CMS’ proposed changes for 2021 would see a 6% reimbursement cut in ophthalmology.

The AAO is urging Congress to take action that would blunt a set of proposed Medicare cuts that, the Academy says, would heap even more financial distress on a specialty still struggling in a pandemic-induced recession.

The cuts proposed by CMS would take effect at the start of 2021 and would reduce payments to most surgical specialties. Ophthalmology, according to the AAO, would be one of the top specialties affected, facing a 6% cut to reimbursements under the proposal. The payment cuts have been triggered by a CMS policy change on evaluation and management (E/M) coding that is selectively applied to certain specialties, according to the AAO.

The AAO is requesting congressional action alongside the Surgical Care Coalition, a group of 12 medical associations representing more than 150,000 surgeons across the United States.

A “DOUBLE HIT”

“Any cut is bad, but the cuts this year, building upon loss of patient care visits in response to the pandemic, the added expenses of managing payroll and protective equipment for seeing patients safely, means it’s a double hit,” says Michael Repka, MD, MBA, clinical spokesperson for the AAO.

While the AAO is also going through the standard regulatory appeal process commenting on CMS’ alterations, they are still on a timeline to take action on these changes before the start of 2021, continues Dr. Repka. This is why the AAO and Surgical Care Coalition are taking the additional step of contacting Congress to obtain their assistance. “This is not something we can wait on to do in a step-wise fashion,” he says.

HOW CONGRESS COULD HELP

The AAO has two proposals for how Congress can help mitigate the financial burden of these cuts, says Dr. Repka. First, they can waive budget neutrality requirements, which would allow CMS to increase payments for E/M visits, yet not reduce the payments for other services like surgery and ophthalmology visits. That could offset the cuts by about 10%, says Dr. Repka.

Those increased rates were promised to primary-care providers for all the hard work they have done during the pandemic, he continues. The second effort involves providing the same fix to postop care visits enjoyed by the E/M codes. Postop care for surgery including retinal detachment and cataract surgery constitute a sizable percentage of surgery payments. “Knocking those down is not fair, has a profound negative effect and is something we believe Congress could rectify.”

While Dr. Repka hopes for a resolution soon, he is also aware that congressional action probably cannot be effectively undertaken until after the presidential election in November.

OTHER VIEWPOINTS

Larry Patterson, MD, founding partner of Eye Centers of Tennessee, says he is “very concerned” that some practices still may not survive this year’s COVID disruption and cataract reimbursement cuts, let alone any planned cuts for 2021.

“I think my practice will be okay because we have become very large and diversified and are not owned by private equity. But I can see some folks out there just shutting down by next year,” he says.

Suzanne L. Corcoran, of Corcoran Consulting Group, is optimistic about the future of ophthalmology, despite the proposed changes in the Medicare Physician Fee Schedule for 2021. “Reimbursement for all established patient E/M codes except 99211 is increased by about 15%; the number of Medicare beneficiaries is increasing 3-4% per year; ophthalmic procedure volume is increasing rapidly for AMD, cataract and glaucoma; and utilization patterns will shift to avoid much of the 7% cut in eye codes,” she says. “In our research, we identified significant time savings of about 45 minutes per day for physicians due to the reduced chart documentation requirements — time that can be used to see a few more patients.”

Ms. Corcoran agrees with ASCRS and AAO that CMS should use the same value for calculating postoperative care as for billable exams.

“We anticipate that ophthalmology will do very well in 2021 compared to 2020, especially due to the impact of COVID-19,” she says. OM