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Winter is the time of year for administration and paperwork. Taxes are due in the spring, and for those of us in private practice, it is the time to clean up and evaluate the business of our practice from the previous year.
For the past several years, it has also been the time to jiggle and juke with our electronic health record (EHR) and try to figure out how in the world we are going to navigate the government’s onerous attestation process for meaningful use and to qualify for Merit-based Incentive Payment System (MIPS).
Optometrists are eligible clinicians, and we often meet the low volume threshold, based on allowed charges under the Medicare Physician Fee Schedule and the number of Medicare Part B patients.
MIPS is a performance-based program that looks at four areas: quality, improvement activities, promoting interoperability and cost. The system is complex and is designed for physicians, with very, very little applicable to eye care in general and optometry in particular. Yet, our payment is based on this program and will be adjusted year to year going forward based on our success with MIPS.
If crafting your EHR to properly collect the minimal points that apply to us and getting your system to create the proper file to upload during attestation sounds complicated, wait until you get on the Quality Payment Program (QPP) web page. First, you will find that you will have to go to the HCQIS Access Roles and Profile (HARP) and get a new password. Of course, unlike the rest of the Internet, the government’s Internet is only available during regular business hours.
If you have a good EHR company, they will have provided you with step-by-step instructions on how to navigate the QPP website. Of course, new for 2019, the website has been updated, and your step-by-step instructions are virtually worthless. You must read a hundred pages of gobbledygook and give it your best shot.
There is growing body of knowledge about a new occupational hazard for health care clinicians known as physician burnout. Burnout is now defined as a syndrome involving one or more of these symptoms: emotional exhaustion, depersonalization and diminished sense of personal accomplishment. Many experts are declaring this new syndrome as a public health crisis. According to a recent study published by a partnership of the Massachusetts Medical Society, Massachusetts Health and Hospital Association, Harvard T.H. Chan School of Public Health and Harvard Global Health Institute, one of the key causes for this new syndrome is inefficient EHRs and the 2009 American Reinvestment and Recovery Act, which started the requirement for meaningful use of EHRs and has led us to MIPS.
Unlike physicians, optometrists have other pressures on our practices that include vertical integration of the optical industry including vision plans and retail optometric practices; online refractions, examinations and the supply of optical goods; and a growing supply of new graduates that are deeply in debt and eager to be employed by all of the above alternate practice modes.
The solutions for physician burnout vary, but many suggest that finding joy in your work is a key element. A recent white paper by the Institute for Healthcare Improvement, “Framework for improving joy in work,” suggests that the issue of burnout can affect more than just the clinicians, it can affect the staff and the entire health care workplace.
In spite of the pressures of modern practice, optometrists, unlike physicians, have many ways to find joy in our work. The core of our practice is the correction of refractive error, and this is often achieved without drugs, surgery or invasive procedures. How many times do we see a young child bought in by an anxious mother who has noticed that her child does not see very well? The exam starts with the child only being able to read the big “E” on the chart. We slide that phoropter over, flash the retinoscope for a few seconds, and suddenly the child can read 20/20. For all in the room there is nothing but joy.
Although technology has brought us the seeds of physician burnout, here are a few items that can bring us the joy to shield us from closing up shop and heading for Florida:
--OCT that can screen for subtle vitreoretinal pathology and define and monitor them over time;
--new freeform progressives that provide better vision across the spectrum of visual demand;
--lens treatment options that can reduce glare, protect the eye from harmful radiation and even improve sleep patterns;
--new contact lens options that can be safely worn by almost anyone and can correct complex problems of keratoconus and ectasia;
--new optometric treatment protocols to correct oculomotor dysfunction from concussion and traumatic brain injury; and
--new horizons in our profession for prevention and primary care.
The secret to thriving in modern optometric practice is to not fall into the many pitfalls of burnout but rather to find joy in all the things that once attracted us to our great profession. Applying technology to our core strengths will not only prevent burnout but make optometry one of the leading health care fields of the future.
References:
Jha AK, et al. A crisis in health are: A call to action on physician burnout. Accessed February 11, 2019.
Perlo J, et al. IHI framework for improving joy in work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017.