AOA MORE Frequently Asked Questions

For information on AOA MORE and our most frequently asked questions, please click on the topics below.

Frequently Asked Questions

About registries

Values and benefits of registry use

Sign-up and cost

Merit-Based Incentive Payment System (MIPS)

Quality measures in AOA MORE

MIPS program participation & requirements

Technical requirements and security 

Should you not find the answer you are looking for, please contact us at QualityImprovement@aoa.org 

About registries

What is a registry?

A registry is a private, secure database that systematically integrates patient data from multiple electronic health record (“EHR”) systems and facilitates secondary uses of the data.

What is the name of the AOA’s registry?

AOA MORE (“Measures and Outcomes Registry for Eyecare”) by Prometheus Research.

How and why was AOA MORE developed?

The registry project was initiated by the AOA Board of Trustees in response to the growing emphasis on quality reporting and measurements through registries as part of health care. The ultimate goal of AOA MORE is to improve eye health and vision outcomes for the patients we serve. We partnered with Prometheus Research because of their experience and reputation in developing high-quality registries.

What other specialties are currently using registries?

Most health care professions are already using registries or are in development to build a registry. Some examples of professions already using registries include cardiology, oncology, osteopathy, and ophthalmology.

Where can I find additional information about AOA MORE?

Visit aoa.org/MORE to find many valuable resources that will introduce you to the benefits of AOA MORE and explain how registries are being used in health care. Contact information is available at  aoa.org/MORE should you need additional questions answered.

Values and benefits of registry use

What are the values and benefits of participating in AOA MORE?

Congress underscored the importance of registries, such as AOA MORE, in the Quality Payment Program including Merit-based Incentive Payment System (MIPS). Additionally, the Centers for Medicare & Medicaid Services (“CMS”) has been directed to explore ways to encourage the use of clinical data registries. Given this backing by Congress, it is clear that using a registry will be a key component in the future of Medicare payments and the health care system overall.

Frequently Asked Questions The bigger picture for AOA MORE is that it will offer our profession the ability to track eye health and vision outcomes over time that can be analyzed and then be improved upon by our profession. For example amblyopia, diabetes, and contact lens complications can all be studied by using a registry.

AOA MORE is offered as a member benefit with no additional cost to members and for a fee to nonmembers.

Will AOA MORE help advocacy efforts for the profession?

Yes! AOA MORE will allow the profession to advocate on behalf of optometry. Data from AOA MORE will provide information on patient care and outcomes to allow optometry to advocate to insurance regulators, state legislatures, and to the public about the services and value of our profession.

How does “benchmarking” work?

ODs will be able to access statistics derived from their own patient base by viewing the AOA MORE dashboard. AOA MORE is preprogrammed to provide statistics on many topics including your patient demographics compared to aggregate non-identifying national averages, your most common diagnosis codes compared to aggregate non-identifying national averages, and your most common medicines prescribed compared to aggregate non-identifying national averages. Your personal dashboard is private for your viewing alone, and only aggregate non-identifying national numbers are visible to the AOA.

In addition, ODs can access benchmarks that compare your patients and care to the profession as a whole. Initially, AOA MORE will show you benchmarks of the Quality measures, glaucoma measures, and more. For example, you will see the percentage of glaucoma patients and glaucoma suspects you have seen in the past twelve (12) months. These measures will be expanded in the future with more information relative to existing measures, and additional measures, with each new release.

What dashboards are available?

AOA MORE will offer different dashboards to view your patient information. The data is updated weekly and intended to strengthen your patient care by providing you with frequent comparison feedback and reporting status.

The Quality dashboard provides your current year-to-date performance on the Quality measures. The Practice dashboard will allow you to view aggregate statistics about your patients (e.g., demographics, diagnoses, etc.) and the care provided to them. For example, you will be able to view the number and percentage of patients in the past twelve (12) months with either glaucoma, or suspected glaucoma, and the most common medications you prescribe compared to the aggregate non-identifying national averages. AOA MORE will soon add a feature that allows you to easily see how many visual fields and OCTs were ordered for those with glaucoma, and suspected glaucoma patients, compared to aggregate nonidentifying national averages. For each measure, you will be able to view these numbers and percentages both within and across practices (if you are in multiple settings) as well as for the registry as a whole.

Is there a practice-level dashboard?

Yes. A practice owner or designated administrator can view the data from multiple NPI’s associated with the practice tax ID number. This feature also supports group reporting to CMS should a practice elect to attest as a group for MIPS.

How easy is it to use AOA MORE?

AOA MORE is simple to use because it integrates with your EHR. AOA MORE does not fetch data directly from your EHR; your EHR will "push" information to AOA MORE on a weekly basis. This will provide the data you view in your dashboard and reports. There is no manual entry required for AOA MORE. To ensure that data is being captured accurately, doctors will need to log in regularly and assess the data captured. At times EHR vendor requirements for documentation will impact how the data is transmitted.

Sign-up and cost

How do I register (enroll) with AOA MORE?

AOA members can go to aoa.org/MORE to register. Follow the “ENROLL” prompt, using your AOA member credentials to register. Be sure to use an 8-digit username (adding zeros before your number as needed to make an 8-digit username). If you are a non-member and would like to pay the fee to participate in AOA MORE, please call 314.983.4270 to begin the registration and payment process.

What is the cost of AOA MORE?

AOA MORE is a member benefit to those who are current with their dues. Non-AOA members will pay $1,800, per annum, to use AOA MORE. While the AOA does not charge fees for members to use AOA MORE, some EHR vendors do charge additional fees for users. The following integrated vendors DO NOT charge extra fees to users: Crystal Practice Management and MaximEyes.

Are there prorated fees for non-AOA members?

No.

Who is eligible to use AOA MORE?

Any AOA member OD can sign-up for AOA MORE.

I am in partial practice; do I have to pay full price?

AOA MORE is an AOA member benefit. There are no additional costs for AOA members. The fee for
non-members is $1,800, per annum, regardless of the number of hours you work per week.

What if I am in multiple practices or locations?

Your individual National Provider Identification (NPI) number is what ties you to the registry. You can use it for multiple locations. If you are in multiple locations (under the same Tax ID number and using the same EHR), your AOA MORE data will display on your provider dashboard under that Tax ID. However, if you work in multiple practices with different Tax ID numbers, each practice will need to signup for the registry and authorize its EHR vendor to release data to the registry. Your AOA MORE provider dashboard will display data for each separate Tax ID under which you practice.

I am an associate in my practice (not an owner); can I register with AOA MORE?

Yes; associates can register with AOA MORE, but they will need their practice’s owner to sign an
agreement to authorize the associate OD to use AOA MORE. The owner is not required to use AOA
MORE. Please refer to the instructions found at aoa.org/MORE/getting-started.

Do my patients need to sign anything to be in AOA MORE?

Patients do not need to sign additional forms, i.e., additional HIPAA disclosures. Because your EHR has coordinated with the registry to remove patient identifying information (patient name, etc.), additional forms are not necessary.

Is training required to use AOA MORE?

AOA MORE is set up to be intuitive. However, like most new things, there is some learning that needs to occur. aoa.org/MORE will have resources, including video education and screenshots to provide you with step-by-step instructions on the use of AOA MORE. Help is also available within AOA MORE. Most measures have a “how is this measure calculated,” and a “HELP” dashboard displays when you are logged into AOA MORE.

What do I do if my vendor is not included?

AOA MORE will be expanding to add additional EHR vendors. If your vendor is not currently integrated, please still sign up. When you register for AOA MORE, the form will ask you what EHR you are using, and we will track the demand of additional vendors going forward. In addition, we encourage you to let your vendor know your preference to participate in the registry.

ANY AOA member can enroll in AOA MORE to participate in MIPS Improvement Activities and also
manually report Promoting Interoperability measures to CMS. You do not have to use an integrated EHR system to access this valuable feature.

Merit-Based Incentive Payment System (MIPS)

What is MIPS?

Medicare created the Merit-based Incentive Payment System (MIPS) as part of their Quality Payment Program. It is their new payment program for Medicare services and includes your optometric services in addition to your use of 4 performance-driven areas:

  • Quality: formerly known as PQRS
  • Promoting Interoperability: formerly known as Advancing Care Information
  • Cost: formerly known as Value-Based Modifier
  • Improvement activities include objectives that support areas of public health.

Doctors of optometry will be paid based on their services and the use of these 4 MIPS categories.

What is MIPS Quality?

MIPS “Quality” is what used to be known as PQRS (Physician Quality Reporting System). PQRS was
started by Medicare in 2007 as PQRI (“Physician Quality Reporting Initiative”) and requested reporting of codes on their claims to indicate that specific tests, counseling, or documentation was performed during a patient encounter. For example, if you saw a patient with glaucoma and documented the cup-to-disc ratio, then you would report code: 2027F. This would tell Medicare that you properly documented the cup-to-disc ratio. While it may seem obvious that doctors of optometry should document a cup-to-disc ratio on a glaucoma patient, evidence shows that many doctor specialists in many areas of medicine do not properly document their findings. PQRS is now known as “Quality” in MIPS. The PQRS started as a voluntary program that gave doctors bonus money for complying. Now Quality imposes potential financial penalties to doctors who do not participate.

What is MIPS Promoting Interoperability?

In MIPS, Advancing Care Information is now known as “Promoting Interoperability” (PI). PI will include the principles of Modified Meaningful Use Stage 2 and Meaningful Use Stage 3.

What is an eCQM?

The short answer is electronic Clinical Quality Measure. Doctors of optometry will see eCQMs as part of MIPS Quality and Promoting Interoperability. eCQMs are essentially an internal component of your EHR that is sent to AOA MORE. It is the internal communication that allows your EHR to communicate with AOA MORE.

Electronic health record vendors have internal counters to track eCQMs. For example, many vendors have a specific letter that, if you generate it for your patient, will pull all the diabetic retinopathy information from your fundus exam findings in your eye exam and populate the information into the diabetic retinopathy letter. That letter (after you generate it) is then counted toward your eCQM for sending the PCP a letter about your patient with diabetic retinopathy. AOA MORE tracks your eCQMs and allows reporting to CMS in that format.

I am using AOA MORE; do I still have to submit the Quality codes on my claims?

You should continue to report the Quality codes through other methods (i.e., claims, EHR) until you see data for six (6) or more Quality measures on your dashboard.

For the Quality codes reporting, what happens once my EHR is fully-integrated with AOA MORE?

Once your EHR is fully-integrated, AOA MORE will collect your Quality data for one (1) full year. Quality data will be sent to AOA MORE on a weekly basis (automatically done through your EHR integration). If you are fully integrated with AOA MORE after January 1 of a Performance Year, AOA MORE will collect your data for the entire year. Once you are fully integrated with AOA MORE, you will no longer need to include extra written codes on claims (i.e., 2027F, 2019F, etc.) as AOA MORE will do it for you. You will be required to formally “agree to submit” this data through AOA MORE to CMS when it is time to do so (data submission occurs during the first ninety (90) days following the calendar Performance Year). The AOA will notify doctors when it is time to report and remind all AOA MORE users of the deadlines.

How do I submit my Quality data from my EHR to the registry?

If your EHR is integrated, your EHR vendor will securely push your Quality data to AOA MORE, which will then calculate your Quality measures for you. Once the data is in AOA MORE, you will simply review and formally approve the data for submission during the MIPS Quality data submission period (January 1 to March 31 of the following year). Only then will AOA MORE submit the data to CMS on your behalf.

Will AOA MORE satisfy Promoting Interoperability (PI)?

AOA MORE is considered a “specialized registry” in the eyes of CMS and a Qualified Clinical Data Registry (QCDR). This means it will satisfy MIPS registry specifications in the Performance Category of PI.

Do the displayed Quality performance rates include non-Medicare patients?

When your practice authorizes your EHR vendor to release data to AOA MORE, it includes all patients regardless of their payer. Therefore, if you see Medicare patients in your practice, and your practice’s EHR is sending data to the registry, then Medicare patients will be included in the calculation of the Quality measures prior to submitting the data to the CMS.

Will my Quality scores that are calculated through AOA MORE be made public through the CMS Physician Compare website?

CMS launched the Physician Compare website in 2010. Over the past several years, CMS has been adding additional information to Physician Compare including physician performance on certain quality measures based on the information you submit to the CMS. Regardless of the Quality reporting method used, each year CMS will consider performance rates on quality measures for possible inclusion on Physician Compare. CMS determines what quality measure performance information to publish based on an analysis of whether the doctor had a minimum sample size of twenty (20) patients for the measure and if the measure proves to resonate with consumers. When you report through a QCDR (AOA MORE), CMS will consider your quality measure performance rates for publication just as is done for every other Quality reporting method.

What are Improvement Activities, and can AOA MORE help me in that category of performance?

Improvement Activities (IA) are designed for doctors of optometry to demonstrate their role in overall public health initiatives. Registry and QCDR reporting (including AOA MORE) is emphasized in the scoring of IAs. AOA MORE will support several IAs.

How do I use AOA MORE for improvement activities?

Doctors using AOA MORE can log in to the AOA MORE dashboard (aoa.org/MORE) and click on “MIPS Participation” in the table menu. Scroll down the page to find Improvement Activities. Several IAs related to QCDR use are listed and/or you can click the “plus” sign at the bottom of the page to “Add IA’s.” This link connects you to the complete menu of IA’s available from the Quality Payment Program (QPP).

Improvement Activities related to QCDR use include print materials and educational videos that can be accessed. We recommend you keep a record of when you accessed the materials and/or watched the webinars in the case of a future MIPS audit. You must perform the activity over a 90-day period, or in the case of educational webinars, watch the presentations during your selected 90-day window. You will be able to attest to the completion of these activities to CMS through the AOA MORE Attestation Portal or through the QPP portal. Attestation for Improvement Activities consists of yes/no checkboxes. No other documentation is required for attestation.

What role does AOA MORE play in the Merit-Based Incentive Payment System (“MIPS”) under Medicare?

AOA MORE plays a critical role in the Merit-Based Incentive Payment System (“MIPS”). There is a total of four (4) categories that doctors will be evaluated on under MIPS — Quality, Promoting Interoperability, Improvement Activities, and Cost. AOA MORE will assist doctors in meeting requirements under three of the four categories (Quality, PI, IA). For the one remaining Cost category, no information has to be submitted by the doctor to CMS.

AOA MORE helps you meet part of the Promoting Interoperability Public Health and Clinical Data
Exchange measure. Even if your EHR is not yet integrated, you can register with AOA MORE and receive MIPS credit for “Clinical Data Registry Reporting.” If no other registry is available to you aside from AOA MORE, you can claim an exclusion for the second required registry.

Quality measures in AOA MORE

What measures does AOA MORE support?

AOA MORE currently supports 8 measures. The complete list with measures specifications can be found  here or by visiting the AOA MORE website and selecting the blue bar entitled “AOA MORE and MIPS Resources.

How were the Quality measures supported by AOA MORE selected?

The AOA Registries and Quality Improvement Committee selected the measures based on several
factors:

  • Availability of an electronic reporting option that would eliminate the need to add PQRS codes
    to claims. (Some quality measures are electronically specified which allows your EHR to pull data from your records and submit that data to AOA MORE. This allows doctors to report on quality measures without having to report PQRS codes on claims as has typically been done by doctors of optometry in the past).
  • Ability to fulfill Centers for Medicare & Medicaid Services (CMS) regulatory requirements related to qualified clinical data registries. (CMS requires QCDRs, such as AOA MORE, to have certain capabilities. When AOA MORE was initially launched, CMS required QCDRs to have the ability to report at least two outcomes measures)
  • Applicability to optometric practice

Why isn’t the “Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% or Documentation of a Plan of Care” quality measure included in AOA MORE?

This measure was not initially selected because it is not an electronically specified measure that can be reported without adding additional codes to a claim. The AOA is continuing to consider additional measures to add to AOA MORE in the future and inclusion of this measure is a priority.

The CMS Quality Payment Program website lists two measures as “EHR only”. The measures are “Diabetic Retinopathy” measure 018 and “Receipt of Specialist Report” measure 374. If these are EHR only, how can AOA MORE collect and report these measures?

AOA MORE’s status as a qualified clinical data registry does provide us with some flexibility. Although those two measures are not listed as “registry measures” they are electronically specified EHR measures (eCQMs) and we are able to submit eCQMs through our QCDR.

Who do I talk to if I have ideas for additional measures to be reported through AOA MORE?

Please send any recommendations or suggestions to qualityimprovement@aoa.org.

MIPS program participation & requirements

Participation

How do I know if I need to report data for MIPS?

Use the NPI look up at  qpp.cms.gov/participation-lookup

How do I know if I am above or below the Low Volume Threshold (LVT)?

Use the NPI lookup at  qpp.cms.gov/participation-lookup

What is the Low Volume Threshold (LVT) and what does it mean?

Doctors of optometry that are higher than the Low Volume Threshold (LVT) are required to participate in MIPS. Doctors that are below the LVT are exempt from MIPS for the year. The LVT is set each year by CMS. In 2020, the LVT is $90,000, 200 patients and 200 covered services. That means if you bill more than $90,000 in Medicare Part B Allowable charges AND you see over 200 different Medicare Part B patients in a year AND provide over 200 covered Medicare Part B services, then you are required to participate in MIPS in 2020. If you are in a group practice, you can combine all of the Medicare allowable charges and patients, and if greater than the LVT, you can elect to participate in MIPS as a group. You must include all providers under the same Tax ID number if you elect to report as a group.

What is opt-in and voluntary reporting?

CMS has added an option for providers who would like to participate in the MIPS program. If a provider meets at least one of the LVT’s listed below, they can Opt-in to the MIPS program and be eligible for a negative, neutral, or positive payment adjustment.

  • ≥$90,000 in Medicare Part B allowable charges or
  • ≥200 Medicare Part B patients or
  • ≥200 covered Medicare Part B services

ANY provider can “Voluntary Report” and receive a MIPS performance score; however, they will NOT be subject to a payment adjustment.

Exemptions

If I am exempt from MIPS do I need to submit any quality information to CMS?

No, if you are exempt, you are not required to submit any data. However, you can submit Quality data, Promoting Interoperability and Improvement Activities to CMS to get a MIPS score, but you will not receive a payment adjustment. Understanding your MIPS score will help you to know how prepared you are for the future when LVT and exemptions may change. If you are exempt as an individual, but your group is higher than the LVT, you can elect to participate in MIPS as a group. Your group will receive a positive, negative or neutral adjustment based on your group score.

Reporting options

What happens if I’ve been reporting Quality data though claims this year, but I also report through AOA MORE or my EHR?

If you submit data by more than one method, CMS will review your data through all of the submission methods you use. CMS will grade each submission method separately to give you credit for whichever has the highest score.

Technical requirements and security 

How does data get from my EHR to AOA MORE?

Each week, the participating EHR vendors send clinical data from their systems to AOA MORE's receiving area. AOA MORE is not reaching into your EHR to pull data. The information is “pushed” from your EHR to AOA MORE by systems your EHR vendor has put into place. The data is encrypted using industrial strength encryption and remains encrypted while in transit and at rest. Once the data has been validated and processed, it is imported into the registry where it is stored securely.

Can you manually enter data into AOA MORE?

Currently, there is no option to manually add data into AOA MORE. As AOA MORE adds additional
functionality, there may be the opportunity to manually add specific procedures and outcomes. This manual entry of specific procedures and outcomes will help AOA MORE collect data to improve best practices for patient care and advocate for expanded scope.

Which EHRs are supported?

AOA MORE supports Compulink, Crystal Practice Management, OfficeMate/ExamWRITER, EyefinityEHR, and MaximEyes by First Insight. The plan is to bring additional EHR vendors on as quickly as possible, and there are many vendors already preparing to be part of the next release. If your vendor is not supported, please register with AOA MORE so we know which EHRs are most in demand.

What browsers are supported?

AOA MORE supports Google Chrome or Firefox.

Who is Prometheus Research?

Prometheus Research is the AOA’s partner in designing, building, and supporting AOA MORE and its many functions. They have spent the past decade building-integrated registries to address the challenges of acquiring, integrating, and repurposing health data for biomedical researchers, academic health centers, philanthropic institutions, and professional societies. Staffed by a unique combination of clinical research informaticians and open-source software engineers, they stand apart from traditional “registry” companies with a partnership model that avoids software licensing fees and vendor lock-in strategies. Instead, they embrace the model in favor of empowering their clients to the point that they will no longer need most—if not all—of Prometheus’ expert data management consultation once the registry is completely built and running. Of course, Prometheus Research will continue to house and maintain the registry for the AOA into the future and make improvements as needed.

What data is shared with the AOA? Is it de-identified?

Only de-identified aggregate data is shared with the AOA. This data is used for benchmarking, i.e., the number of diabetic eye exams seen by all ODs across the country. No individual patient data or doctor specific data can be seen by the AOA. Only individual doctors can see their own data.

How is data de-identified?

Prometheus Research and your EHR vendor have worked together to program AOA MORE. Data fields like a patient’s name, address, phone number, etc., are fields that will only be included in your reporting. All eCQMs require patient- and provider-identifying data, but Prometheus Research does not share patient-identifying data fields or individual patient records with the AOA. The information about you and your practice is used only for you to see your dashboards and will not be visible to any reviewers or other users of AOA MORE. It is very important that your information stays private to you; therefore, AOA MORE will require that you enter a user’s name and password to view your data. All data viewed by the AOA will be in aggregate/cumulative formats.

Single Sign-On (“SSO”)

You can sign into AOA MORE using your aoa.org login credentials. The AOA employs Single Sign-On (“SSO”) to allow access to AOA MORE. SSO is a method by which one login ID works for multiple applications. In this instance, the same username and password used to access areas of aoa.org also can be used to access AOA MORE.

Do I need to install/download anything?

No. AOA MORE is configured at the level of the EHR vendor interface to retrieve the data from an
individual provider's EHR. All set-up and configuration should be handled for you by EHR vendors and Prometheus Research.

Can my staff (other than providers) access AOA MORE?

Yes, but only if you elect to provide access to your staff. Designated staff members may view your data in AOA MORE if you grant them access. Because you, the provider, grant these rights to view the data, you may elect to revoke these rights to staff members at any time, but this may require password changes, etc.

Where do I learn MORE?

You may obtain additional information at aoa.org/MORE. There you will find FAQs, videos, and other resources to teach you about AOA MORE and registry use in general.

Where do I go for technical support?

If you need technical support, first go to aoa.org/MORE. If you are unable to resolve your issue, additional resources and contact information are available on the website. You may click on the “Red” HELP Button to create a “Help Desk Ticket”.

I joined and cannot see my data on my AOA MORE dashboard. What happened?

If you have just signed up for AOA MORE, it can take up to four (4) weeks for your registration and verification to be finalized once your EHR is fully integrated. This critical time period is one where the AOA lets your vendor know you have signed up, the vendor adds your data to the registry, Prometheus tests that your data has been transmitted accurately from the EHR vendor and notifies the AOA, and the AOA notifies you directly. Once finalized, your data will be successfully “pushed” from your EHR to the registry, and you can then view AOA MORE dashboard statistics. After that, data is pushed once per week so you will not see updates instantaneously. You will see them weekly.

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