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January 2016 Issue

Course on Advanced Corneal Surgery at Emory University School of Medicine March 4-5

The Course on Advanced Corneal Surgery (CoACS) is designed for corneal surgeons of all skill levels (novice to advanced) who would like to incorporate ultra-thin DSAEK (UT-DSAEK), Descemet’s Membrane Endothelial Keratoplasty (DMEK), Deep Anterior Lamellar Keratoplasty (DALK) and Collagen Cross-Linking (CXL) into their practice.

For more information, view the full course brochure at http://cmetracker.net/EMORY/Files/Brochures/12523.pdf

 

ASCRS Annual Meeting May 6-10

Join SightLife at this year’s American Society of Cataract and Refractive Surgeons (ASCRS) annual meeting in New Orleans (booth #1817).

For information on the education sessions SightLife will be hosting, visit http://sightlife.org/NOLA or contact Troy Skubitz at troy.skubitz@sightlife.org.

For meeting registration and general information about ASCRS visit http://annualmeeting.ascrs.org/

 
Ankita

Bringing regulatory changes to increase eye transplantation in developing countries

PART A: Current changes in policy

Corneal surgery began in India in the late 1950s when Dr. R.P. Dhanda started transplantation efforts in the small town of Indore. Progress was slow, and by the mid ‘80s only 2,000 surgeries per year were being performed across India.

In 1994, the government of India released The Human Organ Transplant Act. This was a milestone first step, which met aspirational and visionary needs of the developing country. There were many topics not adequately covered or addressed accurately, but these issues were resolved in subsequent legal amendments in 2008, 2011 and 2014. For example, the original act defined the donor family legally able to give consent, as only immediate family members including brothers, sisters, parents and children of the donor. This was not adequate legal provision in practice because many potential donors in urban cities had left their immediate families behind in villages and were not legally able to donate. Amendments in 2011 and 2014 have brought sufficient insight and flexibility—neighbors, friends and other relatives who take possession of the body can now also decide on the merits of donating eyes.

Another case of evolving legal clarity involves eye banks charging processing fees for eyes collected. The law of the land clearly suggests that buying and selling of organs and tissues is not permissible. However, it was unclear if the law permitted eye banks to charge for costs incurred for recovering, processing, and distributing corneas. As a result, eye banks were reluctant to charge processing fees, but sufficient reimbursement of the cost spent to recover, preserve, evaluate and process the tissues is critical in establishing a sustainable eye bank. In 2014, after much effort by the Eye Bank Association of India, SightLife and other NGOs, the law was revised to clearly allow charging fees for retrieval of tissues, their transportation and preservation.

Recovery of tissue by a non-medical practitioner is another legal challenge that India has faced in the last few years. Initially, the law required the presence of a doctor during retrieval, but this decreased efficiency and quality. The law was revised in 2014 to permit paramedical workers or medical technicians to retrieve tissues from a cadaver without a doctor’s presence (subject to appropriate training). With this regulatory change, eye banks now can freely identify and train staff members to become tissue retrieval specialists. This has resulted in higher utilization of tissues due to the care and training undertaken. It has also yielded an increase in staff job satisfaction and pride.

The regulatory changes in India have directly affected tissue recovery and utilization.  India is a case study on the evolution of policy as well as the critical components of successful policy leading to increased donation and transplantation.  SightLife Global Programs will bring lessons learned from India to new places around the world, improving donation rates and effectiveness globally.

 

REIMBURSEMENT UPDATE: CMS Releases Clarification on Corneal Tissue Billing Instructions

CMS released a January 2016 ASC payment system update which included a clarification of billing instructions for corneal tissue.

The 2016 Hospital Outpatient Prospective Payment System/ASC final rule stated that procurement or acquisition of corneal tissue will be paid separately only when it is used in corneal transplant procedures. The update clarified that corneal tissue will be paid separately when used in procedures performed in the outpatient department, but only when the corneal tissue is used in a corneal transplant procedure described by one of the following codes:

  • 65710 Keratoplasty (corneal transplant); anterior lamellar
  • 65730 Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia)
  • 65750 Keratoplasty (corneal transplant); penetrating (in aphakia)
  • 65755 Keratoplasty (corneal transplant); penetrating (in pseudophakia)
  • 65756 Keratoplasty (corneal transplant); endothelial and any successor code or new code describing a new type of corneal transplant procedure that uses eye banked corneal tissue

HCPCS code V2785 (processing, preserving and transporting corneal tissue) should be reported only when corneal tissue is used in a corneal transplant procedure, and not in any other circumstances.  This reverses last April’s policy to reimburse separately for corneal tissue used for glaucoma patch grafts.  This reversal was not unexpected, as CMS indicated in July that this would happen.

 

Big Win For Medicaid Patients and Surgeons in Washington State—Corneal Tissue Now Covered at Cost

Following lobbying efforts by SightLife, Washington State Medicaid, which is known as Washington Apple Health, has agreed to amend its reimbursement policy for corneal tissue. Effective January 1, 2016, Washington Apple Health will reimburse corneal tissue at cost of the invoice for both hospital outpatient and ambulatory surgical centers.  This is similar to the way Medicare pays for tissue.

Background:

Last year, SightLife heard from a number of corneal surgeons across the state that Washington Apple Health reimbursements for grafts were not keeping up with the cost of tissue. The tissue reimbursement was capitated and intended to cover only the cost of the tissue and not any additional eye bank processing for Endothelial Keratoplasty (EK) procedures.

SightLife spearheaded an effort to research the policies of other states and study the impact on patients in Washington State. We found that only five states reimburse for tissue based on the cost of the invoice, and the rest have some form of capitation. Some states do not pay for tissue at all, as it is deemed an elective procedure. We also surveyed surgeons about the impact on their patients and used all this information to help educate policy makers at Washington Apple Health.

New Policy:

The new reimbursement policy is now reflected in the Washington State Medicaid Provider Guides for Hospital Outpatient Services and Ambulatory Surgical Centers (links to the guides are below).  The new policy supports reimbursement for corneal tissue based on the invoice price.  This allows facilities to fully reimburse for tissue for EK procedures, covering the entire cost of the tissue.  Instructions for how facilities should reimburse for tissue are outlined below.

HOPPS Instructions:

How do I bill for corneal tissue?

Effective for claims with service dates of January 1, 2016 and later, the agency will pay for corneal tissue processing (HCPCS procedure code V2785) by acquisition cost (AC). To receive payment, providers must:

  • Bill the amount paid to the eye bank for the processed eye tissue.
  • Attach invoice to claim.

Outpatient Hospital Services

ASC Instructions:

How do providers get paid for corneal tissue?

Effective for claims with service dates of January 1, 2016 and later the agency will pay for corneal tissue processing (HCPCS procedure code V2785) by acquisition cost (AC). To receive payment, providers must:

  • Bill the amount paid to the eye bank for the processed eye tissue.
  • Attach invoice to claim. 


The agency will update the Ambulatory Surgery Centers Fee Schedule to reflect this change. 


The provider guides can be found on SightLife’s website at:

Questions:

If you have questions about this change in policy, SightLife is glad to help or put you in touch with individuals at Washington Apple Health who can assist you. For assistance, please contact Chief Marketing Officer Rusty Kelly at rusty.kelly@sightlife.org or via telephone at 415-254-5818.

 
DMEK gentian violet

SIGHTLIFE SERVICES: DMEK Tissue Preparation Enhancement

Descemet’s Membrane Endothelial Keratoplasty (DMEK) is one of the latest surgical techniques in corneal transplantation that may provide patients with quicker recovery times and better visual acuity. SightLife strives to ensure surgeons have access to the best pre-cut tissue for this advanced procedure.

Recently, we have enhanced the way we prepare DMEK tissue. SightLife will no longer be marking the hinge of Descemet’s left attached to the stroma by cutting a notch in the sclera. Instead, we will be marking the hinge with a gentian violet marking on the sclera. We feel this will be a clearer notation than a notch in the sclera as the sclera is not always uniform in shape. The diagram below illustrates the marking change.

If you would like to see the changes in tissue preparation prior to a scheduled procedure, SightLife can provide you with a whole globe and a pre-cut DMEK research tissue. Please email us at tissue@sightlife.org or call us at 1-877-682-8502 if you have any questions or comments.

DMEK gentian violet

 
DMEK wet lab

SIGHTLIFE SERVICES: Upcoming DMEK Course and Wet Lab April 17-18

The DMEK Surgical Technique Skills Transfer and Wet Lab will include lectures on DMEK procedures, a hands-on wet lab with research grafts and eyes, plus a day of operating room observation. This two-day intensive course is intended to equip participating surgeons with the information and experience needed to return home and perform this procedure.

Course Instructors: Neda Shamie, MD and Nicole Fram, MD

Two Course Packages Available

To register for the course go to https://www.tfaforms.com/401846.  For more information visit SightLife.org/DMEK or contact Troy Skubitz at troy.skubitz@sightlife.org.

 

SightLife Cornea Recipient Lucia had a Great Start to 2016

Part 2:

Cornea recipient Lucia Vasquez celebrated the start of 2016 with what is likely to be one of the most colorful and memorable experiences of her life—riding on the Donate Life float in the Rose Parade. Sponsored by SightLife, Lucia and her sister, Lilia, traveled to Pasadena, Calif. and spent five days meeting other recipients, living donors and their families.

“Being on the float was definitely very moving. Seeing others being touched by the float, the tears in their eyes, was an experience like no other,” said Lucia. “I’m very thankful that I got to experience this and help to bring awareness to donation. The Rose Parade will be in my heart forever.”

Lucia and Lilia share a special connection to donation. Before she received the generous gift of a cornea that restored her sight, Lilia donated one of her kidneys to Lucy. The sisters celebrated that connection in Pasadena by helping to decorate the Donate Life Rose Parade float, watching the official judging of the float (it won the Isabella Colman trophy for best use of color) and attending the Donate Life New Year’s Eve ball. They were joined at many of the events by Lucia’s cornea surgeon, Dr. Douglas Holsclaw of Kaiser Permanente, and his wife, Melody Summers, who serves as chairman of SightLife’s board of directors.

“In my daily practice, I have virtually no interaction with the donor families who, through their generosity, make this life transformation a reality for my patients,” said Dr. Holsclaw. “The Donate Life Rose Parade event opened my eyes to the emotion, heartfelt beauty and immense impact that the decision to donate makes on donor families. Decorating the float with these families and hearing their stories touched me deeply and has changed forever how I will talk to my patients about the magic of their gift. I feel privileged to have attended. It was without question one of the most powerful things I have ever experienced in my practice of medicine.”

Visit SightLife’s Facebook page at https://www.facebook.com/throughNewEyes to learn more about Lucia’s trip to the 2016 Rose Parade—photos and video show this special experience through her new eyes.

Lucy's selfie
Lucia’s selfie with the 2016 Donate Life Rose Parade Float
 
cornea donor
During their memorable trip to the Rose Parade, Lucy and Lilia also had the opportunity to learn more about Lucia’s cornea donor by reading the blog the 17-year-old wrote before she passed away. "Wow. I have the best donor,” said Lucia, adding that she thinks of her donor every day and remains very thankful for her gift of sight.