Payments for ophthalmic surgeons and other physicians are falling in 2025, with doctors facing a 2.83% cut in Medicare reimbursements. Unfortunately, that cut is just the latest in a long trend of declining payments, emphasized Parag Parekh, MD, MPA, during a presentation Friday at the 2025 annual meeting of the American Society of Cataract and Refractive Surgeons (ASCRS) in Los Angeles.
“Five years ago this month, we were in the midst of COVID, and people would applaud as doctors and nurses went to work,” observed Dr. Parekh, the chair of ASCRS’s Government Relations Committee. “Now, here we are getting our payments cut year after year. It’s quite a slap in the face—going from heroes to zeroes, as they say.”
Figure 1. Medicare’s reimbursement for complex cataract surgery (CPT 66982) has declined by nearly 12.5% from 2018 ($815.29) to 2025 ($714.53). The decline is even greater when it comes to simple cataract surgery (CPT 66984), which has dropped by nearly 20.5% in that time, going from $656.27 in 2018 to $521.75 in 2025.
The 2025 Medicare cut is just the latest in a long decline in physician reimbursement. According to the American Medical Association (AMA), when adjusted for practice cost inflation, physician payment under Medicare has declined by 33% from 2001 to 2025. Over the past 7 years, reductions in cataract surgery reimbursement have been particularly steep (Figure 1). “Every other part of medicine keeps going up,” Dr. Parekh said. “Payments to hospitals, to Medicare Advantage plans, to drug companies, to nursing homes—they all rise. But physicians are the only group consistently seeing cuts.”
Earlier this year, sympathetic lawmakers in the House of Representatives introduced the Medicare Patient Access and Practice Stabilization Act (HR 10073), he noted. This legislation would reverse the cut and instead provide a modest 1.8% increase to better align payments with inflation and rising practice costs. However, the bill is still being reviewed in committee and Congress is not expected to act until later this year.
Medicare’s Reimbursement Formula
Medicare determines physician reimbursement using a formula that combines relative value units (RVUs) with a conversion factor (CF) (Figure 2). RVUs measure the value of a medical service based on 3 components: physician work (which includes time, skill, and intensity), practice expenses, and malpractice costs. Each service is assigned a total RVU score, which reflects its relative complexity and resource use. This score is then multiplied by the CF—a dollar amount set by the Centers for Medicare and Medicaid Services (CMS) and updated each year—to calculate the final payment. Although RVUs vary by procedure, the CF applies uniformly to all services and is subject to change due to budget neutrality rules and legislative adjustments. “Every time you hear about a 2% or 5% cut to all doctors, that’s the conversion factor,” explained Dr. Parekh.
Figure 2. The Medicare PFS payment rate formula shows how the payment rate for each procedure is determined.
Certain aspects of the RVUs are based on hard data, such as the cost of supplies for the procedure or the malpractice insurance expense. But when comparing procedures across various medical specialties, other aspects are more subjective. The Relative Value Scale Update Committee (RUC) is an advisory committee organized by the AMA and composed of physicians from across specialties. It evaluates procedures and recommends an appropriate RVU level to CMS.
“What the RUC does is try to compare procedures—cataract surgery to a lung biopsy or a lobectomy,” said Dr. Parekh. “This comes down to 2 key components. One is, how long does the procedure take? The other is, how intense is the procedure? Then they must determine, what is a more difficult procedure? Which takes more judgment? Which has a higher risk of complications? They must compare across different procedures and across different fields to try to figure that out. That is where the most controversy is generated.”
Time is easier to quantify than intensity, so short but intense procedures that require high skill like cataract surgery are vulnerable to being devalued under the current system. Because of this, Dr. Parekh believes that the RUC advisory system is better than simply allowing bureaucrats at CMS to make decisions on procedure difficulty.
“I would much rather have doctors involved in the process,” he said. “It's a difficult process, it's hardly perfect, but at least doctors can appreciate the intensity of different procedures, whereas I don't think non-doctors would have that keen sense of it. It’s hard to quantify how intense something is, but it’s much easier to figure out how long a procedure is, so what would happen is shorter procedures would get devalued and longer procedures would maintain or maybe even increase their values.”
How Can Doctors Help Themselves?
Dr. Parekh says that ophthalmologists have an opportunity to positively influence payments in their specialty because the RUC relies on regular surveys to gather data on the length and intensity of procedures. Physicians who regularly perform a particular procedure may be asked to estimate the preoperative and postoperative work, intraoperative time, and the mental and physical intensity involved.
“Whenever you get surveyed by the RUC or by your society, you have to be very honest,” said Dr. Parekh. “We tend to underestimate how long something actually takes. You can brag about how quick you are when you’re joking around the water cooler with friends, but you don’t want to exaggerate on these surveys.”
Figure 3. Continuing advocacy is essential because the government has control over so many things that affect the care ophthalmologists can provide to their patients, says Parag Parekh, MD, MPA, who is stepping down after 6 years as chair of ASCRS’s Government Relations Committee. Susanne Hewitt, MD, will take over as chair of the committee this spring.
Another way to push back against the erosion of physician payments is by supporting ASCRS’s government relations initiatives. The ASCRS political action committee, eyePAC, advocates on behalf of ophthalmic surgeons and their patients. By contributing to eyePAC, said Dr. Parekh, ASCRS members help the society participate in the policymaking process, ensuring that the perspectives and concerns of ophthalmic surgeons are considered in legislative decisions (Figure 3).
The ASCRS Government Relations Committee has scored some big wins in recent years, Dr. Parekh noted, including a fight against burdensome prior authorization policies for cataract and laser surgeries. The committee also advocates for CF increases.
“In addition to donating to eyePAC, you can get involved by calling your congressman and senator and building a relationship with them,” Dr. Parekh advised. “Tell our side of the story—that specialists are important and doctors are not getting overpaid, and in fact that’s one of the reasons that you see so many practices go under. We must speak up and say, ‘this is enough.’ If we don’t, we’re inviting more cuts.”