Reductions in Medicare payments have made it necessary for retina specialists to become more efficient. Meaningful use and quality reporting requirements have burdened physicians with the demands for  more documentation to avoid additional Medicare penalties. To maintain practice efficiency and meet these additional documentation requirements, physicians are relying on higher-level certified clinical staff.  

Ophthalmology specific certifications include Certified Ophthalmic Assistant (COA), Certified Ophthalmic Technician (COT) and Certified Ophthalmic Medical Technologist (COMT). An employee must complete certain experience and educational requirements and pass a certification test. Certification shows the employee’s commitment to the practice and specifically to ophthalmology as a vocation. Additional information on the certification process and requirements can be found on the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO) website at JCAHPO.org.  

 
Certification Cost vs. Benefit
Studies have shown that certified personnel increase practice efficiency and quality of care. However, with better-trained employees come higher personnel costs. A cost-benefit analysis can determine if the extra costs outweigh potential Medicare penalties and lower productivity of non-certified staff.  

Among the metrics this analysis should measure are: the number of additional patients the physician can see with a certified assistant and the additional practice revenue; potential for better documentation and fewer errors; and improvement in patient satisfaction. Other potential benefits include how well certified staff helps the physician manage clinic time.

What It Means in the Clinic
Meaningful use requires that certified personnel use computerized provider order entry for medication, laboratory and image ordering. Without certified personnel, the onus is on the physician to enter that information, thus reducing efficiency and the time a physician can spend with patients.

Failure to properly order medications and testing in the electronic medical record will result in Medicare payment penalties ranging from 1 to 3 percent depending on what stage of meaningful use the practice is in.

Medicare will not only base future payments on efficiency, but also on quality measures. Many physicians use certified employees as scribes to meet meaningful use requirements. A certified employee has proven job knowledge in ophthalmology and that gives the physician the reassurance that patients will receive the highest quality of care.

Incentives for Certification
Not all clinical employees may want to become certified, so how do you incentivize them to do so?  You can simply make it a job requirement and let your employees know they have a certain period of time to obtain their certification. Explain why you are requiring this certification and the benefits for the employee and practice.  

For the employee, certification makes her or him more marketable as more physician offices move toward hiring certified personnel.  Some retina offices offer incentive programs such as reimbursement for study materials and the exam cost. Other offices offer an immediate pay increase upon successful completion for the certification exam. Or, you can offer some combination of these incentives.  

Certified personnel bring an increased job knowledge that has shown to improve physician productivity, efficiency and quality of care while helping the physician meet the ever-increasing pay-for-performance and meaningful use requirements. With more such mandates on the horizon, each practice needs to make sure it has the certified work force to comply. The benefit of having certified personnel can far outweigh the additional costs to the practice. RS

Mr. Gavin is practice administrator at Palmetto Retina Center, West Columbia, S.C.