Viewpoint

IRIS may be AAO’s finest hour

From The Chief Medical Editor

Larry E. Patterson, MD

When people and organizations focus primarily on quality, quality tends to increase and costs fall over time. When people and organizations focus primarily on costs, costs tend to rise and quality declines over time.”

— W. Edwards Deming, PhD, statistician, 1900-1993

This month’s column is neither depressing, comedic nor sarcastic. It’s mostly good news — and mostly stolen from Dr. Bill Rich, Medical Director of Health Policy for the AAO.

Medicine is changing, whether we like it or not. Reimbursements are shifting from fee-for-service to value-based payments. There will be a new emphasis on comparative effectiveness, as well as a renewed look at safety. Medicare will mandate in 2015 the implementation of a new payment model that measures and rewards physicians for the quality and resource use of services delivered to a physician’s entire covered patient population, not just the individual patient.

The question arises, how will ophthalmologists survive in this new environment that emphasizes the need for measuring our outcomes, resource use and patient quality of life?

In a tip of the hat to what may turn out to be the AAO’s finest hour, one answer may be IRIS, Intelligent Research in Sight. This is ophthalmology’s first major comprehensive clinical registry. To quote Lord Kelvin, “If you can’t measure it, you can’t improve it.”

To try to explain the registry, how it works, and all its benefits goes way beyond the space I have available. Go to www.aao.org/irisregistry for everything you need to know about it. I just want to make a few salient points.

1. This system doesn’t disrupt your practice. If you participate, it will come into your computer system at night and retrieve the data it needs.

2. This isn’t the first time this has been tried. The AAO piggybacked off years of experience from the Society of Thoracic Surgeons and the American College of Cardiology.

3. Ophthalmology can consolidate into one registry, not lots of different registries.

4. With IRIS, in 2014, you won’t have to report on nine different measures for PQRS. This will greatly assist in getting payment incentives and/or avoiding penalties.

5. It works with any EHR system. Yes, it can also be done manually, but frankly I wouldn’t advise that. You’d miss the whole advantage of point #1.

6. You own your data and can receive amazing reports. The AAO only uses aggregated data. This is the concept of “Big Data”. Without the complexity of traditional methods, we will have the ability to measure large population outcomes.

The AAO is offering this registry free for two years to the first 2,000 doctors who sign up. As of this writing, 1,200 are already on board, including my practice. The AAO anticipates more than 20 million patients will be represented in the registry by 2017.

IRIS may very well overhaul how we improve future clinical outcomes. To succeed, a large number of physicians must participate. Especially if you already have your medical records computerized, get on board … now. OM