Ophthalmic Innovation 2016:A View from the AAO

David W. Parke II, M.D.

CEO

American Academy of Ophthalmology

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The Big Three

• V2V: “VOLUME TO VALUE”

• A2A: “ANECDOTES” TO “ANALYTICS”

• P2P: “PATIENTS TO POPULATIONS”

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V2V: Health Care Payments

VALUE = QUALITYCOST

VALUE = healthcare outcomes achieved per dollar spent

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Measuring the ‘Right Stuff’

• What is the most important factor in surgery?

1. Judgment as to whether to operate or not2. Which procedure to perform given clinical factors3. Intraoperative technical skill4. Whether guidelines followed for antimicrobial prophylaxis

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MACRA

Fundamentally changes the way Medicare determines and updates payments to physicians (and hospitals and ASC’s)

Goes into effect January 2017 Final rules this week

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Impact for Industry• Within three years, 30% of each ophthalmologist’s individual score

will be based on “resource use” or total cost• Cataract surgery: site of service (ASC vs HOPD)• Retina: choice of anti-VEGF agent

• Impact on physician payment and behavior:• up to 9% of total Medicare payments at risk

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A2A: Anecdotes 2 Analytics: IRIS Sept 2016

4173

041

944

4200

542

064

4212

542

186

4224

842

30942

35342

38542

46142

53742

629

0

20

40

60

80

100

120

Patient Visits Unique Patients

Timeline

Mill

ions

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CMS Penalties Avoided by IRISYear Physicians MFS PQRS

PenaltyVBMPenalty

MUPenalty

Total

2014 4,130 $338,000 $27.9M $27.9M $55.8M

2015 10,800 $338,000 $73.0M $73M – $146M $109.5M $255.5M-$328.5M

2016 12,000 $338,000 $81.1M $81M – $162M $121.7M $283.9M-$365M

2017 12,000 $338,000 $81.1M $81M – $162M $121.7M $283.9M-$365M

2018 12,000 $338,000 $81.1M $81M – $162M $162.2M $283.9-$405.6M

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IRIS Impact: New Knowledge to Measure “Value”

• Natural history data

• Prevalence data

• Treatment impacts

• Drug interactions

• Complications

• Rare diseases

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Big Numbers 2013-June 2016

• Cataract surgery• 3,738,937 eyes• 2,356,159 unique patients

• Primary open-angle glaucoma• 3,251,938 unique patients

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Big Numbers 2013-June 2016• AMD diagnosis

• 2,230,755 unique patients

• Anti-VEGF injections• 4,468,969 injections• 577,048 unique patients

• Diabetic retinopathy• 1,220,770 unique patients

• Rebranding—AAO and the profession• Communicating externally• Engaging the patient• Demonstrating value• Thinking about populations of patients

P2P: Patients to Populations:Repositioning the Profession

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EyeSmart Audience GrowthQ

1 20

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Visitors

• Data represents monthly totals combined for each quarter• Q3 2016 is projected

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August: Callie’s story

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NASEM Study: Reprioritizing Eye Health

• Examine the core principles and public health strategies to reduce visual impairment and promote eye health in the United States.

• Action plan for public and private collaborations at the community, state, and national levels to elevate vision and eye health as a public health issue.

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