A panel of lobbyists — including Mark Cribben, JD, ASCRS’s director of government relations; Amanda Wiefgrefe, MScHSRA, the associate director of government relations; Jessica Peterson, MD, MPH, the senior director of value-based care policy at Anatomy IT; and retired ASCRS director of government relations Nancey McCann — discussed the future of Medicare physician reimbursement during a post-lunch session of the American Society of Ophthalmic Administrators (ASOA) at the ASCRS annual meeting on Friday in Boston.
Mr. Cribben noted that in March, Congress passed a partial reduction of the scheduled Medicare physician fee cut. The legislation partially offsets a doctor pay decrease that was included in the 2024 Centers for Medicare and Medicaid Services (CMS) Physican Fee Schedule final rule. However, Mr. Cribben pointed out that Congress’s action did not completely eliminate the 2024 CMS pay cut for doctors, and that since the change is not retroactive to the beginning of the year, physicians will still experience a more than 2% cut in Medicare reimbursements. “Permanent solutions are needed to provide an inflationary update for physician payments, reform budget neutrality requirements, and address problems with the MIPS quality reporting program,” he said.
ASOA and ASCRS supports some legislation that has been introduced in the House of Representatives to address these issues. H.R. 2474, the Strengthening Medicare for Patients and Providers Act, has 126 co-sponsors. Currently, Mr. Cribben noted, doctors do not receive payment increases based on inflation, which increased by 73% from 2001 to 2023; this bill would provide an annual inflation update for physician payments equal to the Medicare Economic Index (MEI). Another House bill, H.R. 6545, the Physician Fee Schedule Update and Improvements Act, would adjust the budget neutrality issue that currently forces CMS to reduce physician payments. The legislation would increase the budget neutrality threshold from
$20 million to $53 million in 2025, then increase threshold by the MEl every 5 years starting in 2030. “This is a fairness issue,” said Mr. Cribben.
Ms. Wiefgrefe discussed the new Healthcare Common Procedure Coding System (HCPCS) add-on code G-2211, introduced at the start of 2024. “This code really is designed to capture a long-term relationship between provider and patient,” she explained. “The reimbursement is $16.04, which doesn’t sound like a lot, but there is no cap.” She did note that the G-2211 code cannot be used with eye codes 92002-92014, or with modifier -25.
Ms. Peterson provided an overview of the Quality Payment Program, discussing changes for 2024. She noted that completion of the SAFER guides, to ensure that patients’ health records are protected, is now required, not voluntary. She also noted that MIPS now has a performance period of 180 consecutive days, which could affect practices that change their electronic health record systems after July 5 of this year. “If you are planning an EHR transition, I would try to make sure that you have a whole 180 days,” she advised. “Otherwise you’re going to have to file for hardships.” In a positive change, ophthalmic groups will no longer be scored under the diabetes cost measure for MIPS, she said.
Ms. McCann, who continues to consult for ASCRS 3 years after her retirement, discussed current lobbying initiatives. One of these is to eliminate barriers in the current payment system for cataract surgery. ASCRS has proposed a bundled payment model that would enable appropriate patients to receive same-day bilateral cataract surgery. The payment model would ensure adequate payment for surgeons, maintain/improve outcomes for patients and reduce spending for payers, Ms. McCann said.
The panelists all discussed the importance of surgeons and administrators being involved in lobbying efforts, by commenting on proposed rules and establishing relationships with their local congressional representatives. “You know firsthand how public policy is affecting your patients and your practice,” commented Ms. McCann. “Use your technical knowledge to ensure laws and regulations truly reflect your practice.”
ASOA and ASCRS have collected information related to physician reimbursement for 2024 on the website at https://ascrs.org/advocacy/macra-center.