With commitment for the required 60 votes, Senate majority leader Harry Reid, D-Nev., is moving toward final passage — maybe on Christmas Eve — on a revised health care reform bill (H.R. 3590) that was introduced Saturday. The bill offers some good news. In an accommodation to physicians, the Senate dropped:

• Medicare buy-in for 55-64 year olds;
• A cosmetic surgery tax;
• A Medicare enrollment fee for physicians; and
• A budget neutrality requirement that balanced a bonus for primary care on the back of specialists.

Also dropped was a controversial amendment by Sen. Robert Byrd, D-W.Va., that promoted comprehensive eye exams for infants from six months to one year old performed by optometrists. The amendment was a major issue for the Academy, the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Pediatrics. The Academy joined optometry, however, in a successful effort to block an amendment mandating stand-alone vision plans in the new health insurance exchange.

Despite these positive steps, the Academy will not support the final Senate bill as many problematic provisions remain. The fight for a better bill for patients and physicians is far from over. As the Senate and House merge their health care reform bills over the next few weeks, the Academy will focus on efforts to eliminate the independent Medicare cost control commission and a mandatory quality reporting program for physicians. We will also fight a new provision that allows individual physician data to be made public in the Medicare Physician Compare program.

Practice Expense
The clock has run out on efforts by some specialties to halt the Jan. 1 implementation of new practice expense data that sets ophthalmology on a path for an 11 percent improvement by 2014. As a result, ophthalmologists will see a minimum improvement of 5 percent on Jan. 1.

Sustainable Growth Rate
There will be no sustainable growth rate (SGR) cut on Jan. 1. The Senate acted over the weekend to pass a Department of Defense appropriations bill that included a 60-day zero update for physicians – a provision that derails the scheduled 21 percent SGR cut. The one-year SGR fix in the Senate health reform bill was dropped, and the AMA reports that they have a commitment by Senate leadership for a vote on a long-term SGR fix before the end of the 60-day SGR bridge period.

CMS has instructed its carriers to hold all 2010 claims for 10 business days (until Jan. 15) in order to assure proper payments. Physicians who submit charges less than the 2010 (revised upward now with the SGR fix) MPFS amount will need to request an adjustment (in other words, if you have the 21 percent reduction built into your charges). According to CMS, submitted charges on claims cannot be altered without a request from the physician.