Policyholder Services

Revised ROP Requirements and Recommendations

The American Academy of Pediatrics Section on Ophthalmology, the AAO, and the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) released a revised Policy Statement (PS) called “Screening Examination of Premature Infants for Retinopathy of Prematurity.” The new PS was published in Pediatrics Volume 131, Number 1; it can be downloaded from http://pediatrics.aappublications.org/content/131/1/189.

OMIC’s ROP Task Force reviewed the new PS and accordingly revised many of our ROP documents to reflect recommendations found in the Policy Statement. Revisions address initiation of screening, follow-up intervals during screening, initiation of treatment, and conclusion of treatment.

The PS also for the first time includes a discussion of remote screening and the use of anti-VEGF agents for ROP treatment. OMIC’s risk management recommendations and conditions of coverage for ROP are consistent with the new Policy Statement. For example, we adopt the PS recommendations on follow-up after treatment with anti-VEGF agents as conditions of coverage, and require exams at one week intervals until the ophthalmologist confirms “full retinal vascularization in close proximity to the ora serrata for 360° — that is, the normal distance found in mature retina between the end of vascularization and the ora serrata.” In two instances, OMIC’s position differs from the PS:

• ANTI-VEGF
  • OMIC’s sample consent form has more indications for treatment than the PS, based upon review of articles on the use of anti-VEGF agents. At its May 2013 Board meeting, OMIC expanded its approved indications for the treatment of ROP with anti-VEGF agents to include posterior Zone II aggressive posterior ROP.
• REMOTE SCREENING OF ROP
  • OMIC is more conservative in calling for a binocular indirect exam prior to discharge from the hospital as opposed to before the end of acute screening. This recommendation is based upon our claims experience, which shows that discharge is the riskiest moment in the process of care.

RISK MANAGEMENT RECOMMENDATION AND CONSENT FORM CHANGES
OMIC revised “ROP: Creating a Safety Net,” the clinical guideline tables in the hospital and office toolkits, the consent forms for laser and anti-VEGF, the letters to the parent/caregivers, and the risk management recommendations for anti-VEGF treatment of ROP. All of these documents are included in the toolkits. No changes have been made to the sample process-of-care protocols. To access these documents, please go to the ROP page on the OMIC website and click on the download button: http://www.omic.com/rop-creating-a-safety-net/.

If you would like a copy of the Safety Net material that highlights the changes, or have any questions about ROP, please contact OMIC Risk Manager Anne M. Menke, RN, PhD. She may be reached at 800-562-642, extension 651, or by email at amenke@omic.com. All calls to Risk Management are considered confidential.