What does the shift from fee for service in optometry to value-based models of care mean for optometrists and their practices?
According to Dr. Bryan Rogoff, president of EyeExec consulting, this change need not be a cause for panic.
He acknowledges that many OD’s have been wary of the move toward value-based models, being used to the current dominant system of fee for service in optometry. In this model, professionals are paid for providing procedures.
In value-based care, by contrast, they are paid based upon the outcome of these procedures rather than the procedures themselves.
Several years back, in response to concerns over rising health-care costs, Medicare introduced a program called MIPS (Merit-based Incentive Payment System), which operates using a value-based care model. Since 2016, more and more health professionals (including optometrists) have started to be paid based on their MIPS score.
The program is expanding and will continue to do so over the next few years, into 2019. For physicians who are just beginning to educate themselves about these issues, Dr. Rogoff recommends consulting the American Optometric Association, which has an entire department devoted to providing resources on MIPS.
He emphasizes that optometrists must adapt their goals and strategies to this new context.
For example, many groups are currently fighting to expand scope-of-care and advocacy rights while assuming a fee-for-service framework. These groups need to be asking themselves how such rights will work in a value-based care context.
Dr. Rogoff also points out the role of “big tech” in the industry’s response to these developments. The 2007 recession, along with legislative changes, created the opportunity for big tech companies (e.g. Apple, IBM, Google) to become involved with data collection. This has had major effects on a variety of industries. For instance, insurance companies now utilize compiled data from wearable technologies (analyzing patients exercise, sleeping patterns, standing patterns, etc.) in order to calculate premiums.
Although Dr. Rogoff understands how developments like these might provoke uncertainty and apprehension, he encourages us to think in terms of the opportunities that such changes will open up. “We want to look at these as resources we can use to help our clinical diagnosis, to help better outcomes.”