At the federal and state levels, we have taken strong actions to protect our profession and patient care. The Academy’s key ophthalmology federal priorities for the year include: fair Medicare reimbursement; reduced prior authorization and step therapy burdens; and drug policy reforms to address shortages, high prices and patient access.
As part of our advocacy efforts, the Academy and its political action committee, OPHTHPAC®, are working to address the critical issues facing ophthalmologists and their patients. Through OPHTHPAC’s support, there are now 17 physician members of Congress — including ophthalmologist Rep. Mariannette Miller-Meeks, R-Iowa — who are strong champions for ophthalmology.
Here, in our 2021 Advocacy Mid-Year Report, are the Academy’s top nine issues and the actions we have already taken during the first six months of the year.
Medicare Physician Payment Reform
At the end of 2020, the Academy, OPHTHPAC and the Surgical Care Coalition — which we helped establish — successfully averted steep Medicare payment cuts for ophthalmology in 2021.
Where We Are Today
In addition to getting Congress to intervene in mitigating a roughly 6% cut in Medicare payments for this year, the Academy helped push Congress to extend a moratorium on the Medicare 2% sequestration cut until the end of 2021. These were only short-term fixes, and now surgeons are facing significant Medicare physician payment cuts in 2022 unless Congress acts. The Academy, OPHTHPAC and the Surgical Care Coalition are working to prevent or soften cuts in the Centers for Medicare & Medicaid Services' proposed 2022 Medicare Physician Fee Schedule released July 13.
Step Therapy and Prior Authorization
Prior authorization for medical services and step therapy requirements for Part B drugs delays and disrupts the sight-saving care ophthalmologists provide patients. The policies also can place needless administrative burdens on physicians.
Where We Are Today
The Academy is calling on CMS to reinstate a 2012 Obama-era ban on step therapy in Medicare Advantage plans for Part B drugs that the last administration reversed in 2018. The Academy-led Regulatory Relief Coalition is also working with congressional allies to advance legislation improving the prior authorization process for Medicare Advantage. Over 150 House co-sponsors and more than 275 stakeholders have endorsed HR 3173. Aetna’s recent cataract surgery policy is a startling example of prior authorization abuse. The Academy is acting staunchly to get the policy rescinded.
Drug Shortages and Prices
The Academy is seeking opportunities under the Biden administration and the 117th Congress to develop solutions for reducing drug shortages and curbing spiking drug prices, which prohibit our patients from receiving timely access to sight-saving treatments.
Where We Are Today
The Academy has been proactive in addressing and mitigating the effect of drug shortages. We have worked with the Food and Drug Administration and medical industry to resolve or achieve a temporary solution for two drugs — Phospholine Iodide and Visudyne. We endorsed new legislation in June that would provide pathways to address shortages and ensure ophthalmology practices can obtain important compounded drugs they need to treat patients.
Fair Reimbursement for Part B Drugs
In late 2020, the Academy and members urged lawmakers to halt CMS’ Most Favored Nation model, which was billed as a way to make U.S. drug prices more competitive with international rates, because it could prevent patients from getting timely access to sight-saving treatments. Because the Biden administration considers reforming Part B drug payments, we continue advocating for physicians to be kept whole and treated fairly.
What’s Happening Today
The Academy continues to advocate for withdrawing the Most Favored Nation model. It is on hold until the Biden administration determines how to proceed. Meanwhile supply chain disruptions are making it challenging for ophthalmology practices to get repackaged Avastin for patients. With increased Avastin shortages and rising prices, the Academy urges CMS and Medicare administrative contractors to make needed payment improvements.
Vision Research Funding
Increasing vision research funding for the National Institutes for Health (NIH) and the National Eye Institute (NEI) is a key Academy priority, and our advocacy is paying off.
What’s Happening Today
The Academy is advocating for Congress to increase NEI funding to $900 million and NIH funding to $46.1 billion for fiscal year 2022. The Biden budget proposal includes nearly $52 billion for NIH and $859 million for NEI. In addition, the Academy continues to support the Research Investment to Spark the Economy (RISE) Act, which if passed will provide $10 billion to NIH to address the negative effects of COVID-19 on research projects.
VA National Standards of Practice
The U.S. Department of Veterans Affairs (VA) issued a rule last year that preempts state scope of practice laws and would establish “national standards of practice” for VA health care professionals. Although the rule stopped short of establishing these standards, the Academy and physicians are concerned it would expand nonphysician providers’ scope of practice and lower veterans’ standard of care.
What’s Happening Today
The Academy urges the VA to rescind its rule and is educating members of Congress on how it would lower the standard of care at veterans’ facilities.
State Scope of Practice Laws
The number of states across the country with harmful optometric scope laws is growing. The Surgical Scope Fund is needed now more than ever to help states facing dangerous scope legislation preserve surgery by surgeons and patient safety.
What’s Happening Today
In Mississippi and Wyoming, lawmakers passed dangerous optometric surgery bills in 2021 despite ophthalmology’s efforts. However, we successfully defeated legislation that would have allowed optometrists in Alabama, Florida, Oregon and Texas to perform eye surgery. We blocked a Utah regulatory initiative, helped enact an early eye drop prescription refill legislation in Arkansas and a medical waste bill in Illinois. Members and the Academy’s Surgical Scope Fund supported these patient victories.
The IRIS Registry and MIPS Bonuses
The Academy’s IRIS® (Intelligent Research in Sight) Registry continues to be the best tool for achieving success in the Merit-Based Incentive Payment System (MIPS). Ophthalmologists in practices whose electronic health records are integrated with the IRIS Registry tend to have higher MIPS scores.
What’s Happening Today
Most ophthalmologists who reported data in 2019 for MIPS through the IRIS Registry achieved a perfect score and saw a 1.79% bonus in 2021. More than 85% of IRIS Registry participants qualified for the superior bonus in 2021 based on 2019 performance. No ophthalmologist who submitted MIPS through the IRIS Registry received a penalty.