmel said. “CMS data show that many physicians are not yet participating in the PQRS program. A significant number of those who are trying have been unable to participate, showing that barriers to success still remain.”

    In 2010, overall PQRS participation rose to 244,145 physicians and other health professionals, but 76% of eligible professionals, or nearly 750,000 doctors, nurses and others enrolled in Medicare, chose not to report any quality data to CMS. Most who did report earned bonuses. About seven in 10 participating professionals qualified for payouts equal to 2% of their Medicare charges that year.

    Bonuses went to a total of 168,843 health care professionals and 19,232 physician practices in 2010, and the average payout was $2,157 per doctor and $20,364 per practice. In 2009, about 120,655 health professionals pulled down incentives that averaged $1,962 per individual.

    Those incentive amounts are becoming smaller, with doctors receiving a 1% bonus for successful reporting in 2011 and 0.5% for 2012, 2013 and 2014, the final year to receive higher pay before the first noncompliance penalty is applied to pay rates in 2015.

    A flurry of Medicare penalties

    Despite their successes in PQRS, physicians who have earned bonuses expressed doubts about their ability to prevent all the potential future penalties outlined by CMS. A 1% penalty was applied this year to thousands of physicians for not reporting enough eligible electronic prescribing encounters with patients in 2011.

    In addition to the 2015 PQRS penalty, Medicare rates would be reduced by 1% that year for those who do not achieve meaningful use of an electronic health record system. CMS also plans to adjust pay with a value-based modifier for physicians starting in 2015. The modifier would increase pay for some doctors who are deemed to provide high-quality, efficient care, but it would decrease rates for an as-yet-unknown pool of other physicians.

    “It’s tough for small practices,” said Brent W. Beasley, MD, an internist who works part time at Plaza Primary Care and Geriatrics in Kansas City, Mo. “We are doing our best to break even.”

    The practice is working on a plan to meet the requirements of the multiple incentive programs, said Dr. Beasley, who also is a medical director for Saint Luke’s Care, a quality improvement organization within Saint Luke’s Health System in Kansas City, Mo. Improving quality is difficult in offices with just four or five physicians as those practices try to contain overhead costs. The larger health systems have the resources to keep up with Medicare’s demands, he said.

    Plaza Primary Care and Geriatrics has used its EHR system to help capture thousands of dollars in PQRS bonuses, Dr. Beasley said. But he is uncertain about whether the success will continue as the program shifts into punitive mode. “I’m not confident we will avoid penalties. We’ll do our best.”

    Meeting PQRS requirements is very difficult without an EHR system, said Derrick O’Connell, RN, the chief quality officer at Patients First Health Care in Washington, Mo. The 80-physician group has earned bonuses by having its doctors enter quality data into designated EHR fields during eligible patient encounters. Without such automation, quality data must be aggregated and reported by hand.

    Success with group reporting option

    Participation in PQRS was boosted somewhat by a new reporting option in 2010. Academic organizations such as the University of Texas Medical Branch and Loyola University Health System opted to send physician quality data as group practices. Thirty-five organizations, with 24,823 eligible professionals, later earned bonuses by using CMS’ new group practice reporting option that year.

    The group option is patient-centered and cuts down on duplication, said Rex McCallum, MD, UTMB’s chief physician executive. For instance, the group would be credited when a physician reports a flu vaccine measure for a patient. If the patient sees another doctor at the group, that doctor would not report the flu measure but could focus on another applicable measure for which the group could claim credit.

    About 500 physicians earned bonuses in 2010 at Loyola, said Daniel J. Post, senior vice president of ambulatory programs and system services. In previous years, some physicians would earn bonuses for reporting measures as individuals, while others would fail to meet the minimums.


    Low turnout for Medicare PQRS

    Most physicians who are eligible for Medicare quality reporting bonuses do not participate in the incentive program. If that trend continues into 2013, many will be penalized with lower pay. Medicare recently compiled figures for doctors reporting measures as individuals between 2007 and 2010. A smaller number of additional physicians reported as group practices.




    Qualified for




    no bonus




    no bonus









    Sources: “2010 Reporting Experience, Including Trends (2007-2011): Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program,” Centers for Medicare & Medicaid Services, Feb. 22; “Details for Name: 2009 Reporting Experience, Including Trends 2007-2010,” CMS

    Practice managers want e-prescribing deadline delay

    The agency overseeing the Medicare program should extend the deadline for physicians filing an exemption to stop the 2013 electronic prescribing penalty, said the Medical Group Management Assn.

    The MGMA has asked the Centers for Medicare & Medicaid Services to move the June 30 deadline for exemption applications to Dec. 31. “This will give practices the additional time they need to assess their providers’ success in reporting for the first several months of 2012,” the MGMA stated in a May 15 letter to CMS.

    Physicians must report at least 10 eligible e-prescribing transactions for Medicare patients by June 30 to prevent a 1.5% pay reduction from being applied to Medicare rates in 2013. Physicians who earned 2011 e-prescribing bonuses also will not be penalized in 2013.

    In March, CMS began accepting requests for significant hardship exceptions, such as for a doctor who orders fewer than 100 prescriptions over six months. Physicians who can’t meet e-prescribing program requirements should consider filing applications for an exemption, said Cecil B. Wilson, MD, American Medical Association immediate past president. “While we do not think physicians are being given enough time to comply with the Medicare e-prescribing program, we want to make them aware of the upcoming e-prescribing deadline so they can take steps now to prevent being hit with the 2013 penalty,” he said.

    The MGMA also urged CMS to take additional steps to protect Medicare physician payments from unnecessary cuts. For instance, the Medicare agency should deem all physicians meeting meaningful use requirements in the electronic health record incentive program as also successfully meeting e-prescribing and physician quality reporting system requirements. The AMA also has called for this change.

    CMS had not responded to the MGMA letter by this article’s deadline.

    In the meantime, physicians can apply for exemptions to the e-prescribing penalty online.

  • 25 May 2012 9:00 AM | Arkady Yatskevich (Administrator)

    Millions of teenagers suffer from acne, and they deal with the embarrassing skin blemishes by taking popular prescription medications such as Accutane or Roaccutane. Now, however, research from Tel Aviv University shows that these pills can also cause eye infections such as conjunctivitis (pink eye) or sties.

    According to Dr. Gabriel Chodick of TAU's School of Public Health at the Sackler Faculty of Medicine, clinicians have long theorized a connection between acne and eye infections, but there was little available statistical research on the subject. "Acne itself can increase the risk of ocular diseases," he explains. "There is a greater tendency towards inflammation, and sometimes this leads to irritation." His research revealed that patients who took these oral medications doubled the risk of developing an eye infection, compared to acne sufferers who did not.

    Published in Archives of Dermatology, the work was done in collaboration with Drs. Meira Neudorfer, Orna Shamai-Lubovitz and Varda Shalev from the Sackler Faculty of Medicine and Inbal Goldshtein from Maccabi Health Care Services.

    Drying those tears

    The researchers looked at records of almost 15,000 adolescents from the Maccabi Health Care Services database, one of Israel's largest health funds. They were divided into three groups: those who were acne-free; those who had acne but did not take oral medication; and those who had acne and were prescribed a medication such as Accutane or Roaccutane.

    Out of the 15,000 subjects, 1,791 people developed inflammatory ocular diseases, including 991 in the medicated group, 446 in the acne group, and 354 in the acne-free group. The most common infection was conjunctivitis, commonly called pink eye. Four percent of patients who were on acne medication contracted pink eye, compared to 2 percent for the normal population.

    "A very common side effect of Accutane and Roaccutane is dryness of skin and lips, so it's only natural that these medications would also effect the lubrication of the eyelids - specifically the oil glands along the rim of the eyelid," explains Dr. Chodick. Tears are crucial because they lubricate the surface of the eye and they wash away debris, including bacteria and viruses, that can lie on the eye or its lid. Infection of the gland itself can lead to sties, and more serious bacterial infections might lead to the swelling of the entire eyelid.

    A simple solution

    Though not a serious medical condition, acne is still worth treating, says Dr. Chodick. But dermatologists and patients should be aware of these side effects, because there is the potential for long-term damage. According to some studies, including one published in Clinical and Experimental Optometry, irritation and eye rubbing can lead to structural eye problems such as keratoconus, a degeneration of the cornea.

    Dr. Chodick advises that patients on oral acne medication ask their doctors how to minimize eye damage. One simple step is to use artificial tears, or eye drops, to keep the eyes lubricated. Local pharmacies can offer several inexpensive over-the-counter options, he says.



    American Friends of Tel Aviv University

  • 23 May 2012 8:33 AM | Arkady Yatskevich (Administrator)

    A 2-year comparison showed that the drugs Avastin and Lucentis lead to similar vision improvements in patients with age-related macular degeneration (AMD). The study also found that visual gains were slightly better with monthly rather than as-needed treatments.

    AMD is the leading cause of vision loss and blindness in older Americans. The condition affects the macula, the central portion of the retina that allows us to look straight ahead and see detailed images. In its advanced stages, AMD can trigger growth of abnormal blood vessels that leak fluid and blood into the macula, damaging the macula and obscuring central vision. Without treatment, most patients with this “wet” form of AMD lose their ability to drive, read, recognize faces or perform certain tasks.

    In 2006, the U.S. Food and Drug Administration (FDA) approved the use of Lucentis (ranibizumab) for treating AMD. By that time, some ophthalmologists had already begun treating AMD with a similar drugundefinedthe cancer medication Avastin (bevacizumab)undefinedalthough it hadn't been FDA-approved for that purpose. Both drugs are injected directly into the eye, and both are now widely used to treat AMD. But doctors didn't know which drug might be more effective or what dosing schedule might be best.

    In 2008, NIH's National Eye Institute (NEI) launched a 2-year clinical trial to compare the 2 drugs. The study, called the Comparison of AMD Treatments Trials (CATT), published its first-year results in May 2011. That initial report found that both drugs were equally effective in preventing vision loss from AMD. The new report describes the findings from the trial’s second year. It appeared in the April 30, 2012, online edition of Ophthalmology.

    At enrollment, about 1,200 patients with AMD were randomly divided into 4 treatment groups. The groups were defined by drug (Avastin or Lucentis) and dosing regimen (monthly or as-needed). After the first year, patients on monthly dosing were randomly reassigned to monthly or as-needed regimens. All continued to receive their initial drug.

    By year 2, the researchers found that both drugs led to similar improvements to vision. At least 60% of patients in all groups achieved 20/40 vision or betterundefinedthe level needed for driving. In contrast, earlier research showed that less than 15% of AMD patients receiving previously available treatments could attain that level of visual accuracy.

    The study found slightly less vision gain with as-needed than with monthly dosing, regardless of the drug. As measured on an eye chart, monthly treatment resulted in a mean improvement of about half a line better than as-needed dosing. Switching to as-needed treatment after a year of monthly dosing led to outcomes nearly equal to those obtained with 2 full years of as-needed treatment.

    "Both drugs were highly effective regardless of the approach to dosing. There was slightly less vision gain with as-needed treatment,” says CATT study chair Dr. Daniel F. Martin of the Cleveland Clinic. “Patients seeking the small extra advantage of monthly treatment need to be mindful of the additional burden, risks and costs of monthly injections. Since as-needed dosing required 10 fewer eye injections over the course of 2 years and yielded similar visual results, many patients may choose this option.”

    Reference: Ophthalmology. 2012 Apr 26. [Epub ahead of print]

  • 22 May 2012 10:55 AM | Arkady Yatskevich (Administrator)

    A device which could restore sight to patients with one of the most common causes of blindness in the developed world is under development in an international partnership.

    Researchers from the University of Strathclyde and Stanford University in California are creating a prosthetic retina for patients of age related macular degeneration (AMD), which affects one in 500 patients aged between 55 and 64 and one in eight aged over 85.

    The device would be simpler in design and operation than existing models. It acts by electrically stimulating neurons in the retina, which are left relatively unscathed by the effects of AMD while other 'image capturing' cells, known as photoreceptors, are lost.

    It would use video goggles to deliver energy and images directly to the eye and be operated remotely via pulsed near infra-red light- unlike most prosthetic retinas, which are powered through coils that require complex surgery to be implanted.

    The prosthetic retina is a thin silicon device that converts pulsed near infra-red light to electrical current that stimulates the retina and elicits visual perception. It requires no wires and would make surgical implantation simpler.

    The device has been shown to produce encouraging responses in initial lab tests and is reported in an article published in Nature Photonics. The technology is now being developed further.

    Dr Keith Mathieson, now a Reader in the Institute of Photonics at the University of Strathclyde in Glasgow, was one of the lead researchers and first author of the paper. He said: "AMD is a huge medical challenge and, with an aging population, is continuing to grow. This means that innovative, practical solutions are essential if sight is to be restored to people around the world with the condition.

    "The prosthetic retina we are developing has been partly inspired by cochlear implants for the ear but with a camera instead of a microphone and, where many cochlear implants have a few channels, we are designing the retina to deal with millions of light sensitive nerve cells and sensory outputs.

    "The implant is thin and wireless and so is easier to implant. Since it receives information on the visual scene through an infra-red beam projected through the eye, the device can take advantage of natural eye movements that play a crucial role in visual processing."

    The research was co-authored by Dr. Jim Loudin of Stanford and led by Professor Daniel Palanker, also of Stanford, and Professor Alexander Sher, of the University of California, Santa Cruz.

    Professor Palanker said: "The current implants are very bulky, and the surgery to place the intraocular wiring for receiving, processing and power is difficult. With our device, the surgeon needs only to create a small pocket beneath the retina and then slip the photovoltaic cells inside it."

    Dr Mathieson was supported through a fellowship from SU2P, a venture between academic institutions in Scotland and California aimed at extracting economic impact from their joint research portfolio in photonics and related technologies.

    Strathclyde leads the collaboration, which also includes Stanford, the Universities of St Andrews, Heriot-Watt and Glasgow and the California Institute of Technology. SU2P was established through funding from Research Councils UK- as part of its Science Bridges awards- the Scottish Funding Council and Scottish Enterprise.

    The research links to Photonics and Health Technologies at Strathclyde- two of the principal themes of the University's Technology and Innovation Centre (TIC), a world-leading research and technology centre transforming the way universities, business, and industry collaborate.

    Through Health Technologies at Strathclyde, academics work with industry and the health sector to find technologies for earlier, more accurate disease detection and better treatments, as well as life-long disease prevention.



    Please use one of the following formats to cite this article in your essay, paper or report:


    University of Strathclyde. "Simple Solution For Age Related Macular Degeneration." Medical News Today. MediLexicon, Intl., 21 May. 2012. Web.
    22 May. 2012. <>


    University of Strathclyde. (2012, May 21). "Simple Solution For Age Related Macular Degeneration." Medical News Today. Retrieved from

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