Congenital optic disc anomalies are uncommon causes of vision loss that may be recognized shortly after birth but may also be identified in later childhood and sometimes well until adulthood. They may be unilateral or bilateral and isolated or associated with other systemic findings. In some conditions the origin of the developmental abnormality is understood as in the case of optic disc colobomas resulting from failure of closure of the embryonic fissure whereas in others the cause is hypothetical. Recognition of these anomalies is usually by direct observation though ancillary testing may aid in the diagnosis. Understanding the spectrum of congenital optic disc anomalies can help the clinician with diagnosis and treatment, counsel the patient and their family regarding prognosis, and to recognize when further evaluation is indicated.

A comprehensive review of the initial 25-year experience of Ophthalmic Mutual Insurance Company claims in the field of pediatric ophthalmology and strabismus was reported in 2015. The current report is a retrospective analysis of 28 new closed claims arising from 22 cases in the decade since that study. The frequency of claims declined during the study period, although claim severity continued to be high. Successes and new areas for risk management were identified. Ophthalmologists may use this information to supplement the findings of the prior study to improve quality of care for patients in this population.

PURPOSE:North Carolina Macular Dystrophy (NCMD) and Best Vitelliform Macular Dystrophy (BVMD) are rare autosomal dominant macular dystrophies. Both BVMD and NCMD have markedly variable expressivity. In some individuals, it can be difficult to differentiate between the two disease entities.METHODS:Clinical findings including fundus photography, fundus autofluorescence (FAF), and spectral domain optical coherence tomography (SD-OCT) were evaluated in 5 individuals with NCMD and 3 with BMD. Electrooculography (EOG) was performed in 2 NCMD subjects. Molecular diagnosis was performed using Sanger DNA sequencing. IRB approval was obtained.RESULTS:Five NCMD subjects had clinical findings indistinguishable from three of our BVMD subjects. Molecular diagnosis was confirmed in all but one BVMD subject who had an abnormal EOG prior to discovery of the BEST1 gene. Two NCMD subjects had an abnormal EOG with a normal ERG, which has been considered a unique feature of BVMD. SD-OCT in one BVMD subject demonstrated a small lucency/excavation into the choroid similar to that in grade 3 lesions of NCMD. Two NCMD subjects had elevated sub-macular lesions giving a pseudo-vitelliform appearance on OCT similar to BVMD.CONCLUSION:Best Vitelliform Macular Dystrophy can be a phenocopy of NCMD. There is considerable clinical overlap between NCMD and BVMD, which can cause diagnostic inaccuracies. Our new findings demonstrate that like BVMD, NCMD can also have an abnormal EOG with a normal ERG. The overlapping phenotypes of BVMD with NCMD may provide insights into the mechanisms of the macular changes.

Purpose: The phenotype of North Carolina macular dystrophy (NCMD) is highly variable and remains poorly appreciated and understood, often causing misdiagnoses in isolated cases. One of the features of NCMD is the general lack of progression despite its original name, "dominant progressive foveal dystrophy," as reported in 1971 by Lefler et al (W.H.L.). The purpose of this study was to report the long-term follow-up of this condition.Design: Systematic, longitudinal, and detailed documentation along with the imaging of the peripheral retina.Subjects: We reexamined 27 of the original family members with NCMD in an office setting 30 to 50 years after they were first reported. Methods: The evaluation of all the affected subjects included best-corrected visual acuity (BCVA), slit-lamp and dilated-fundus examinations, wide-field fundus and autofluorescent photography, and spectral-domain OCT (SD OCT). Blood was collected for DNA extraction, banking, and sequencing.Main Outcome Measures: Best-corrected visual acuity, slit-lamp and dilated-fundus examinations, wide-field fundus and autofluorescent photography, and SD OCT.Results: The 27 subjects examined were a part of the original family with NCMD that was initially reported in 1971. A point mutation (NC_000006.11:g.100040906G>T) (Hg19) in a noncoding region of a deoxyribonu-clease I hypersensitivity binding site was found in all the affected subjects. Nine subjects were the affected children of those originally examined 30 to 50 years ago by Kent W. Small (K.W.S.) and W.H.L., and the remaining 17 subjects (34 eyes) had been examined 30 years previously by K.W.S. Of these 17 subjects (34 eyes), 4 of 34 (11%) eyes showed worsening of vision and evidence of fibrosis due to choroidal neovascular membranes (CNVMs). Fourteen of the 27 (51%) patients showed peripheral retinal drusen, which did not seem to correlate with the severity of the macular disease.Conclusions: Most patients with NCMD have stable vision and fundus findings throughout their lives. The ones who experienced BCVA decline did so because of the apparent evidence of CNVMs. Patients with grade 2 NCMD seem to be at an increased risk of further or progressive vision loss due to CNVMs. Intravitreal therapy with vascular endothelial growth factor inhibitors may benefit these patients if they are treated in a timely fashion. Peripheral retina drusen of varying degrees of severity were found in slightly more than half of the affected subjects. Ophthalmology Retina 2022;6:512-519 2022 by the American Academy of Ophthalmology

From getting started to retirement, pediatric ophthalmologists face scores of strategic decisions that influence their practices' effectiveness. In this workshop, experienced pediatric ophthalmologists will dissect practice life into the three phases of start-up, growth and retirement.

Determining whether a doctor-patient relationship exists is an important issue in medical professional liability cases as this relationship creates a duty to care for the patient. If there is no relationship, there can be no malpractice. In most situations, establishing this relationship is clear cut though in some cases the existence of a relationship is ambiguous and can even result in a claim being filed when the physician has not examined the patient. A lack of understanding of this relationship has resulted in professional liability claims and, in some cases, patient harm.

Pediatric ophthalmologists are finding it increasingly challenging to maintain profitability in their practices.

Retinopathy of prematurity (ROP) screening and treatment require a high level of specialized care, can involve a significant investment of time and travel to neonatal intensive care units, and incur a high amount of liability. As such, ophthalmologists involved in ROP care are increasingly looking to creation of contracts with hospitals to provide appropriate financial remuneration, adequate liability coverage, and strong safety nets to ensure improved patient care.

The purpose of this workshop is to discuss practice management issues specific to pediatric ophthalmology practices in a largely interactive format. Subjects to be covered include coding, benchmarking, human resource concerns, risk management, as well as other practice management topics of concern indicated by attendees. Audience participation is strongly encouraged.

IMPORTANCE There is disagreement as to whether Maintenance of Certification is creating value for physicians and their patients. To our knowledge, this report provides the first measures of the effectiveness of Part 4 of this activity in assisting ophthalmologists with quality improvement in their practices.OBJECTIVE To evaluate the effectiveness of the American Board of Ophthalmology's quality improvement program-Maintenance of Certification Part 4 (Improvement in Medical Practice)-in assisting its diplomates with quality improvement in their practices.DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis was conducted of the performance of 1046 American Board of Ophthalmology diplomates on Practice Improvement Modules between September 1, 2012, and December 31, 2014. The mean baseline scores for each process or outcome measure on a medical record abstraction were calculated before and after the practice improvement activity. Paired t tests were used to assess improvement before and after the activity. Diplomates' comments and ratings of the usefulness of the activity in assisting them with quality improvement were also analyzed.MAIN OUTCOME MEASURES Diplomate performance on process and outcome measures before and after a performance improvement activity and diplomate satisfaction that the activity met the stated goals of assistance with quality improvement in their practices.RESULTS The 1046 American Board of Ophthalmology diplomates completed 1408 Practice Improvement Modules. When measures with participation by at least 20 diplomates were analyzed, there was improvement in 24 of 30 individual process measures (80.0%; 95% CI, 61.4%-92.3%) and in 7 of 18 individual outcome measures (38.9%; 95% CI, 17.3%-64.3%) chosen for improvement by diplomates. Analysis of the mean results for each diplomate on process measures chosen for improvement showed gains occurring in 9 of 12 modules and, for outcomes chosen for improvement, in 6 of 12 modules with at least 20 participants. A total of 826 of 1115 modules (74.1%) assessed by diplomates were rated from good to excellent; positive comments outnumbered negative ones by a ratio of 5:1.CONCLUSIONS AND RELEVANCE Quantitative and qualitative analyses, while limited by self- report that has not been validated, suggest that the American Board of Ophthalmology's Maintenance of Certification Part 4 can help diplomates improve quality on process, and to a lesser extent, outcome measures. Findings of this study may provide a basis to improve this activity.

Diagnostic error occurs in up to 15% of patients. OMIC conducted an analysis of seven years of malpractice claims, and found that 12% of claims related to diagnostic error. These errors impact pediatric patients and lead to delay in treatment, permanent harm, and professional liability lawsuits. Pediatric ophthalmologists can learn ways to reduce the incidence of these claims.

While Young Ophthalmologists are taught to provide excellent patient care, there is no formal education during residency or fellowship regarding legal issues that ophthalmologists may face during their careers. This workshop provides an introduction to legal and ethical issues that pediatric ophthalmologists may encounter, techniques to limit legal liability and malpractice claims, and how operating within the parameters set by the Academy's Code of Ethics improves patient care and establishes public trust.

Contracts underlie all commercial relationships, including those between physicians and insurers as well as physicians and patients. In an environment where physician reimbursement is under constant scrutiny, proper contracting is essential to the clinical and financial health of all physicians, regardless of their practice type. Effective contracting also affects the ability and efficacy of physicians to serve the patient population in their catchment area.

Although there are a number of benefits of electronic health records (EHR), ophthalmologists are concerned about the costs and potential loss of productivity associated with their use.1Blumenthal D. Stimulating the adoption of health information technology.N Engl J Med. 2009; 360: 1477-1479Crossref PubMed Scopus (541) Google Scholar, 2The Physicians Foundation. 2014 survey of America’s physicians: practice patterns and perspectives. Available at: www.physiciansfoundation.org/uploads/default/2014_Physicians_Foundation_Biennial_Physician_Survey_Report.pdf. Accessed September 25, 2014.Google Scholar The purpose of this study is to report a detailed postimplementation financial analysis of 1 practice's experience with EHR implementation. Data that impacted the incremental cash flows relevant to the implementation of EHR (Medflow) at the authors' practice, Asheville Eye Associates, was collected for 2006, the last year the practice used paper records, and between 2007 and 2011, the first 5 years after implementation of EHR, in a prospective fashion. Asheville Eye Associates is a private multisubspecialty ophthalmic practice that had 10.8 full-time equivalent (FTE) providers (11 ophthalmologists and 2 optometrists) practicing in 3 locations at the beginning of the study. All providers had been in practice for ≥3 years in the community and had full clinic schedules based on each provider's template at the initiation of the study. The provider population remained stable with the exception of 1 optometrist who left the practice in 2009 and was replaced by another optometrist and 1 part-time medical ophthalmologist who retired from practice at the end of 2010. The incremental cash flows for the first 5 years of implementation are shown in Table 1. Details related to each category of cash flow are provided in Table 2 (available at www.aaojournal.org).Table 1Incremental Revenues and Expenses Implementation Years 1–5Revenues VariancesYear 1Year 2Year 3Year 4Year 5ProductivityA Change in provider productivity (patients per day)−0.410.000.000.001.23B Average revenue/patient/year$155.83$154.84$164.58$189.50$195.46C Days worked per year240240240240240D Total number of providers10.8010.8010.8010.8010.20E Total physician productivity (A × B × C × D)$(165 604)$0$0$0$588 538F Incremental optical revenues$268 347$385 732$349 669$244 795$216 093G Total productivity (E + F)$102 743$385 732$349 669$244 795$804 631Improved collectionsH Charge capture$0$0$0$0$50 322I Billing efficiency$(148 000)$0$0$0$113 425J Total improved collections (H + I)$(148 000)$0$0$0$163 747Meaningful use incentivesK Meaningful use payment per provider (Medicaid)$0$0$0$0$21 250L Number of providers achieving meaningful use$0$0$0$02M Total meaningful use incentives (K × L)$0$0$0$0$42 500Staffing variancesN Total FTE staff reductions (from Table 3)$(108 003)$(142 945)$(310 193)$(540 820)$(594 279)O IT staff$69 600$69 600$69 600$69 600$69 600P Staff scanning expenses$5682$5801$6002$6797$6720Q Total staffing variance (N + O + P)$(32 721)$(67 544)$(234 591)$(464 423)$(517 959)Supply costR Total clinical charts per year$(83 100)$(84 307)$(84 044)$(85 746)$(87 449)S Printing of records$13 208$5188$5243$4942$5148T Electronic claims$0$0$0$0$(25 170)U Patient statements$0$0$0$0$(92 648)V Total supply cost (R + S + T + U)$(69 892)$(79 119)$(78 801)$(80 804)$(200 119)Maintenance expenseW Annual maintenance expense$2412$50 262$50 262$54 612$54 612Variable optical expenseX Total variable optical expense$115 550$157 764$166 408$112 851$96 702Depreciation/interest expenseY Depreciation$141 013$198 557$82 980$45 289$22 700Z Interest expense (financing)$25 013$20 486$15 733$10 742$5502AA Total operating cash flow (G + J + M) - (Q + V + W + X + Y + Z)$(226 631)$105 326$347 679$566 529$1 549 441AB Net operating cash flow (AA - AG)$(128 613)$ 60 036$199 046$324 338$887 055FinancialsAC Initial cost of EHR/PMS hardware/software: $500 250AD Net salvage value (10% of initial hardware purchase) ($225K × 0.10)$0$0$0$0$22 500AE Federal tax rate35%35%35%35%35%AF State tax rate8.25%8.00%7.75%7.75%7.75%AG Total taxes (AE + AF) × AA$(98 018)$45 290$148 633$242 191$662 386AH Inflation Rate (CPI-U Avg-Avg)2.8%3.8%-0.4%1.6%3.2%AI Net cash flow (AB + Y + AD)$12 400$258 593$282 026$369 627$932 255AJ Net cash flow (inflation adjusted)$12 062$242 341$265 362$342 310$836 588EHR = electronic health record; FTE = full-time equivalent; PMS = practice management system. Open table in a new tab EHR = electronic health record; FTE = full-time equivalent; PMS = practice management system. Provider productivity changes specific to the initiation and implementation of EHR as a result of changes in physicians' schedule templates were recorded by physician for each year relative to 2006. The schedule for the initial 7 providers who underwent EHR implementation was reduced in the first month. After the first month of implementation, all schedules were returned to the baseline. The remaining 6 providers had no reduction in their schedules. Schedule reduction in the first month resulted in an average decrease in productivity of 0.41 patients per day for the first year of implementation. In years 2-4, there were no changes in the physicians' schedules. In year 5, there was a net annual increase in productivity for the entire group of 1.23 patients per day as familiarity with the EHR grew and a greater proportion of patients were returning patients, which reduced the amount of new data entry. Actual productivity changes (number of patients seen per day) closely mirrored changes in providers' schedule templates. Provider productivity is a sensitive factor in the return on investment of EHR, because small changes can result in significant changes in annual revenue. Other factors which impacted revenues are shown in Table 1. Incentive payments related to the Medicare and Medicaid EHR incentive programs were relatively small because the study period, for the most part, predated this program. The greatest positive cash flows among expenses related to the net reduction in staffing as a direct result of changes in processes related to EHR. These changes were progressive and cumulative during the course of the study period and resulted from reductions in staffing in the areas of medical records, transcription, billing, check-out, and appointment scheduling (Table 3, available at www.aaojournal.org). Increases in incremental expenses were related primarily to addition of information technology staff, EHR maintenance costs, scanning of paper medical records, and increased printing costs in the initial phase of implementation. The incremental net cash flows for each year relative to the base year of 2006 are shown in Table 1. The return on investment multiple measured 3.71. The payback period was 2 years and 10 months. When 5-year cash flows were discounted by the inflation rate, the net present value was $1 198 414 or $112 211 per FTE provider and was $1 024 275 or $95 906 per FTE provider with a 5% discount rate, the cost of capital (mean FTE providers over study period = 10.68). The internal rate of return on the investment was 41%. This study reports the actual financial results of EHR implementation. Postimplementation audits are not performed commonly after a capital acquisition, although a number of benefits may accrue. First, the organization that performs such a study will improve its forecasting skills for future projects, and second, operations on the project under consideration often improve as the organization attempts to realize the gains anticipated from the project and looks for reasons for negative variances and seeks to remedy those variances. These studies are not performed more frequently because those who recommended the project may have moved on to other departments or organizations, the analyses are time consuming, and the results of the capital acquisition are often difficult to isolate from those of the organization as a whole. Nonetheless, the benefits to medical practices contemplating significant capital acquisitions in an era of increasingly constrained resources may be significant, and it has been suggested that organizations that do so tend to be more successful.3Horngren C.T. Sundem G.L. Stratton W.O. Introduction to Managerial Accounting.12th ed. Prentice Hall, Upper Saddle River, NJ2002: 461Google Scholar This report demonstrates that an EHR can produce financial and operational benefits in a large, single-specialty, multioffice ophthalmic practice over a 5-year period. Although the generalizability of the results may be limited, because each implementation will have a different impact depending on the specifics of each practice, this report provides a methodology all practices can use in thinking about the return on this significant capital investment.4Adler-Milstein J. Green C.E. Bates D.W. A survey analysis suggests that electronic health records will yield revenue gains for some practices and losses for many.Health Affairs. 2013; 32: 562-570Crossref PubMed Scopus (44) Google Scholar, 5Miller R.H. West C. Brown T.M. et al.The value of electronic health records in solo or small group practices.Health Aff. 2005; 24: 1127-1137Crossref PubMed Scopus (174) Google Scholar Furthermore, we emphasize that the introduction of EHR was not by itself responsible for the positive financial returns but rather because it was seen as an opportunity to examine workflow efficiency continuously over the 5-year period. A key factor in the outcome included physician and staff engagement, training, and workflow changes, which resulted in significant net staff reductions. Physician productivity is a sensitive factor in the analysis of financial returns and should be maintained in the early phases of implementation. Improved efficiencies and productivity, which occurred during the latter part of the implementation period, contributed to the positive return. It will be important that vendor software upgrades facilitate and future regulatory requirements related to EHR minimize impacts on productivity to avoid negatively impacting the return on investment for practitioners. Table 2Detailed Description of Incremental Revenues and ExpensesRevenues VariancesProductivityA Change in Provider Productivity (Patients per day)Provider productivity changes specific to the initiation and implementation of the EHR as a result of changes in providers' schedule templates were recorded by provider for each year relative to 2006. The schedule for the initial 7 providers who underwent EHR implementation was reduced in the first month. After the first month of implementation, all schedules were returned to the baseline. The remaining 6 providers had no reduction in their schedules. The reduction in productivity in the first month was due to a reduction in provider schedules secondary to EHR implementation and resulted in an average reduction in productivity of 0.41 patients per day for the first year of implementation. In years 2-4 there were no changes in the physicians' schedules. In year 5, efficiency gains allowed 3 FTE providers to increase their schedule template, while one decreased the template and the remainder had no change. These changes resulted in a net annual increase in productivity for the entire group of 1.23 patients per day (Row A). The net incremental increase in productivity was factored by the average revenue/patient (Row B), days worked in the clinic per year, and number of FTE providers (Row D) to arrive at the annual incremental change in revenues related to provider productivity (Row E)B Average Revenue/Patient/YearC Days worked per yearD Total Number of ProvidersE Total Physician Productivity(AxBxCxD)F Incremental Optical RevenuesImplementation of the EHR resulted in a process change whereby the optical prescriptions were forwarded electronically to the optical department where the patients picked up the prescription. This change in process resulted in an increase in the percentage of optical prescriptions written in the clinic that were filled in the practice's optical department in the main facility from 46% in 2006 to 60%-64% between the years of 2007-2011 and an associated increase in optical revenuesG Total Productivity(E+F)Improved CollectionsH Charge CaptureIn May 2011, with the implementation of a new practice management system, a new process was implemented which involved posting charges in the exam room. At this time it was determined that$50 322 in one diagnostic procedure (A Scan) had been missed in the base year using paper (as well as subsequent years), which was captured using the new process. The coding profile of the practice did not change as a result of EHR implementation. The EHR did not have a functional coding analyzer during the first 5 years of implementation.I Billing EfficiencyThe average days in Accounts Receivable (AR) increased from a steady state of 40.0 days in 2006 prior to the implementation of the EHR/PMS to an average of 51.0 days in 2007 and did not return to baseline until 2008 with an average of 39.5 days. The decrease in efficiency of collections was attributed both to the changes related to a new PMS as well as the strained resources among the billing department staff, which was also assisted in managing the EHR implementation. This resulted in a loss in collections of $148 000 in the first year of implementation which was not recovered. In May of the 5th year of implementation the process change of posting charges from the exam room resulted in a 3-day improvement in the collections of accounts receivable in the amount of $113 425 over an 8-month period.J Total Improved Collections(H+I)Meaningful Use IncentivesK Meaningful Use Payment Per Provider (Medicaid)Two providers, both pediatric ophthalmologists, received EHR “Meaningful Use” incentive payments in the first year of the Medicaid program in 2011. The remaining ophthalmologists began participation in 2012, beyond the time frame of this study.L Number of Providers Achieving Meaningful UseM Total Meaningful Use Incentives(KxL)Expense VariancesStaffing VariancesN Total FTE Staff Reductions (From Table 3)Positive cash flows as a direct result of changes in processes related to EHR were due to reductions in staffing in the areas of medical records, transcription, billing, check-out and appointment scheduling. In 2011, a change in PMS created an interface between the PMS and the EHR allowing technicians to post charges and make follow-up appointments in the exam rooms. This allowed the elimination of 5 billing positions (posting and billing) and 3 check-out positions. This process change resulted in claims being submitted within 24 hours (98% clean) compared to greater than 72 hours (71% clean) prior to 2011. The improved clean claims ratio also resulted in a need for less billing staff. Negative cash flows were related to expenditures to scan entire paper records primarily using a separate server and software (PC Archiver) and to a limited extent into the EHR. Other additional staff expenses included the addition of 1.5 FTE information technologists and $7500 for staff training allocated to the first year of operation. The IT specialists were employed to manage the system for the duration of the study period (row O). These individuals managed on-site hardware, communicated with the vendor regarding software, performed daily back up of the data, and managed the network.O Information Technology (IT) StaffP Staff Scanning ExpensesQ Total Staffing Variance(N+O+P)Supply CostR Total Clinical Charts per YearThe supply cost of a new paper medical record was $1.95. The annual cost savings was obtained by multiplying this figure by the number of new patient visits per year.S Printing of RecordsIn the early phases of implementation, all physicians would have a copy of the technician evaluation printed for review prior to entering the examination room. In time, the majority of physicians would either preview the record electronically prior to entering the room or view it electronically within the examination room and forego review of a paper report. The extra printing costs associated with this activity (paper and printer ink) are accounted for in this section.T Electronic ClaimsWith an update to a new PMS in year 5, the system allowed claims and payments to be submitted and received electronically which resulted in a savings in paper, printing, and scanning costs. (Row T). Similarly, the new PMS allowed for a process change whereby collection of co-pays and deductibles was performed at check-in resulting in a savings associated with the cost of paper statements (Row U).U Patient StatementsV Total Supply Cost(R+S+T+U)Maintenance ExpenseW Annual Maintenance ExpenseAnnual maintenance expenses are reported including data lines and back-up tapes. Variable Optical ExpenseX Total Variable Optical ExpenseIncremental supply costs were also accounted for to reflect the additional optical revenue (row F) generated from the increased capture rate.Depreciation/Interest ExpenseY DepreciationDepreciation of the initial software and hardware expense was reported for each year (row Y). Payments for the conversion to a new PMS in 2011 did not begin until 2012. Therefore, no depreciation or interest payments are recorded as a result of this purchase.Z Interest Expense (Financing)Interest expense on the bank loan was reported for each year.AA Total Operating Cash Flow(G+J+M)-(Q+V+W+X+Y+Z)AB Net Operating Cash Flow(AA-AG)Capital Expenditure/Salvage Value/Tax and Inflation RatesAC Capital ExpenditureInitial cost of EHR/PMS Hardware/SoftwareAD Net Salvage Value10% of Initial hardware purchase ($225 000)AE Federal Tax RateThe marginal federal and North Carolina state income tax for the individual providers was utilized for this cash outflow in this for-profit limited liability companyAF State Tax RateAG Total Taxes(AE+AF) x AAAH Inflation RateCPI-U Avg-AvgTotal Net Cash FlowsAI Net Cash Flow(AB+Y+AD)AJ Net Cash FlowInflation AdjustedEHR = electronic health record; FTE = full-time equivalent; PMS = practice management system. Open table in a new tab Table 3Staff SavingsSavings in Positions PositionYear 1Year 2Year 3Year 4Year 5 Medical Records311 Transcription1110.5 Billing32 Check In/Check Out3 Appointment Scheduling3 Total41572.5Average Salary and Benefits PositionYear 1Year 2Year 3Year 4Year 5 Medical Records$82 047$27 442$27 442$0$0 Transcription$33 456$0$33 456$33 456$16 728 Billing$0$0$0$100 368$36 731 Check In/Check Out$0$0$0$96 803$0 Appointment Scheduling$0$0$106 350$0$0 Additional Training (Overtime)$(7500)$0$0$0$0 Total41572.5Cumulative Average Salary and Benefits PositionYear 1Year 2Year 3Year 4Year 5 Medical Records$82 047$109 489$136 931$136 931$136 931 Transcription$33 456$33 456$66 912$100 368$117 096 Billing$0$0$0$100 368$137 099 Check In/Check Out$0$0$0$96 803$96 803 Appointment Scheduling$0$0$106 350$106 350$106 350 Additional Training (Overtime)$(7500)$(7500)$(7500)$(7500)$(7500) Total$108 003$135 445$302 693$533 320$586 779 Open table in a new tab EHR = electronic health record; FTE = full-time equivalent; PMS = practice management system.

To improve physicians’ skills in handling difficult situations in clinical practice.

We are rapidly moving from a reimbursement system that pays for volume (fee-for-service) to one that pays for value. This means that physicians are increasingly rated according to the costs and quality of their care. The Physician Quality Reporting System (PQRS) is expanding with the move to value-based purchasing. Meanwhile, large-scale registries (such as the AAO IRIS Registry) are providing unprecedented opportunities for access to clinical data that may be used for quality measurement. These trends are critical for pediatric ophthalmologists to understand. The purpose of this workshop is to discuss these topics, including ongoing work by AAO and AAPOS on developing quality measures for pediatric ophthalmology and strabismus.

PURPOSE To summarize the claims statistics of the Ophthalmic Mutual Insurance Company (OMIC) in the field of pediatric ophthalmology and strabismus (POS).METHODS Internal OMIC case summaries and defense counsel case evaluations of all claims in the field of POS closed between December 1, 1988, and February 19, 2013 were retrospectively analyzed.RESULTS A total of 140 claims were closed over the 25-year study period, of which 44 were closed with an indemnity payment. Claims related to strabismus and retinopathy of prematurity (ROP) were most common, and claims related to ROP resulted in the highest indemnity and expense payments. Issues related to follow-up represented the most significant risk factor among system-related claims.CONCLUSIONS Claims in pediatric ophthalmology and strabismus were infrequent but associated with three times higher average indemnity payments relative to all claims paid by OMIC during the course of the study.

The purpose of this presentation is to present financial data gathered by a survey of AAPOS members. This will be the fourth consecutive year that key metrics for a successful pediatric ophthalmology practice have been evaluated and discussed. Each year, the survey continues to be refined and new metrics added.

Summarize material to be presented at the workshop : This workshop will present an analysis of 25 years of claims related to pediatric opthalmology and strabismus. Frequency, severity (money paid to settle), causes, and trends will be explained. Key lessons on how to improve patient safety and reduce the likelihood of successful claims will be shared.