Succeeding in SGR Repeal and Other Federal Initiatives
President Barack H. Obama and Academy CEO David W. Parke II, MD, exchange greetings at the White House. The president hosted an April ceremony in the Rose Garden to celebrate the repeal of the sustainable growth rate — the focus of extraordinary advocacy efforts for more than a decade.
PHOTO: Saul Levin, MD
Won years-long battle for SGR repeal: For physicians, 2015 proved an historic year in Washington, D.C. It marked the end of the sustainable growth rate formula, and charted a course to a new era in health policy. The SGR repeal was the result of several years of tireless advocacy work by the Academy, its members and other like-minded physician groups. Ophthalmologists across the country played a key role in the SGR repeal, writing and calling their representatives in Congress to hammer on the importance of this legislation.
With the repeal now on the books, medicine’s challenge shifts to ensuring that CMS implements the replacement law as Congress intended. The new law is not perfect. Still, it remains a meaningful step toward achieving stable funding,which supports continuity of care for Medicare patients who rely on longterm, ongoing treatment from their physicians. The legislative effort that ended the SGR also preserved global surgical payments, which CMS had planned to jettison. Eliminating global surgical payments would have particularly hurt ophthalmologists. It would have significantly undervalued surgical work in our profession, which already faces higher practice expenses. At a minimum, ophthalmologists would have lost 4 percent of their income from surgeries, according to an analysis of CMS’s approach. The SGR repeal law averted that.
Extended VA directive for laser surgery by ophthalmologists: Legislative wins in 2015 didn’t stop with CMS. The U.S. Department of Veterans Affairs also renewed a decade-old directive that limits performance of all laser eye surgery in its medical facilities to ophthalmologists.
The VA first established this directive in 2004. It expired in November of last year. Through its commitment to ensuring that America’s veterans receive the best possible eye care, the Academy worked with VA ophthalmologists and leaders to successfully extend the initial directive. The new policy will remain in effect until May 2020.
Won battle to eliminate eye visit codes from CMS's misvalued codes list: The ophthalmology community outlasted a significant challenge to the value of a set of codes covering a patient’s initial medical eye exam. CPT 92002, one of these “eye visit codes,” was targeted under a Centers for Medicare and Medicaid Services initiative to ensure pay accuracy by identifying codes that may be misvalued. The Academy made a compelling case during the AMA/Specialty Society Relative-Value Update Committee (RUC) review process that this code was inappropriately targeted. This was successful and the eye visit codes were removed from the misvalued codes target list. This avoided a larger review of new and established eye exam visit codes because CMS requires that all codes related to ones identified as misvalued also be reviewed.
Strengthening Ophthalmology’s Influence in Washington
Senator Mitch McConnell (R-Ky.) and OPHTHPAC member Woodford S. Van Meter, MD, FACS, at a fundraising event. Read Dr. Van Meter’s thoughts
on the importance of getting involved in the political process by hosting political fundraisers for your elected officials.
The end of the SGR
For physicians, an historic year in Washington, D.C., was marked by the end of the sustainable growth formula, and charted a course to a new era in health policy. The SGR repeal was the result of several years of tireless advocacy work by the Academy, its members and other like-minded physician groups. Ophthalmologists across the country played a key role in the SGR repeal, writing and calling their representatives in Congress to hammer on the importance of this legislation.
Global surgical payments preserved The legislative effort that brought an end to the SGR also preserved global surgical payments. Eliminating global surgical payments would have been particularly detrimental to ophthalmologists. The approach CMS proposed would have under-recognized ophthalmology's higher practice expenses. It would have meant a minimum loss of 4 percent income from surgeries, according to an analysis of CMS’s approach.
Capping a particularly fortuitous legislative year, the U.S. Department of Veterans Affairs renewed a decade-old directive that limits performance of all laser eye surgery in its medical facilities to ophthalmologists. The new policy will remain in effect until May 2020.
Helping elect more physicians to Congress OPHTHPAC® is the Academy’s federal political action committee, working to support candidates and elected leaders at the federal level. It leverages the support of ophthalmologist investors to ensure medicine has a voice in the U.S. government. Often, this involves supporting physicians seeking public office in the U.S. Congress.
2015 OPHTHPAC Highlights:
- Supported the effort to repeal the Sustainable Growth Rate, the culmination of years of hard work lobbying Congress on this issue.
- Halted the elimination of global surgical payments.
- Secured the renewal of the Department of Veterans Affairs’ laser surgery directive, along with $10 million for defense vision trauma
- Implemented successful, innovative grassroots campaigns to further issues important to the ophthalmology community, including an ambitious campaignto engage ophthalmic patients in advocacy.
- Matched 86 percent of Congress with an ophthalmologist to enable more direct, personal advocating while providing advocacy trainingto Academy members via three webinars.
Impeding Threats to Surgical Safety Nationwide
Through the Surgical Scope Fund, the Academy works with state ophthalmological and medical societies to ensure patient safety and surgical standards. We uphold this commitment by opposing state-level efforts to grant medical and surgical privileges, legislatively or through regulations, to non-physician health care practitioners.
In each state, the laws and people change, but the mission remains unchanged: support the ophthalmology community’s goals in every region.
In California, a major, coordinated effort with the California Academy of Eye Physicians and Surgeons turned back a major threat to the surgical privileges of trained physicians. If the Academy and its allies failed, optometrists would have been authorized to do eye surgery with minimal education and training. However, the California Academy of Eye Physicians and Surgeons, the California Medical Association and the Academy worked closely to execute an aggressive advocacy campaign. We successfully educated lawmakers on the risks of allowing optometrists to perform surgery without the necessary level of education and training. As a result, the bill died before it could become law.
Surgery-by-surgeons goes undefeated
Over the last 17 years, the Surgical Scope Fund has been instrumental in helping defeat attempts by organized optometry to gain surgical
privileges in 32 states and territories. We went undefeated in those fights in 2015, and look at 2016 with confidence that we can turn back the challenges we expect to emerge.
The Academy worked closely with numerous other state ophthalmic societies to derail legislation that would have given inappropriate surgical privileges to non-physician eye care professionals. The Academy strung together a seven-state undefeated record, turning back efforts by optometry to make gains on a number of legislative issues. The Academy strung together a sevenstate undefeated record, turning back efforts by optometry to make gains on a number of legislative issues.
Where the Academy’s efforts protected ophthalmologists and their patients in 2015:
- Defeating attempts to add scalpel, laser and injection surgical privileges in California, Alaska, Delaware and Texas
- Fought off attempts to broaden surgical scope laws in Massachusetts, New Mexico and Puerto Rico
- Prevented optometrists in Alaska from performing all injections (minus intravitreal) and from prescribing any controlled substance
- Important pediatric victories in California and Minnesota to defeat optometry-backed mandates for comprehensive eye exams for children
- A pilot program to screen for Irlen Syndrome was stopped in Maine
- Early prescription refill rights for patients who use eye drops were gained in seven states