Northern Sights Newsletter

Vol. 22 Issue 6 November/December 2010

North Dakota NDOA’s 2010 BOARD OF DIRECTORS Optometric Association 921 South 9th Street, Ste. 120 Bismarck, ND 58504 Phone: 701-258-6766 Fax: 701-258-9005 E-mail: [email protected] WebSite: ndeyecare.info

2010 NDOA OFFICERS

Dr. James Helmers President President President Elect Vice President Secretary/Treasurer Past President 113 3rd Ave. NW Dr. Bob Nyre Dr. Todd Metzger Dr. Taya Patzman Dr. Paul Dunderland Dr. James Helmers Mandan, ND 58554 701-663-2020 [email protected] Incoming President’s Message ~Dr. Bob Nyre Dr. Robert Nyre President Elect 10 1st Street SW meibomian gland dysfunction in dry Minot, ND 58701 G reetings to my fellow NDOA eye. MGD is the new emphasis in 701-852-2020 members : causation and may lead to some [email protected] interesting treatments like meibomian I want to thank you again for your Dr. Todd Metzger gland expression, hot packs, and allowing me to be involved in your Vice President different emphasis on tear association management for another 1702 South University Drive supplements. Keep an eye on your year. This just goes to prove recycling Fargo, ND 58103 journals for more updates. [email protected] is alive and well in North Dakota. I want to give a personal and Thankfully it is just about time for the Dr. Taya Patzman association thank you to our staff in election. It is always great to get this Secretary/Treasurer Bismarck for another great meeting. Continued on Page 3 1830 East Century Ave. Ste. 1 Bismarck, ND 58504 Nancy and Tracy work hard to set up Inside This Issue and run these meetings, and they 701-222-1140 Incentive Payment Update for usually do it at profit for the [email protected] 2009 Physician Quality association. Reporting Initiative Dr. Kris Engstrom Past President Right after the NDOA’s Annual Thank You NDOA-PAC Meeting, I took a trip to Vision Expo 4731 13th Ave. South Antitrust Do’s & Don’ts Fargo, ND 58103 in Las Vegas. It’s a tough job, but 701-281-2746 someone has to be there. I actually Co-Payment Changes for [email protected] took a group of courses while I was Medicaid

there and I keep getting more AOA State Legislative Meeting Nancy Kopp Executive Director comfortable with the new OCT technology. As a clinical tip we are Now is the Time to Review hearing more and more about Insurance Provider Agreements

Incoming President’s Incentive Payment Update for 2009 Message Continued . . . Physician Quality Reporting Initiative process behind us so we can move forward again. It is unknown at this time, whether the legislative process I ncentive payments for the 2009 Physician Quality will be as important to Optometry, as the regulatory Reporting Initiative (PQRI) are available this fall for process in the next year. I urge you to maintain you, eligible professionals who met the criteria for successful contacts with our legislative officials, as this is always reporting. Carriers and Medicare Administrative worthwhile. But, the new buzzword is access and by Contractors (MACs) began processing and distributing that we mean access to patients in the health care 2009 PQRI incentive payments as of October 25, 2010. plans. The state insurance programs and health and is scheduled to be completed by November 12, exchanges will be forming and we will be watching 2010. this in North Dakota. Thankfully ND eyecare Remember that PQRI incentives earned by individual practitioners have a long history of working together participating physicians and other eligible professionals for the betterment of our patients. We occasionally are paid as a lump-sum to the Taxpayer Identification have spirited discussions on scope, but we have a Number (TIN) under which the professional’s claims complimentary system in place in North Dakota. were submitted. Currently North Dakota has the best economic climate in the United States and this will continue to be a Effective January 2010, CMS revised the manner in positive for us. Eyecare needs Optometry in North which incentive payment information is communicated Dakota and this is our message to the state insurance to eligible professionals receiving electronic remittance exchanges. The NDOA will be monitoring this process advices. CMS has instructed Medicare contractors to for all of us. use a new indicator of LE to indicate incentive payments instead of LS. LE will appear on the Back in the office, I never cease to be amazed by how electronic remit. In an effort to further clarify the type my practice has shifted in the last few years. Although of incentive payment issued, CMS created a 4-digit part of this is my age, the management of AMD and code to indicate the type of incentive and reporting Glaucoma is becoming a major part of what we do year. For the 2009 PQRI incentive payments, the 4-digit daily. In the past I had to refer a great deal of these code is PQ09. This code will be displayed on the cases for dye studies or for evaluation of the nerve electronic remittance advice along with the LE fiber layer. Technology has made a huge difference in indicator. Additionally, the paper remittance advice will all of our days and it is truly adding to my professional read, “This is a PQRI incentive payment.” The year will gratification. not be included in the paper remittance. Respectfully Submitted, Bob Nyre, O.D. 2009 PQRI feedback reports will be available on the Physician and Other Health Care Professionals Quality Reporting Portal (http://www.qualitynet.org/pqri) Words of Wisdom starting the second week of November. TIN-level Kindness is the language which the deaf can hear reports on the Portal require an Individuals Authorized and the blind can see. —Mark Twain— Access to CMS Computer Services (IACS) account. A man who dares to waste one hour of time has not Participants may also contact their Carrier/MAC to discovered the value of life—Charles Darwin request individual NPI-level reports via an alternate I have not failed. I’ve just found 10,000 feedback report fulfillment process (http:// ways that won’t work.—Thomas A. Edison www.cms.gov/MLNMattersArticles/downloads/ Far and away the best prize that life has to offer is the chance to SE0922.pdf). work hard at work worth doing.—Theodore Roosevelt If you have questions about the status of your PQRI I am imagination. I can see what the eyes cannot see. incentive payment please contact your Provider I can hear what the ears cannot hear. I can feel what the heart cannot feel.—Peter Nivio Zarlenga Contact Center. The Contact Center Directory is available on the CMS website at http://www.cms.gov/ A lot of people like snow. I find it to be an MLNProducts/Downloads/CallCenterTollNumDirectory.zip unnecessary freezing of water.—Carl Reiner or contact the QualityNet Help Desk. The Help Desk is

A mistake is simply another way of available Monday - Friday from 7:00 a.m. – 7:00 p.m. doing things.—Katharine Graham at 1-866-288-8912 or via [email protected].

Northern Sights November/December 2010 Page 3

From The Desk Of Your Executive Director ~ Nancy Kopp

is limited. To date, it has been reported that 67,000 T he leaves have fallen, a few citizens of North Dakota do not have any kind of snowflakes, but definitely not private or public health insurance coverage. It means the sky in North Dakota! In more than 10% of people in North Dakota rely on comparison to other states, our emergency rooms to get basic and critical medical care. economy and optometry Will Obamacare offer coverage to these people? If so, remains strong. who will foot the bill? We’ll keep an eye on the emerging details of implementation or repeal . . . The NDOA Annual Congress in Bismarck, September 30– For your information, the North Dakota Public October 2, was again an astounding success! Over 80 Employees Retirement System has awarded a new OD’s and 20 exhibitors attended our annual event. vision plan contract to Superior Vision. In the past, Thank you for supporting the state events. Your Ameritas provided vision benefits. Superior Vision’s participation truly does contribute to the financial plan includes In-Network providers, as well as Out-of- stability of your NDOA. This year we did not provide Network. Participation in this plan, or any other plan for education for your staff members, outside of the that matter, is a business decision only you can make. Children’s Vision and Learning Summit. The reason Dr. Chuck Brownlow has provided you with some behind the decision, was that in past years we could insight in an article on page 9 of this newsletter. only attract approximately 20-25 para’s to attend. It is In the last month or so, I’ve done quite a bit of research difficult to lineup good speakers for so few in and negotiation to find a credit card processing attendance. If you have suggestions on how to provide company for the association office, that offers better quality education and attract more to attend, please pricing than we currently have at 3.6%, plus fees. contact me. Sooner is better than later. Enclosed, you will find a flyer on BNG Holdings out of 2011 will be a great year! As you know our very own Fargo, which the NDOA has partnered with, to provide Dr. Dori Carlson of Park River, will ascend to the credit card processing. This partnership will reduce our office of president of the American Optometric expenses quite a bit. This company also will pass along Association. I for one am so darned proud to have Dori a residual to the NDOA, for every member who serve as AOA’s first female and North Dakota’s first participates in the program. The plan will save you optometrist as President. She will be installed June 18, money and can provide enough of a cost savings, to 2011 at AOA’s Annual Congress in Salt Lake City, cover your annual NDOA membership dues. I would Utah. Please make every effort to attend and proudly encourage you to consider participating . All take part in the grand march. In addition, a celebration information submitted is held in strict confidence. of Dori’s accomplishment is being planned for July As this will be our last newsletter of the year, I wish 30th in Park River. A number of out of state AOA you and your families a very happy holiday season. members are planning to attend and I hope that a good number of NDOA members will come for the fun, As always, if you have any questions, concerns or food and friends! suggestions, do not be bashful. We are here to serve your chosen profession of optometry. The most popular buzz word of recent months seems to be “Health Care Reform”. What shape it will take either on a state or national level, is yet to be Mark your calendars to attend determined, as to the effects on optometry. The NDOA the NDOA’s Legislative and CE is presently “at the table” in North Dakota. We received a letter today from Insurance Commissioner Conference and Carrot Cake Day Adam Hamm, inviting the NDOA to a healthcare at the Legislature February 17-18, 2011. provider group forum on November 10th, to discuss what critical decisions will have to be made to set the state for implementing the federal health care reform Happy law, during the upcoming North Dakota Legislative Assembly. I do plan to attend. If anyone else is interested in attending, please let me know. Attendance Holidays

Northern Sights November/December 2010 Page 5 Northern Sights November/December 2010 Page 6 NDOA’s 2011 Board of Directors Thank You NDOA Annual Congress Sponsors & Exhibitors! A & A Optical Alcon Laboratories Allergan Barb Neitzke of ASPEX Carl Zeiss CIBA Vision L-R: Dr. James Helmers, Dr. Paul Dunderland, CooperVision Dr. Todd Metzger, Dr. Taya Patzman, Dr. Bob Nyre Essilor Laboratories of America Inspire ISTA Pharmaceuticals Johnson Ophthalmic Equipment Marco ND State University Nidek Soderberg Optical The Guardian Tura 2010 OD of the Year 2010 Employee of the Year VSI Dr. Douglas Nordby Laverne Diede VSP Vistakon Walman Instrumentation NDOA 2009—2010 New Members Walman Optical Dr. Allison Anderson—Williston, ND Dr. Blaine Burdick—Devils Lake, ND Dr. Mike Koeppe—Fargo, ND Dr. Michelle Leidenix—Bismarck, ND Dr. Michael Ranum—Bismarck, ND Dr. Susan Safratowich—Grand Forks, ND

AOA 10 Year Member Awards Dr. Vincent Biesiot—Dickinson, ND Dr. Barbra Brookshire—Fargo, ND Dr. Darin Johnson—Minot, ND Dr. Kristen Kosir—Fargo, ND Dr. Joy Quitberg—Valley City, ND

AOA 25 Year Member Awards Dr. Dori Carlson—Park River, ND Dr. James Connelly—Wahpeton, ND Dr. Shari Kensok—Fargo, ND Dr. Tamara Mathison—Jamestown, ND Dr. Tim Tello—Bismarck, ND Dr. Blaine Zieman—Fargo, ND

AOA 50 Year Member Awards Dr. Quentin Zimmerman—Jamestown, ND

AOA 60 Year Member Awards Dr. Roy Douglas—Bottineau, ND Dr. James Gaustad—Grafton, ND

Northern Sights November/December 2010 Page 7 Thank You NDOA-PAC!

Thank you for the campaign contribution. Every piece of I would like to extend my thank you to NDOA-PAC for the puzzle is fitting together and I’m hopeful for a the contribution to our campaign. Your support is successful outcome. Your contribution will go towards appreciated—Nancy Johnson & —Dist. 37 radio.—Margaret Sitte—Dist. 35 Thanks for the contribution towards my Senate Thank you so much for your generous contribution to my re-election campaign. Your support is much appreciated. re-election campaign! I am working hard to return to the The upcoming session will be filled with challenges large ND Senate and continue our work on issues important to and small. Please know that I will make myself available all of us. I appreciate your support.——Dist.13 to hear your goals and or concerns and listen with an open mind—Bob Horne—Dist. 3 Thank you for the financial support to my campaign for re-election to the ND Senate. I truly appreciate it. I look Thank you for the contribution It is appreciated and will forward to working with you in the legislature again.— be used for marketing strategies. I will contact you Sincerely —Dist. 29 regarding any questions relative to healthcare reform and eyecare in ND.——Dist. 31 Thank you for the contribution to my campaign. I am working hard to retain my House seat and look forward Thank you for the support. The race is very close and I to working with you in the upcoming legislative project a win in November. If you need anything , please session.—Brenda Hiller—Dist. 33 feel free to contact me.——Dist. 3

Thanks so much for your generous donation to our re- Thank you for the contribution to my re-election election campaign. We appreciate your support and look campaign. The donation will be used for our testimonial forward to working with you in the upcoming legislative drop on the last Saturday before the election.—Ralph session!— & — Dist. 35 Kilzer—Dist. 47

I would like to extend my thanks for the campaign Thank you for the donation to our campaign fund. By contribution. I really appreciate the support. —Kari working together we have been able to move our state Conrad—Dist. 3 forward in many areas. Again, we wish to sincerely thank you for your support of our campaign efforts.—Bill Thank you for the recent investment in my campaign for Devlin, —District 23 the District 5 House. We are excited for the final few weeks and look forward to a victory in November.—Scott Thank you so much for the financial contribution to Louser—Dist. 5 my campaign. With continued hard work on the

I would like to thank you for your contribution to my campaign trail, I look forward to working with you Senate re-election committee. Your help is sincerely in the next legislative session.——Dist. 43 appreciated. Your contribution will be used for direct Thank you for the donation towards my campaign. mailings and final media expenses this fall. I have been Many costs arise while trying to get information out aggressively campaigning throughout the district as I have done in previous elections. Please call me if you to the people and I plan to use your donation in the have any questions or comments on the campaign or the best way possible. I am looking forward to serving upcoming legislative session. Your continued input is the people in District 7 and the people of North important. ——District 17 Dakota.—Cindy Shattuck—Dist. 7

I want you to know that I am very grateful for your recent I would like to thank the NDOA for the kind gift to contribution to my campaign for. If re-elected, I will my campaign. With a lot of hard work, and your appreciate your continued support in the form of your support, I am confident of a positive outcome on input on the various issues that affect you.—Clark Nov. 2nd.——District 31 Williams—Dist. 25 I would like to thank you for your contribution to my Thanks so much for the contribution to my campaign. I campaign. I appreciate the concerns expressed with look forewarned to working with you on healthcare healthcare reform. I look forward to working with reform—Kathy Hogen—Dist. 21 you in the upcoming legislative season—Dr. Frank Walker—Dist. 23

Northern Sights November/December 2010 Page 8 Antitrust Do’s and Don’ts 1. Impermissible Actions under the Antitrust Laws Educate third party payers on the scope of an ODs practice as authorized by various states. Coordinate with competitors to engage in joint negotiations with third party payers on the Educate third party payers as to the reasons that reimbursement policies. AOA believes having full participation by ODs adds value to the plan. Facilitating concerted action with competitors to increase fees or reimbursement rates. Such Explain to third party payers the reasons that ODs concerted action would include: and ophthalmologists should be provided with the same opportunities within networks and plans. (1) A recommendation by AOA/NDOA that its members withdraw from contracting with a Obtain information from third party payers on third party payer (group boycott); whether the rates for identical procedures within individualized plans for ODs and (2) An AOA/NDOA resolution that its members ophthalmologists are different; and if there is a should not participate in a third party payer’s difference, seek an explanation for that difference. plan or prohibiting members’ participation in the plan; Advise third party payers that reimbursement rates are too low for ODs as compared to (3) An AOA/NDOA recommendation that its ophthalmologists. members not disclose certain patient medical information requested by a third party payer; Lobby state legislatures or other governmental bodies on behalf of the AOA/NDOA’s members (4) The AOA/NDOA members pledging that they for governmental action. will not submit patient information requested by a third party payer; Individual members may take whatever action they deem appropriate, as long as the individual (5) An AOA/NDOA recommendation that its member has made the decision to take that action members protest or challenge every unilaterally and is not taking the action based on a reimbursement made by a third party payer; or collective agreement with competitors. (6) The AOA coordinating the mass resignation of members if the third party payer’s policies are not acceptable. Practice Opportunities Optometrist needed at Prairie Vision Center in 2. Permissible Actions under the Antitrust Laws Wahpeton, ND. Please call Dr. Bill Welder at 701-642-4090 for more information Provide educational information to third party payers regarding the procedures performed by ODs and explain—where appropriate—that such Optometrist needed at Dakota Eye Care in procedures are identical to the procedures of Williston, ND. Please call Dr. Amanda Lee at ophthalmologists. 701-577-2020 for more information.

Educate third party payers on the costs to ODs for Job Seekers providing various procedures. Jason Erhardt Obtain information from third party payers 3699 7th Street NW regarding the justification for the disparities in Coleharbor, ND 58531 reimbursement rates. Phone: 701-400-8677 [email protected] School: SCO, 2011

Northern Sights November/December 2010 Page 9 Co-Payment Changes for AOA State Legislative Meeting Recap Medicaid Women’s Way, Submitted by: Dr. Todd Metzger Medicaid Hospice & Indian Contract Health Services O n October 21-23, I, along with Nancy Kopp and Dr. Dori Carlson, attended the AOA’s State Legislative and Third Party National Conference in Denver, Co. This meeting ecent Federal changes will affect cost sharing for consisted of O.D. representation from all 50 states. R Medicaid members who are receiving Medicaid Dr. Joe Ellis, our current AOA President, opened the Women’s Way, Medicaid hospice services and American conference and gave us, as optometrists and a profession, Indians enrolled in Medicaid who are receiving services three goals that we need to accomplish during this healthcare at facilities under a referral from contract health services reform transition: 1) improved patient access 2) improved (CHS). patient access 3) improved patient access.

Effective July 1, 2010, Medicaid co-payment changes Every discussion and debate, both on a state to state level and include the elimination of co-payments for Medicaid national level, centered on how we, as optometrists, can be at clients receiving services through the Medicaid Women's the “table” during the on going healthcare reform debate so Way and Medicaid hospice programs. This co-payment that we can have equal and non-discriminatory access to elimination affects any type of medical services received, patients in future years to come. As one speaker stated, “If including physician visits, prescriptions, etc. If recipients optometry is not at the healthcare reform table, we will surely were charged co-payment after July 2, 2010, the facility be on the menu.” collecting the co-payment will need to repay the recipient for the co-payment. With approximately 31 million uninsured people available for coverage under healthcare reform in 2014, with the first baby- In addition, the American Recovery and Reinvestment boomers becoming Medicare eligible in 2011 and with 55% act of 2009 (Recovery Act), Public Law 111-5 provides of all current insured people being on a self-insured plan and protections for Indians (enrolled) in Medicaid. Section falling under the proposed Harkin amendment, it is 5006 (a) of the Recovery Act amends sections 1916 and imperative that optometry be at the healthcare reform “table” 1916A of the Act, to preclude states from imposing so that we have access to all these patients. Medicaid premiums or any other Medicaid cost sharing on Indian applicants and participants served by Indian Healthcare reform presents opportunities for our profession Health Services and to assure that Indian Health Services, that are enormous, but so are the upcoming challenges. Our and providers of contact health services (CHS) under a profession has an opportunity to truly define, during referral from and Indian Health Services, will receive full healthcare reform, what optometry is. We have an Medicaid payment. opportunity to safeguard and possibly expand our scope of practice laws. We have an opportunity to secure the “vision/ Retroactive to July 1, 2009, agencies providing services eye health” language in the current healthcare bill. We have to American Indians enrolled in Medicaid and receiving an opportunity to secure, as written, the Harkin amendment, services at facilities under a referral from CHS are not which is to become effective on 01/01/14. What do all of allowed to assess the Medicaid co-payments for the these opportunities have in common? The ability to ensure services delivered through a CHS referral. If recipients that optometry has better access to patients in the future. But were charged co payments after July 1, 2009, the facility make no mistake about it, there are many entities and collecting the co-payment will need to repay the recipient organizations that would prefer to get optometry away from for the co-payment. the “table” and put us on the “menu” as healthcare reform It should be noted that all the co-payment changes above moves forward. do not pertain to recipient liability. Also, these changes I was truly amazed by the work already put forth by the AOA do not bypass the Primary Care Provider program (PCP) in an effort to put our profession at the healthcare reform or the Coordinated Service Program (CSP) rules. “table”. And know that your state association’s leadership is For Women’s Way recipients, because of the recipient partnering with the AOA to make sure that the optometrists number, i.e., WW-000-000, optometrists do not have the of North Dakota have a seat at the “table” as well. ability to call in and check eligibility At the end of healthcare reform, the AOA and NDOA have status for these recipients. They must one common goal: That every optometrist in this state and contact the state office for eligibility nation has full and complete inclusion to patient access with of exam, frames and lenses as 800- parity in reimbursement as to other medical providers. 755-2604 or contact Sara Regner at 701-328-4825. The NDOA, along with your help, will make every effort to ensure that the goal previously mentioned is met. Northern Sights November/December 2010 Page 10 Now is the Time to Review All Your Insurance Provider Agreements

Dr. Ryan Ames and Dr. Charles Brownlow, PMI, LLC.

net income from each patient. Chair cost O ctober is a great time to launch your ‘annual’ analysis is the old stand by for initiating this review of all the agreements you’ve signed with HMOs, process (a Chair Cost Calculator is available medical insurers, and vision plans. Most of the contracts at the AOA website, http://www.aoa.org/ will renew effective January 1, and many of them will x9619.xml), but your consultants should be automatically renew, at the current terms, unless you take able to come up with a more useful and more action to negotiate or resign as a contracted provider. predictive process. Many plans also invite you to submit your current fee schedule before the end of each year, too. If you don’t do It may cost a few bucks, but if it identifies that, you certainly shouldn’t wonder why the adjustments contracts that result in negative net income in the payers’ fee schedule don’t seem to move in concert (which is pretty likely), leading you to eliminate them, it will be well worth it. with your own.

The review process provides several potential benefits to Remember that the money you spend to your practice: become more businesslike will yield benefits First, in order to review the contracts, you first have for years to come as you repeat this process every October! to be able to find them. Don’t be surprised if the search for some or all of the contracts comes up Fourth, apply this process to every new contract that empty or if it takes much longer to locate the comes into your office and don’t sign or renew any contracts than you expect. Doing this every year will contract that does not respect the value of your mean that no contract will have been lost or services, your scope of practice, and national rules misplaced for longer than twelve months. Finding the for coding. contracts, even if you don’t read them, will put you ahead of many of your colleagues in the race to be the ‘Best Optometric Business Person’ contest. Not much competition there, as we know.

Second, you’ll probably find that you are treated as a ‘contracted provider’ by some insurers that you don’t have a contract with. Blue Cross/Blue Shield and its offspring seem to be prone to paying doctors as contracted providers even though no signed contract exists. If you can’t find a contract for an insurer, contact the insurer’s provider relations department and get a copy. If they won’t give you one or say that you don’t need it, contact the Office of the Commissioner of Insurance, as this is probably a violation of the state’s insurance law.

Third, compare the fee schedule included in each insurer’s contract with your own fees to determine which you can afford to renew, which are so bad that you must cancel, and which are close enough to the limit of fees you can accept. Contact the insurers you wish to negotiate with and let them know that this year’s fees will not cut the mustard for 2011 and that you are prepared to negotiate. Important note: ‘Bluffing’ insurers doesn’t work…They’re better at it than you are. If you are not prepared to negotiate, don’t try it. Instead, contact your accountant or other consultant and ask for help to determine what fees you have to receive in order to realize

Northern Sights November/December 2010 Page 11 Bismarck, ND 701-223-7640

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