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The California Academy of Eye Physicians and Surgeons (CAEPS) is the only statewide organization representing California ophthalmologists and their patients. CAEPS' activities include public education about important eye health care concerns, legislative advocacy, interaction with third party payers about reimbursement and coverage issues, and continuing medical education for ophthalmologists and their staffs.


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Aetna "blurs the line" with Cataract Surgery precertification

In July, Aetna – the nation’s third-largest provider of health insurance and services – implemented a policy that is in complete contradiction of its stated commitment (see 2018) to build an “open health care model that will help consumers improve their health and simplify their health care experience.” Specifically, Aetna is now requiring precertification for all cataract surgeries without any clear explanation.

During a meeting with CAEPS’ national counterpart – the American Academy of Ophthalmology (AAO) – Aetna admitted that its own internal calculations found that there would be less than a 5 percent chance that it would deem a surgery “unnecessary.” Yet, they are implementing this policy that could negatively affect more than 95% of beneficiaries.

“Visual impairment due to cataract is real, reduces our patients’ quality of life, interferes with their work, and puts them at increased risk for falls and car accidents,” said Craig H. Kliger, MD, Executive Vice President of CAEPS.  “About 4 million Americans undergo cataract surgery every year, a number that will grow as our population ages.” He recently penned an Op-Ed that appeared on the Sacramento-based political website Capitol Weekly.

CAEPS, the California Medical Association, and the American Academy of Ophthalmology working in concert, have asked Aetna to immediately withdraw the program, which – because Aetna published no updated policy documents and provided limited prior education before implementation -- is already causing chaos at doctors’ offices and places where surgery is performed.

“Uncertainty in regard to whether or not a surgical procedure will be covered is untenable when expensive supplies and facilities are involved,” said Kliger. “There must be a better way for Aetna to address whatever issue they are trying to fix. It is imperative that a different solution is implemented in order to avoid delays or potentially denying our patients access to vision-restoring surgery.”

The AAO estimates that 10,000 to 20,000 Aetna patients had their cataract surgery unnecessarily delayed in the month of July alone, and frequently patients have been blaming ophthalmologists for surgical cancellations that are beyond their control. In short, this policy threatens to erode trust between patients and physicians, seemingly for no real benefit.

Practice Management Dollar$ and Sense: Modifier 25 as an Audit Target

A US Department of Health and Human Services Office of the Inspector General (OIG) Audit of a southern California retina practice reported in March resulted in recoupment requests of $398,625 under the Medicare program.

Billing for E/M services in addition to the intravitreal injections with Modifier -25 that was felt not to meet the standard of "Significant, separately identifiable Evaluation and Management (E/M) by the same physician or other qualified health care professional on the same day of the procedure or other service," was a significant finding of the audit.

This new video -- which is typically a "members only" benefit -- is being shared publicly because of its importance in helping ensure the integrity of the Medicare Program.

The full report can be read on the OIG's website.
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  • June 09, 2020 12:00 AM | Craig H Kliger MD (Administrator)
    What to Expect When You Return to your Ophthalmologist’s Office

    We can’t tell you when it will be safe to go back to the hair salon, when the kids will return to school or when you can hug your grandparents again. But we can say that your next trip to the ophthalmologist will be different. That’s because ophthalmologists are devising new office procedures to prevent the spread of COVID-19.

    As California "reopens," the California Academy of Eye Physicians and Surgeons in partnership with our national counterpart the American Academy of Ophthalmology (AAO) want to share how ophthalmologists are working to protect their patients and staff.

    In March, CAEPS and the AAO urged ophthalmologists to immediately stop routine surgical and in-office visits to preserve protective equipment such as masks and to mitigate the risk of spreading COVID-19, the illness caused by the novel coronavirus. Although both groups made recommendations to curtail routine care — in turn based on recommendations from the Centers for Disease Control and Prevention and public health officials — the decisions to reopen more normal practice are being handled locally and regionally.

    Ophthalmologists are ready with new procedures. Here is what you should expect to see:

    • The clinic may ask you to wait outside or in your car instead of in the normal waiting room. This is to protect you, the other patients and the office staff from possible virus exposure in crowded waiting areas and until you can be screened.
    • The clinic is likely restricting the number of people who enter. If you do not need someone to be there with you, do not bring anyone to your appointment.
    • Expect to see hand sanitizer when you enter the building and in the waiting room and exam rooms.
    • Expect to be asked to wear a mask. Here’s a video on how to properly put on and take off your mask. You won’t be alone. The staff as well as all visitors should wear a mask.
    • Waiting room chairs -- when used -- will be spaced out to accommodate social distancing. The office may also have made arrangements or adjustments for additional waiting areas to prevent crowding.
    • You will not see magazines, clip boards, or other high-touch materials that could help spread the virus.
    • Cleaning will occur more frequently throughout the clinic.
    • As usual, exam rooms and equipment will be thoroughly cleaned before every patient.
    • Expect to be asked a series of questions to determine your risk profile.
    • Expect everyone to have their temperature taken, whether they are at high risk of being infected or not.
    • Your eye doctor may use a special plastic breath shield on the slit lamp machine they use to look into your eyes. They may also wear a plastic shield over their eyes in addition to a mask.
    • Your doctor may ask you to wait to speak until after your eye exam is complete. He or she can then talk with you and answer questions when they can be a safe distance from you.

    As you can imagine, there may be a backlog of patients who postponed care, so you may have to wait for an appointment. Also, the additional precautions required in operating rooms will likely result in fewer surgeries performed each day.

    "Ophthalmologists are doing everything possible to ensure patients are comfortable with the updated processes and techniques. We recognize these are challenging times, but those challenges must be balanced with your needs as a patient," said Amin Ashrafzadeh, MD, CAEPS President and a  Cornea and Refractive Surgery specialist practicing in Modesto.

    “Our primary responsibility as physicians is to our patients’ safety and health,” said Dianna Seldomridge, MD, clinical spokesperson for the AAO. “It’s the core of the medical profession. If you have questions or concerns about coming into the office, give your ophthalmologist's office a call. As always whatever is done will be guided by what’s best for you.”

  • April 01, 2020 12:00 AM | Craig H Kliger MD (Administrator)
    In this time of national pandemic, experts say guarding your eyes — as well as your hands and mouth — can slow the spread of coronavirus. Read an article from the American Academy of Ophthalmology's EyeSmart site that describes why it's important to protect your eyes during the coronavirus disease 2019 (COVID-19) pandemic, and five ways you can help yourself and others.
  • February 01, 2020 12:00 AM | Craig H Kliger MD (Administrator)

    Age-related Macular Degeneration (AMD) is one of the leading causes of blindness over age 50, affecting about 2.1 million people nationwide. Early diagnosis and treatment are the keys to preventing vision loss.CAEPS and the American Academy of Ophthalmology (AAO) are therefore educating the public about the facts on AMD. 

    AMD is a degenerative disease that happens when part of the retina called the macula is damaged. It’s the part of the eye that delivers sharp, central vision needed to see objects straight ahead. Over time, the loss of central vision can interfere with everyday activities, such as the ability to drive, read, and see faces clearly.

    Ophthalmologists – physicians who specialize in medical and surgical eye care – have more tools than ever before to diagnose the disease earlier, and to treat it better. But these advances cannot help patients whose disease is undiagnosed, or patients who are unaware of the seriousness of their disease. People’s lack of understanding about AMD is a real danger to public health. A recent study showed that most people with AMD don’t realize it’s a chronic health issue that requires regular attention for the rest of their lives. 

    Both Academies offer these seven steps to help people take control of their eye health:

    • Get regular comprehensive medical eye exams. AMD often has no early warning signs, so getting regular comprehensive eye exams from an ophthalmologistis critical to diagnosing and treating the eye disease in its early stages. Both CAEPS and the AAO recommend that adults with no signs or risk factors for eye disease get a baseline eye disease screening at age 40 — the time when early signs of disease and changes in vision may start to occur. By age 65, the recommended exam frequency is every one to two years, even in the absence of symptoms or eye problems.
    • Quit smoking. Numerous studies show smoking increases the risk of developing AMD, and the speed at which it progresses. Smokers are twice as likely to develop macular degeneration compared with a nonsmoker.
    • Eat a well-balanced dietMany studies demonstrate that eating a diet rich in fruits, vegetables, and nutrient-packed foods, such as salmon and nuts, may reduce the risk of AMD. Researchalso suggests that patients who ate fresh fish, an important source of omega-3s, were at lower risk of developing AMD.
    • Take the right kind of vitamins. Vitamins can delay progression of advanced AMD and help people keep their vision longer if they have intermediate AMD or advanced AMD in one eye. But make sure it’s the right combination of vitamins. A recent study found that some of the top-selling products do not contain identical ingredient dosages to eye vitamin formulas proven effective in clinical trials.
    • Exercise regularlyExercising three times a week can reduce the risk of developing wet AMD by 70 percent. Studies also show that physical activity may lower the odds of both early and late-stages of AMD.
    • Monitor your sight with an Amsler Grid. This simple, daily routine takes less than one minute and can help people with AMD save more of their vision. Using this grid is essential to finding any vision changes that are not obvious, so you can report them to your ophthalmologist.
    • Know your family’s eye health history. If you have a close relative with AMD, you have a 50 percent greater chance of developing the condition. Before your next eye exam, speak with your family about their eye health history. You may need more frequent eye exams based on your family history.

    “Most people understand the importance of annual medical examinations," said Rahul N. Khurana, MD, Immediate Past President of CAEPS, and a clinical spokesperson for both CAEPS and the AAO. “However, we often forget that our eyes also need regular evaluation by a medical doctor. Degenerative diseases, such AMD, can now be successfully treated, but early detection is imperative to avoid lasting consequences."

    To learn more ways to keep your eyes healthy, visit the American Academy of Ophthalmology’s EyeSmart® website.

  • September 01, 2019 12:00 AM | Craig H Kliger MD (Administrator)
    According to a national survey released by the American Academy of Ophthalmology (AAO), nearly two out of three American adults report having eye or vision problems. A significant percentage of them, however, fail to seek medical attention in the form of regular, sight-saving eye exams. In observance of Healthy Aging Month in September, The California Academy of Eye Physicians and Surgeons joins the AAO in emphasizing the importance of having regular eye exams to maintain healthy eyes and vision.

    Some of the more common age-related eye diseases include
    age-related macular degeneration, cataract, diabetic retinopathy and glaucoma. Early detection and treatment of these conditions can help to save sight before vision loss occurs. Ophthalmologists – the physicians that specialize in medical and surgical eye care – recommend a dilated comprehensive eye exam as the best way to prevent these conditions from becoming debilitating.

    U.S. Adults Do Not Get Eye Exams as Often as Recommended
    The survey results emphasize a need for more education about the importance of medical eye exams. Findings showed that 64 percent of adults had at least one or more of the following issues with their eyes or vision:

    • difficulty seeing at night;
    • blurry vision;
    • reading up close;
    • flashes of light;
    • red, watery eyes; and,
    • double vision.

    Despite experiencing some level of impairment, only 13 percent admitted they had been seen by an ophthalmologist.

    How Often Do Adults Need Eye Exams?
    Both Academies recommend that a healthy adult get a baseline eye exam at age 40, even if they have no history of eye problems or eye disease. Those who have chronic conditions, such as diabetes or high blood pressure, may require more frequent exams.

    "Sight is precious, and catching problems early can make a big difference in maintaining vision for the long term, says Rahul N. Khurana, MD, a retina specialist and CAEPS President.

    Those over age 65 who may be concerned about cost or lack of health insurance, the AAO’s EyeCare America program offers eligible seniors a comprehensive eye exam and up to one year of treatment at no out-of-pocket cost.

    To learn more ways to keep your eyes healthy, visit the AAO's  EyeSmart® website.
  • February 01, 2019 12:00 PM | Craig H Kliger MD (Administrator)

    One in four Americans age 65 or older has diabetes, putting them at increased risk for vision loss and blindness. Fortunately, diabetes-related vision loss is largely preventable with regular care. Yet studies have found a majority of Medicare beneficiaries with diabetes do not get the necessary eye exams despite the fact that the exams could be covered under their existing insurance.

    Image showing features of diabetic retinopathy

    The California Academy of Eye Physicians and Surgeons (CAEPS) and the American Academy of Ophthalmology (AAO) are reminding older Americans with diabetes that they should obtain these critical eye exams each year.

    “When it comes to diabetes-related vision loss, the good news is it is largely preventable. Unfortunately, many seniors in California are simply not aware that they need these eye exams,” said Rahul N. Khurana, MD, CAEPS president. “We are encouraging seniors—indeed, all Californians with diabetes—to take a minute to think about whether they have had an exam within a year, and if not, to make an appointment as soon as possible.”

    Both type 1 and type 2 diabetes can affect the small blood vessels in the eyes, causing them to leak and grow irregularly. This leads to vision loss if left untreated. This condition is known as diabetic retinopathy and affects about 30 percent of people living with diabetes. It can also lead to other blinding ocular complications, such as diabetic macular edema. In this disease, the macula—the part of the eye responsible for detailed vision—swells, damaging vision and leading to blindness. Risk for these complications increases with age and duration of diabetes.

    To prevent diabetes-related vision loss, both Academies recommend people with diabetes get a dilated eye exam each year. Getting these exams can help prevent 95 percent of this type of vision loss. The exams are performed by ophthalmologists—physicians that specialize in medical and surgical eye care—and optometrists. For those with Medicare, because plans vary, people with diabetes should talk with their primary care doctor to determine the best process for setting up an eye exam. Those with Medicare Advantage may have different benefits from those with only Medicare Part B, which is traditional Medicare. Those with commercial insurance would need to check their specific policy.

    Comprehensive eye exams include putting dilating drops into the eyes to help the pupil expand. This allows a better view of the retina—the light-sensitive tissue lining the back of the eye—and makes it easier to see early signs of diabetic retinopathy. Cameras may also be used to record any disease progression. These special cameras include a microscope to get close-up images of the retina.

    These eye exams allow early detection, monitoring and, if needed, treatment of diabetic eye disease. This can prevent unnecessary vision loss, enabling people with diabetes to continue to live full and productive lives. Such exams also allow checking for conditions such as glaucoma and cataracts, for which people with diabetes are at an increased risk.

    “It is essential for people with diabetes to get eye exams every year,” said Rahul N. Khurana, MD, a clinical spokesperson for the American Academy of Ophthalmology, a member of the CAEPS Board of Councilors, and a retina specialist. “Sometimes my patients are surprised to find that Medicare or other insurance covers these sight-saving exams, which are simply one of the best steps a person can take toward preventing vision loss.”

    For those with Medicare, the program covers 80 percent of the cost of eye exams for people with diabetes and the remaining 20 percent is typically paid for by the patient. If this cost is a concern, EyeCare America may be able to help. This is a public service program of the Foundation of the American Academy of Ophthalmology. It can help older Americans get a comprehensive eye exam and up to one year of care at no out-of-pocket cost. Learn more or see if you or your loved one qualifies at www.eyecareamerica.org. 

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