To understand eye care, look outside!

Look outside! Outside eye care, that is. In the early days of the health care reform movement, I heard a number of speakers qualify their comments saying, "I don't have a crystal ball." The implication was no one could really know where this was all going. There were many unknowns, yes, especially if you were trying to understand by looking inside eye care. The elusive crystal ball became something of a mantra for leaders inclined to wait and see. 

Medicare's December 15 press release, "CMS announces first results for program to improve care for dialysis patients" is another great example of how we can understand health care reform implications for eye care by looking outside eye care. Some quotes from the press release are instructive.

The Centers for Medicare & Medicaid Services (CMS) today released the first results for a new Federal pay-for-performance or “value-based purchasing” program for dialysis facilities that is designed to give facilities payment incentives to improve the quality of care furnished to patients diagnosed with End-stage Renal Disease (ESRD).  Nearly 70 percent of dialysis facilities that were evaluated under the program will receive no payment reduction in payment year (PY) 2012, while the remaining 30 percent will receive reductions ranging from 0.5 percent to 2.0 percent depending on their final performance scores.
“The real purpose of value-based purchasing is to raise the bar on quality and that’s exactly what CMS is aiming to do for Medicare patients who have ESRD,” said CMS Acting Administrator Marilyn Tavenner. “This is one of many efforts CMS is making to drive quality improvement in all settings in communities across the country.”

What are our eye care takeaways from this announcement?

1. Let's admit that pay-for-performance is another of the key concepts of health care reform that has fallen on deaf ears in the eye care profession. Then let's start taking it seriously.

2. Let's understand that the Feds are serious about introducing pay-for-performance programs not only for renal diseases but for "all settings in communities across the country", and that that includes eye care.

3. Let's start putting pressure on the eye care profession to anticipate the eye care diseases likely to become pay-for-performance candidate programs and then begin developing the quality measures that make sense for eye care. 

4. Knowing that 'this too shall come' and, regardless of what happens at the national level, let's get ready with local, even individual initiatives. 

5. Once again, let's come back to EHRs. These are the health IT core of your participation in pay-for-performance and other value-driven health care initiatives. Choose well.

Alistair Jackson, M.Ed.