1. Optometry Low Vision Rehab Productivity Update
Low Vision Workgroup
Conference Call 10/19/15
Patti Fuhr, OD, PhD

2. Critical Elements used to Calculate Productivity
1. Person Class 2. DSS Labor Mapping 3. Resident Only Workload Productivity calculations in the Physician Productivity Cube rely on the accurate classification of an individual provider based on the person class code for their discipline and labor mapping to determine the number of clinical FTE responsible for the workload

3. Person Class
Person Class (Taxonomy) is assigned in the (VistA) NEW PERSON File (
VHA DIRECTIVE
Taxonomy is based on NUCC (National Uniform Claim Committee) guidelines
Chief of Staff Office, C&P Office, Supervisor, AO can assist in reviewing and updating person class (should be reviewed annually)
See Attachment 3 – Physician Productivity Cube Algorithms
Update in VetPro

4. Optometry Person Class
Each attending OD is assigned one person class (practicing specialty). The primary person class for Optometry is
Optometrist (060800)
Optometrist Low Vision Rehabilitation (060802)
Optometrist Occupational Vision (060803)
Optometrist Pediatrics (060804)
Optometrist Sports Vision (060805)
Optometrist Vision Therapy (060806)
Optometrist Corneal and Contact Management
Translation: An OD should be assigned a person class other than ONLY if practicing that specialty more than 50% of time in clinic

5. DSS Labor Mapping
Productivity is determined by the ratio of specialty service RVUs generated by VA Paid Attendings divided by the adjusted clinical MD FTE of VA Paid Attendings
The adjusted clinical MD FTE is derived from DSS Labor Mapping
% Clinical, % Administrative, % Education, % Research
Clinical MD FTE = Total MD FTE – Administrative MD FTE - Education MD FTE - Research MD FTE
Translation – Productivity is the ratio of the RVUs you generate (based on coding) divided by the amount of time you are mapped for direct patient care

6. Resident Only Workload
Only workload that can be traced back to an attending physician is included in the calculation of productivity
the attending physician should be identified as the primary provider on the encounter
If a resident is assigned as the primary provider and no attending physician is identified, this workload is not included in the specialty service workload
Translation – The attending OD should ALWAYS be the primary provider

7. Specialty Physician Productivity Report
To View the report
RAMP Search
Physician Productivity Cube
“Specialty Physician Productivity Statistical Process Control (SPC) Charts for Selected Measures”
Open in Pyramid Analytics
Reports: P1. Productivity Data Profile by Specialty
Optometry
Click to drill down

8. Specialty Physician Productivity Report
P1. Productivity Data Profi...
Filter Selection: (All Facility, FY 2015, All Provider Type)
RVU Sum, RVUSumFiltered, MD FTE (C), Adjusted MD FTE (C), Productivity Measure, Encounters and RVU Sum Per Encounter by Specialty (Specialty) on rows sub-setted by All Facility, FY 2015 and All Provider Type
RVU Sum
RVUSumFiltered
MD FTE (C)
Adjusted MD FTE (C)
Productivity Measure
Encounters
RVU Sum Per Encounter
Optometrist (060800)
2,905,153.84
2,648,988.97
529.44
529.42
5,003.55
1,805,825
1.61
Optometrist Corneal and Contact Management (060807)
12,735.72
12,311.97
2.55
4,835.85
7,440
1.71
Optometrist Low Vision Rehabilitation (060802)
108,994.03
103,490.24
34.65
34.54
2,996.38
70,547
1.54
Optometrist Occupational Vision (060803)
5.4 5
1.08
Optometrist Pediatrics (060804)
19.45
0.19
103.81 30
0.65
Optometrist Sports Vision (060805)
153.59
161
0.95
Optometrist Vision Therapy (060806)
8,109.17
7,504.40
1.97
3,815.96
4,682
1.73

9. Productivity Measures for Optometry Low Vision Rehabilitation (060802)
The Productivity Measures in the Physician Productivity Cube for Optometry Low Vision Rehabilitation (060802) compared to other Optometry person class categories were significantly lower than for other Optometry person classes, and outside the 25th to 75th percentile ranges for Fiscal Year (FY)14 and FY15.
The productivity values of Low Vision Rehabilitation Optometrists may be influenced by relatively fewer encounters compared to general Optometry due to complexity of patient workload, by coding errors, by erroneous person class, by CMS zero RVU codes for Low Vision Rehabilitation services, or by lack of appropriate codes that reflect the difference between a low vision examination and an eye examination.

10. Work to clean up the productivity measure
Review and correct any errors in person class
Review procedure codes and RVUs
Work with OPES and DSS to analyze workload and update RVUs
Work to implement discipline specific coding so that all VAs have the same guidelines
Workgroup established. Starting with person class cleanup

11. FY 15 Optometrists with Person Class Low Vision
BECKER,EMILY N (060802)
BELDYGA,BRENT L (060802)
BUNTING,KATHRYN A (060802)
CAJAMARCA,DIANA OD (060802)
CHAN-O'CONNELL,LISA (060802)
CHONG,THERESA (060802)
CHRONISTER,CONNIE L (060802)
CORREA,MARIA J (060802)
CRAMMER,ROBERT J (060802)
DALMASY-FROUIN,LAURA E (060802)
DANG,SALLY H (060802)
DELLA BELLA,MATIAS (060802)
DZIADUL,JOHN (060802)
ELDRED,KIA B (060802)
ESSINGER,JOHN A (060802)
FREESTONE,BRADLEY D (060802)
FUHR,PATTI S (060802)
GILBREATH,MARILYN K (060802)
GREENFIELD,BOBETTE (060802)
HASKES,CHERYL B (060802)
HENRY,JENNIFER J (060802)
HUANG,MICHAEL A (060802)
IHRIG,CAROLYN (060802)
JACKOWSKI,MARY (060802)
JOHNSON,MATTHEW A (060802)
JUN,WEON (060802)
KESSLER,SHANNON S (060802)
KIRBY,JENNINE E (060802)
KLEMENS,JULIE H (060802)
KWON,ELLEN E (060802)
LEAR,LINDSEY K (060802)
LEE,JENNY OD (060802)
LIMCHAIYAWAT,PAULA T (060802)
LINDSAY,DIANE M (060802)
MARTINEZ,BETHANY S (060802)
MCCARTHY,MARY (060802)
MCCONNAHA,DEBRA L OD (060802)
MCKEE,NATALIE K (060802)
MESSER,TIMOTHY I (060802)
MILLER,AMY M (060802)
MONTERROSO,EDDIE A (060802)
MORAND,TIMOTHY M (060802)
MORDUCHOWITZ,STEVEN (060802)
MORSE,STEPHEN E (060802)
MURPHY,ANDREA (060802)
NGUYEN,THERESE ANNE VY-PHUC T (060802)
O'CONNELL,WILLIAM F (060802)
PAYNE,SUSAN H (060802)
PENA,JULENE (060802)
PEREZ,ANA M (060802)
PERKINS,ELIZABETH (060802)
PETERSON,MICHAEL S (060802)
RAKOCZY,CHRYSTYNA M (060802)
RAWLINGS,DANA L (060802)
ROSS,MEGHAN A (060802)
SAXON,MOLLIE C (060802)
STELMACK,JOAN OD (060802)
STONE,SHANNON R (060802)
TARBETT,AARON (060802)
TOKUMARU,GAY (060802)
TRAN,CATHERINE T (060802)
WACKER,RICHARD T (060802)
WAISS,BRENDAL (060802)
WHITE,JANIS M (060802)
WILCOX,DENISE T (060802)
WOLF,VERONICA (060802)
WOOD,JENNIFER D (060802)
YANG,IRENE L (060802)
YANG,IRENE L OD (060802)
YU,XIAO X (060802)

12. Low Vision Coding Patti Fuhr, OD, PhD
ICD 10
Low Vision Coding
Patti Fuhr, OD, PhD

13. ICD 9 Low Vision Encounter Form
Normal (20/25 or better)
Mild VI (20/30 to 20/60
Moderate (20/70 to 20/100)
Legal Blindness USA Definition
Totally Blind, NLP or LPO
Field < 10 deg., 20/500 – 20/1000
Field <20 deg., 20/200-20/500
Field <5 Deg., HM at <10’, Count Fingers <3’

14. ICD 10 H540 Blindness, both eyes H5410
Blindness one eye, low vision other eye, unspecified eyes
H5411
Blindness right eye, low vision left eye
H5412
Blindness left eye, low vision right eye
H542
Low vision both eyes
H543
Unqualified visual loss, both eyes
H5440
Blindness one eye, unspecified eye
H5441
Blindness, right eye, normal vision left eye
H5442
Blindness left eye, normal vision right eye
H5450
Low vision one eye, unspecified eye
H5451
Low vision, right eye, normal vision left eye
H5452
Low vision, left eye, normal vision right eye
H5460
Unqualified visual loss, one eye, unspecified
H5461
Unqualified visual loss, right eye, normal vision left eye
H5462
Unqualified visual loss, left eye, normal vision right eye
H547
Unspecified visual loss
H548
Legal blindness, as defined in USA

15. Categories of Visual Impairment
ICD 10 Appendix 4 Tables
Categories of Visual Impairment
Maximum less than: Minimum equal to or better than
Category 1 20/70-20/200
Category 2 20/200-20/400
Category 3 20/400 to 5/300
Category 4 5/300 – LP
Category 5 NLP
Category 9 Undetermined/Unspecified

16. Diagnosis Coding
Blindness in both eyes = Categories 3, 4, 5 both eyes (20/400 or worse) H540
Blindness right eye, low vision left eye =
Categories 3,4,5 in right eye(20/400 or worse)
Category 1 or 2 left eye (20/70 to 20/400) H5411
Legal Blindness = no change in definition H548

17. National Optometry Low Vision Encounter Form
Submitted with updated diagnoses codes
Need to work on procedure code updates