AAO Sees Good and Bad in Consolidation

Speaking at the recent OIS@AAO meeting, American Academy of Ophthalmology EVP and CEO David W. Parke II, MD, highlighted health care system integration forces that are aggregating physicians into larger groups, encouraging hospital mergers, and accelerating physician employment.

Much of the consolidation is happening as part of the push towards accountable care organizations (ACOs). About 25% of physicians overall participate in ACOs, but the participation rate in ophthalmology is less than half that, and only 1% of ophthalmologists are employed by ACOs. One consequence of ACO growth and other elements of the Affordable Care Act is the narrowing of in-plan physician networks. “It will be a very different payer community in the future,” Parke said.

He warned that ophthalmic procedures are very much on the radar at the Centers for Medicare and Medicaid Services (CMS), which is now focusing on identifying higher quality and more efficient care, even within the fee-for-service system. On a total cost basis, including Part B outpatient drug costs, ophthalmology accounts for four of the top 20 conditions paid for by Medicare: cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy.

One form of consolidation that Parke is excited about it is the Academy’s data collection effort. The IRIS Registry has already recorded data from nearly 10 million patient encounters and expects to have 33 million by 2016, a 16-fold increase from earlier projections. The data, which come from more than 3,300 physicians using 23 different electronic health record (EHR) systems, could be used for faster, cheaper clinical trials with “real-world” data, better post-market surveillance, and more rapid comparison of products. “This has the potential to change the world in which so many of the companies presenting at OIS live,” he said.