Are Nonphysiologic IOP Targets Necessary?

Many patients may achieve disease stability without aggressive goals.

Natalia Londoño De Vivero, MD, and Arsham Sheybani, MD

Glaucoma Today

Key Takeaways As the only modifiable risk factor in glaucoma, elevated IOP should be addressed to slow disease progression. Because patients have difficulty adhering to prescribed treatment regimens and because IOP is inherently variable, a single in-office IOP measurement fails to capture a true picture of their glaucoma. The risk of decreasing the IOP more than is necessary should be a concern. Why is IOP one of the rare variables in the human body that is targeted below physiologic values? Is this approach truly necessary? Is it safe? Are glaucoma specialists actively considering the downsides of bringing the IOP lower than 10 mm Hg? As the only modifiable risk factor in glaucoma, elevated IOP should be addressed to slow disease progression. However, because patients have difficulty adhering to prescribed treatment regimens and because IOP is inherently variable, a single in-office IOP measurement fails to capture a true picture of their glaucoma. IOP fluctuates throughout the day with blinking, eye movement, postural changes, and circadian rhythm.

Plugging Hidden Profit Leaks

Here’s what’s worth keeping an eye out for—and addressing if found.

Christopher Lopez, OD, FAAOMS

Modern Optometry

Using Data to Catch Problems Early

How operational safety nets can turn practice data into early warnings for workflow and reimbursement issues.

Bill James, MHA, COE

Retina Today

Key Takeaways Leadership at Talley Eye Institute used structured query language (SQL) programming to develop operational “scrubbers” to identify potential workflow, coding, and billing issues. The SQL-based program reported an unexpected change in the allowable reimbursement for aflibercept 8 mg (Eylea HD, Regeneron), allowing the practice to identify the issue before significant additional underpayments occurred. Proactive data reporting can help practices identify workflow gaps and reimbursement trends early, so that staff can intervene before small issues become larger operational or financial problems. As retina practices adjust to growing patient volumes, reduced reimbursement, employee turnover, and the introduction of new therapies (including biosimilars), the opportunity for operational mistakes is ever-present. At the same time, insurance companies are becoming increasingly aggressive in denying or underpaying claims for rendered services and intravitreal injections. In retina care, small operational misses can quickly become significant clinical or financial problems. While practice data is often used to monitor overall financial and operational performance, a deeper analytical approach can help identify workflow gaps, catch errors before they escalate, and monitor reimbursement at a granular level. IDENTIFYING THE PROBLEMS At Talley Eye Institute, we recognized that despite the best efforts of our staff, errors in appointment scheduling, coding, and billing can still occur. For example, patients may be added to the schedule after the day’s prior authorizations for injections or surgeries had been completed, creating gaps that are easy to miss in real time. To help ensure that intravitreal injections were reimbursed accurately, we identified areas where rare scheduling exceptions could create operational or financial consequences if left undetected.