Letters to the editor

Dear Editor,

Your readers’ attention was dramatically captured by the cover of the January 2016 edition of Ophthalmology Management entitled “CMS wields the axe; now what happens?” The metaphor of an axe to symbolize the Medicare reimbursement cuts to glaucoma surgical procedures was unmistakable but unfortunate because it was misapplied to the iStent resting on a log stump. CPT 0191T (insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach) was not one of the procedures whose Medicare reimbursement was reduced in January.

Physician reimbursement for the iStent procedure, along with other Category III codes, is paid at a rate determined by the local Medicare Administrative Contractor on a case-by-case basis and therefore not included in the national Medicare Physician Fee Schedule.

For 2016, Congress required CMS to address Medicare payment rates for overvalued procedures in the Achieving a Better Life Experience Act of 2014. Some glaucoma and retina procedures were significantly impacted including: trabeculectomy (-19%), trabeculoplasty (-19%), panretinal photocoagulation (-66%), and retinal detachment repair (-19%). While any cuts in physician reimbursement are unwelcome, they are not unexpected.

The political debate about protecting the Medicare program from budgetary challenges or possible insolvency has raged for decades. The driving factors threatening Medicare are a swelling population of baby boomer beneficiaries, longer life expectancies and higher expenditures associated with advances in medical technology including pharmaceuticals.

While Congress chips away at the growing national healthcare expenditures, successful healthcare reform is elusive. The numerous failures of state cooperative health insurers (or co-ops) created under a federal grant and loan program in the Affordable Care Act are evidence of a substantial problem with the current effort at reform.

Your readers engaged in strategic planning to cope with these turbulent times in healthcare ought not to expect steadily increasing physician payment rates in the future. They can expect to see more patients and hence perform more procedures.

An old Chinese proverb says, “When the winds of change blow, some people build walls and others build windmills.” Maybe your next cover should have a windmill on it.

Sincerely,
Kevin J. Corcoran, COE, CPC, CPMA, FNAO
President, Corcoran Consulting Group
San Bernardino, Calif.

Dear Editor,

As a reader of Ophthalmology Management who has relied on your fine publication as an incredible resource for the ophthalmologist practicing in the modern era, I was surprised to come across an inaccurate and misleading cover image on the January 2016 issue.

While the cover story article on changes in CMS reimbursement rates entitled, “CMS wields the axe; now what happens?” was well written and perfectly accurate, the cover included a startling graphic of the iStent Trabecular Micro-Bypass (Glaukos Corp.) as the target of a falling axe. The image strongly implied that reimbursement for the iStent had been cut by CMS, and this is certainly not the case.

It is true that other glaucoma therapies including trabeculoplasty, tube shunts and trabeculectomy have all seen cuts by CMS in reimbursement over the past several years. However, the iStent has not had any such reduction. In fact, each passing month sees additional commercial payers reimbursing use of the iStent, making it even easier to use this option.

I think it is particularly important to recognize that our use of the iStent continues to be supported by CMS. Not only is it a safe and effective treatment for our patients with glaucoma, but the iStent was projected to offer a cost savings to both patients and health plans in comparison to topical medications over a six-year period.¹ In addition, this therapy may prevent patients from needing riskier and costlier glaucoma surgeries in the future.

I have seen very positive outcomes with the iStent in my patients, and will be deeply saddened if your mistake causes other physicians to not use the iStent as often as appropriate.

Sincerely,
Nathan Radcliffe, MD

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