A message from the Academy's CEO/EVP David W. Parke II, MD, and Board President Michael W. Brennan, MD. Dr. Parke expanded on this decision in a Nov. 12 letter.

Nearly a year ago the Academy, along with the American College of Surgeons (ACS), the AMA and other specialties, began negotiations with Congressional leaders on a health care reform bill. Throughout those negotiations, the Academy has called for expanded coverage and maintenance of a pluralistic health care system that provides choices for patients and physicians. As part of health care reform, the Academy has sought repeal of the sustainable growth rate (SGR) and creation of a new Medicare payment system that is fair to medicine.

Health care reform legislation has now reached a crucial juncture. Final adjustments are being made to legislation in the House and Senate, and the stage is set for votes on the bills. We wanted to let you know that, as a result of Board action this week, the Academy has issued its opinion on the House and Senate bills.

The Academy joined the ACS and 18 other surgical groups, giving final notice to senators that, without changes, all groups would oppose the Senate’s health care reform bill. The Senate bill includes troublesome provisions including:

• An independent Medicare advisory commission that is charged with cutting Medicare spending by 1.5 percent per year
• A 5 percent penalty for the top 10 percent of physicians who are resource-use outliers
• Penalties for non-participation in Medicare’s Physician Quality Reporting Initiative (PQRI)

There has been no sign of changes despite our detailed recommendations and face-to-face meetings with Senate leadership.

Today the Academy gives its support to two House measures, the Medicare Physician Payment Reform Act (H.R. 3961) and the America's Affordable Health Choices Act (H.R.3962). House leadership has listened and been responsive to the Academy’s key concerns in these bills. H.R. 3961 would permanently reform the Medicare physician payment system by repealing the SGR and eliminating the accumulated debt it has produced, replacing it with a new physician payment formula. We estimate that this change will improve payments to ophthalmology by a minimum of 4 percent over the next five years compared with current payments.

H.R. 3962 is the larger health care reform bill that would expand coverage, promote and incentivize high-quality care and maintain a pluralistic health care system. The bill includes key provisions developed by ACS and the Academy in our united surgical agenda:

• Moves to multiple conversion factors – eye visit codes receiving the same preferential treatment as E&M codes in the new system
• Does not create an independent Medicare payment advisory commission
• Provides a bonus for primary care that is not paid for by cuts to specialties
• Exempts ultrasound and other in-office procedures from major imaging payment cuts
• Preserves voluntary participation in PQRI
• Requires pilot testing of new physician payment reform ideas, such as accountable care organizations (ACO)
• Makes physician participation in the public insurance plan optional, and allows negotiated rates to pay no less than Medicare rates in effect
• Provides grants to test alternative liability reforms at the state level, while protecting current, stronger state laws that include caps and other limitations

We understand that no single piece of legislation is perfect and that more improvements are needed before a final bill emerges from a joint House-Senate conference committee. Because of the likelihood of problematic provisions in the Senate legislation, the House position must be especially strong during the House-Senate reconciliation effort. The Academy will continue to participate in the health care reform process and work with House and Senate leadership to address remaining concerns and ensure that final legislation meets our key objectives.