Optometry Low Vision Rehab Productivity Update Low Vision

Optometry Low Vision Rehab Productivity Update Low Vision Workgroup Conference Call 10/19/15 Patti Fuhr, OD, Ph. D

Critical Elements used to Calculate Productivity 1. Person Class 2. DSS Labor Mapping 3. Resident Only Workload Productivity calculations in the Physician Productivity Cube rely on the accurate classification of an individual provider based on the person class code for their discipline and labor mapping to determine the number of clinical FTE responsible for the workload

Person Class • Person Class (Taxonomy) is assigned in the (Vist. A) NEW PERSON File – (http: //vaww. aac. va. gov/npcd/) – VHA DIRECTIVE 2012 -003 • Taxonomy is based on NUCC (National Uniform Claim Committee) guidelines – http: //www. nucc. org/ • Chief of Staff Office, C&P Office, Supervisor, AO can assist in reviewing and updating person class (should be reviewed annually) – See Attachment 3 – Physician Productivity Cube Algorithms • Update in Vet. Pro

Optometry Person Class • Each attending OD is assigned one person class (practicing specialty). The primary person class for Optometry is 060800. – – – – 060800 060802 060803 060804 060805 060806 060807 Optometrist (060800) Optometrist Low Vision Rehabilitation (060802) Optometrist Occupational Vision (060803) Optometrist Pediatrics (060804) Optometrist Sports Vision (060805) Optometrist Vision Therapy (060806) Optometrist Corneal and Contact Management Translation: An OD should be assigned a person class other than 060800 ONLY if practicing that specialty more than 50% of time in clinic

DSS Labor Mapping • Productivity is determined by the ratio of specialty service RVUs generated by VA Paid Attendings divided by the adjusted clinical MD FTE of VA Paid Attendings • The adjusted clinical MD FTE is derived from DSS Labor Mapping % Clinical, % Administrative, % Education, % Research • Clinical MD FTE = Total MD FTE – Administrative MD FTE Education MD FTE - Research MD FTE • Translation – Productivity is the ratio of the RVUs you generate (based on coding) divided by the amount of time you are mapped for direct patient care

Resident Only Workload • Only workload that can be traced back to an attending physician is included in the calculation of productivity • the attending physician should be identified as the primary provider on the encounter • If a resident is assigned as the primary provider and no attending physician is identified, this workload is not included in the specialty service workload • Translation – The attending OD should ALWAYS be the primary provider

Specialty Physician Productivity Report • To View the report – RAMP Search – Physician Productivity Cube – “Specialty Physician Productivity Statistical Process Control (SPC) Charts for Selected Measures” – Open in Pyramid Analytics – Reports: P 1. Productivity Data Profile by Specialty – Optometry – Click to drill down

Specialty Physician Productivity Report P 1. Productivity Data Profi. . . Filter Selection: (All Facility, FY 2015, All Provider Type) RVU Sum, RVUSum. Filtered, MD FTE (C), Adjusted MD FTE (C), Productivity Measure, Encounters and RVU Sum Per Encounter by Specialty (Specialty) on rows sub-setted by All Facility, FY 2015 and All Provider Type RVU Sum Optometrist (060800) Optometrist Corneal and Contact Management (060807) Optometrist Low Vision Rehabilitation (060802) Optometrist Occupational Vision (060803) Optometrist Pediatrics (060804) Optometrist Sports Vision (060805) Optometrist Vision Therapy (060806) RVUSum. Filtere MD FTE (C) Adjusted MD FTE Productivity Encounter RVU Sum Per Encounter d (C) Measure s 2, 905, 153. 84 2, 648, 988. 97 529. 44 529. 42 5, 003. 55 1, 805, 825 1. 61 12, 735. 72 12, 311. 97 2. 55 4, 835. 85 7, 440 1. 71 108, 994. 03 5. 4 19. 45 153. 59 8, 109. 17 103, 490. 24 34. 65 34. 54 2, 996. 38 19. 45 0. 19 103. 81 7, 504. 40 1. 97 3, 815. 96 70, 547 5 30 161 4, 682 1. 54 1. 08 0. 65 0. 95 1. 73

Productivity Measures for Optometry Low Vision Rehabilitation (060802) • The Productivity Measures in the Physician Productivity Cube for Optometry Low Vision Rehabilitation (060802) compared to other Optometry person class categories were significantly lower than for other Optometry person classes, and outside the 25 th to 75 th percentile ranges for Fiscal Year (FY)14 and FY 15. • The productivity values of Low Vision Rehabilitation Optometrists may be influenced by relatively fewer encounters compared to general Optometry due to complexity of patient workload, by coding errors, by erroneous person class, by CMS zero RVU codes for Low Vision Rehabilitation services, or by lack of appropriate codes that reflect the difference between a low vision examination and an eye examination.

Work to clean up the productivity measure • Review and correct any errors in person class • Review procedure codes and RVUs • Work with OPES and DSS to analyze workload and update RVUs • Work to implement discipline specific coding so that all VAs have the same guidelines • Workgroup established. Starting with person class cleanup

FY 15 Optometrists with Person Class Low Vision BECKER, EMILY N (060802) BELDYGA, BRENT L (060802) BUNTING, KATHRYN A (060802) CAJAMARCA, DIANA OD (060802) CHAN-O'CONNELL, LISA (060802) CHONG, THERESA (060802) CHRONISTER, CONNIE L (060802) CORREA, MARIA J (060802) CRAMMER, ROBERT J (060802) DALMASY-FROUIN, LAURA E (060802) DANG, SALLY H (060802) DELLA BELLA, MATIAS (060802) DZIADUL, JOHN (060802) ELDRED, KIA B (060802) ESSINGER, JOHN A (060802) FREESTONE, BRADLEY D (060802) FUHR, PATTI S (060802) GILBREATH, MARILYN K (060802) GREENFIELD, BOBETTE (060802) HASKES, CHERYL B (060802) HENRY, JENNIFER J (060802) HUANG, MICHAEL A (060802) IHRIG, CAROLYN (060802) JACKOWSKI, MARY (060802) JOHNSON, MATTHEW A (060802) JUN, WEON (060802) KESSLER, SHANNON S (060802) KIRBY, JENNINE E (060802) KLEMENS, JULIE H (060802) KWON, ELLEN E (060802) LEAR, LINDSEY K (060802) LEE, JENNY OD (060802) LIMCHAIYAWAT, PAULA T (060802) LINDSAY, DIANE M (060802) MARTINEZ, BETHANY S (060802) MCCARTHY, MARY (060802) MCCONNAHA, DEBRA L OD (060802) MCKEE, NATALIE K (060802) MESSER, TIMOTHY I (060802) MILLER, AMY M (060802) MONTERROSO, EDDIE A (060802) MORAND, TIMOTHY M (060802) MORDUCHOWITZ, STEVEN (060802) MORSE, STEPHEN E (060802) MURPHY, ANDREA (060802) NGUYEN, THERESE ANNE VY-PHUC T (060802) O'CONNELL, WILLIAM F (060802) PAYNE, SUSAN H (060802) PENA, JULENE (060802) PEREZ, ANA M (060802) PERKINS, ELIZABETH (060802) PETERSON, MICHAEL S (060802) RAKOCZY, CHRYSTYNA M (060802) RAWLINGS, DANA L (060802) ROSS, MEGHAN A (060802) SAXON, MOLLIE C (060802) STELMACK, JOAN OD (060802) STONE, SHANNON R (060802) TARBETT, AARON (060802) TOKUMARU, GAY (060802) TRAN, CATHERINE T (060802) WACKER, RICHARD T (060802) WAISS, BRENDAL (060802) WHITE, JANIS M (060802) WILCOX, DENISE T (060802) WOLF, VERONICA (060802) WOOD, JENNIFER D (060802) YANG, IRENE L OD (060802) YU, XIAO X (060802)

ICD 10 Low Vision Coding Patti Fuhr, OD, Ph. D

ICD 9 Low Vision Encounter Form • • Normal (20/25 or better) Mild VI (20/30 to 20/60 Moderate (20/70 to 20/100) Legal Blindness USA Definition Totally Blind, NLP or LPO Field < 10 deg. , 20/500 – 20/1000 Field <20 deg. , 20/200 -20/500 Field <5 Deg. , HM at <10’, Count Fingers <3’

ICD 10 H 5410 Blindness, both eyes Blindness one eye, low vision other eye, unspecified eyes H 5411 H 5412 H 543 H 5440 H 5441 H 5442 H 5450 H 5451 H 5452 H 5460 H 5461 Blindness right eye, low vision left eye Blindness left eye, low vision right eye Low vision both eyes Unqualified visual loss, both eyes Blindness one eye, unspecified eye Blindness, right eye, normal vision left eye Blindness left eye, normal vision right eye Low vision one eye, unspecified eye Low vision, right eye, normal vision left eye Low vision, left eye, normal vision right eye Unqualified visual loss, one eye, unspecified Unqualified visual loss, right eye, normal vision left eye H 5462 Unqualified visual loss, left eye, normal vision right eye H 547 H 548 Unspecified visual loss Legal blindness, as defined in USA

ICD 10 Appendix 4 Tables Categories of Visual Impairment Maximum less than: • • • Category 1 Category 2 Category 3 Category 4 Category 5 Category 9 Minimum equal to or better than 20/70 -20/200 -20/400 to 5/300 – LP NLP Undetermined/Unspecified

Diagnosis Coding • Blindness in both eyes = Categories 3, 4, 5 both eyes (20/400 or worse) H 540 • Blindness right eye, low vision left eye = – Categories 3, 4, 5 in right eye(20/400 or worse) – Category 1 or 2 left eye (20/70 to 20/400) H 5411 • Legal Blindness = no change in definition H 548

National Optometry Low Vision Encounter Form • Submitted with updated diagnoses codes • Need to work on procedure code updates