Washington, D.C. - The American Academy of Ophthalmology continues to fight for fair physician payment as it names Medicare reimbursement as one of its top priorities for 2007. The Academy's agenda was set at its Secretariat for Federal Affairs Meeting in Washington on Jan. 27, 2007. The Academy's Federal Secretariat comes together once a year to discuss a wide array of interests to ophthalmology.

"Ophthalmology is facing a number of significant reimbursement challenges in 2007, and our agenda reflects the areas in which we will continue our successful advocacy efforts to ensure ophthalmologists we are fighting for issues that are important to them." said Michael X. Repka, MD, secretary for federal affairs

In addition to the sustainable growth rate (SGR) Medicare challenges, the Academy will spend a significant amount of time and resources on re-establishing the link between eye visit codes and evaluation and management (E/M), advancing a medicine-wide practice expense survey, supporting children's vision screening legislation, and working to increase funding for the National Institute of Health's National Eye Institute.

Fixing the Sustainable Growth Rate (SGR)  

The Academy, along with other organizations such as the American Medical Association (AMA) was successful in halting a 5 percent cut in Medicare payments in 2007. In response to predictions that a reduction of 10 percent is possible in 2008, specialty organizations are banding together to fight for a reasonable approach for updating physician payments. Options for reforming the SGR will be sent from MedPAC to Congress in March, and the Academy expects to work closely to shape any reform legislation to ensure fairness for ophthalmology.

Pay-for-Performance

The Academy will continue to focus on quality of patient care and developing appropriate measures for ophthalmology based on its Preferred Practice Patterns. In October of last year, an Academy-led effort resulted in the development of eight quality measures by the AMA's Physician Consortium for Performance Improvement (PCPI). Quality measures for glaucoma, macular degeneration, cataract and diabetic retinopathy were endorsed by the Ambulatory Care Quality Alliance (AQA) and CMS has proposed to include them in the 2007 Physician Voluntary Reporting Program (PVRP). The measures are currently under review by the National Quality Forum (NQF). The Academy will also continue to educate ophthalmology on how to successfully qualify for a 1.5 percent bonus.

Practice Expenses 

In response to Medicare fee schedule changes from the five-year review of work values and the Centers for Medicare and Medicaid Services (CMS) policy changes that relate to practice expenses; the Academy is fighting a practice expense change which leads to a 3 percent cut to ophthalmology payments phased in by 2010. The Academy continues to lead a coalition that derailed a similar plan in 2005 for 2006. The cuts will be phased in over four years and the Academy will strive for implementation of a specialty-wide practice expense survey with the goal of halting the cut by 2009, and appropriate payments for ophthalmology before the final cuts are effected.

Other Priorities

The Academy will continue its efforts in addressing the needs of the nation's uninsured children by supporting the Vision Care for Kids Act of 2007. This legislation is aimed at combating undiagnosed and untreated vision problems. While many states have screening programs in place, uninsured children often do not have the resources for diagnosis and follow-up. This legislation will bridge the gap in vision care by partnering with these states and providing grants for the eye exams and follow-up treatment. The Academy will work other organizations, such as the Vision Council of America and Prevent Blindness America to ensure that Congress makes this a top priority for 2007.

With the change in leadership in Congress, the Academy is hopeful that through the National Alliance for Eye and Vision Research (NAEVR), an Academy-sponsored advocacy group, that additional research funding will be available for FY2007. The Academy is also working with the Food and Drug Administration (FDA) to ensure that ophthalmic drugs continue to be reviewed efficiently and that new, safe, and effective therapies become available to ophthalmologists and patients.