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  • Midway through 2022, the Academy and its political action committees, OPHTHPAC® and Surgical Scope Fund have been working to address the critical issues facing ophthalmologists and their patients.

    That’s included hosting our Congressional Advocacy Day in April, when ophthalmologists from all over the country came to Washington, D.C., to talk with lawmakers about issues like prior authorization reform, physician payment reform and increased investment in vision research.

    In our 2022 Advocacy Mid-Year Report, we highlight the Academy’s top 10 issues and explain the actions we have already taken during the first six months of the year.

                   
    A delegation of ophthalmologists from Michigan attended Congressional Advocacy Day at the Academy’s Mid-Year Forum 2022 and discussed prior authorization reform with members of Congress. Photo credit: Olivia Killeen, MD

    Prior Authorization

    Prior authorization requirements for medical services and procedures delay and disrupt the sight-saving care ophthalmologists provide patients. These policies also place unnecessary administrative burdens on physicians. The Academy has used Aetna’s new prior authorization requirements for cataract surgery as a classic example of the documented abuse of prior authorization by health plans. We have doubled our efforts with a public relations campaign against Aetna and are making progress on legislation.

    Where We Are Today

    The Academy has been steadily building momentum for prior authorization reforms on Capitol Hill. The Academy-led Regulatory Relief Coalition is also working with congressional allies to advance legislation to reform the prior authorization process in the Medicare Advantage program.

                   

    Step Therapy

    Step therapy, which requires patients to try and fail on insurers’ preferred medications before physician-prescribed therapy is covered, was banned for Part B Drugs under Medicare Advantage plans in 2012. The previous administration reversed the ban in 2018 and the Academy has been pressing the Centers for Medicare & Medicaid Services (CMS) to reinstate the prohibition.

    Where We Are Today

    Throughout the year, the Academy has collected stories illustrating the ways step therapy has harmed patients and interfered with the physician-patient relationship. It has limited successful outcomes for some of the sickest Medicare beneficiaries. We have shared those stories with CMS and followed up with a letter to CMS Administrator Chiquita Brooks-LaSure (PDF), reiterating the concerns of provider and patient organizations, including the Better Medicare Alliance.

                   
    Academy Vice President of Governmental Affairs Cathy Cohen meets with ophthalmologist and member of Congress, Rep. Mariannette Miller-Meeks, MD, R-Iowa.

    Medicare Physician Payment Reform

    We’ve had success mitigating a roughly 9% cut in 2022 Medicare payments with a major congressional push that engaged thousands of ophthalmologists and other physicians across the country. Although a moratorium on a Medicare 2% sequestration cut began phasing out with a 1% cut on April 1, the Academy, the American Medical Association (AMA) and hospitals have renewed the call for a moratorium in view of the continued pandemic. The Academy and OPHTHPAC, the Academy’s federal political action committee, and the Surgical Care Coalition are now focused on preventing or softening cuts expected for 2023 in the Medicare Physician Fee Schedule.

    Where We Are Today

    This year, the Academy joined the AMA in a multiorganization campaign to revisit the Medicare physician payment system to improve physician practices’ financial viability and ease their administrative burdens.

                   

    Medicare Payment Equity

    The Academy and the Surgical Coalition have pressed CMS to reconsider a decision that caused ophthalmologists and other surgeons to be paid less than other specialties for office visits starting in 2021. During Congressional Advocacy Day, Academy members urged members of Congress to push CMS to apply increased evaluation and management payment values to the postoperative visits included in 10- and 90-day global surgical codes. The Academy has met with policy officials at the U.S. Office of Management and Budget and CMS to advocate for Medicare payment equity.

    Where We Are Today

    In March, the American College of Surgeons and American Society of Cataract and Refractive Surgery joined us in a meeting in which we urged CMS to restore equity for surgeons in the proposed physician fee schedule due out this summer.

                   

    Drug Waste and Shortages

    The health care sector generates about 9% of total greenhouse gas emissions in the United States and is the second largest source of landfill trash. Current U.S. practice during ophthalmic surgery often leads to significant waste of topical drugs and ointments, such as eyedrops and injectables. Recognizing the importance of this issue, the Academy continues to call for the elimination of waste in ophthalmology to make quality eyecare delivery financially and environmentally sustainable.

    Where We Are Today

    The Academy continues to bring together ophthalmology, industry partners and the federal government to eliminate waste and make the practice of ophthalmology more sustainable.

                   
    Academy CEO Stephen McLeod, MD, discusses the issues with U.S. Rep. Kim Schrier, MD, D-Wash., the only pediatrician in Congress, at Mid-Year Forum 2022 in Washington, D.C.

    Vision Research Funding

    We appreciate Congress’ continued funding increases for the National Institutes of Health (NIH) and the National Eye Institute (NEI) in fiscal year 2022 despite the country’s enormous economic challenges due to the COVID-19 pandemic. Adequately funding the NEI can delay, prevent or save expenditures associated with Medicare and Medicaid programs, private insurance programs and family care. Increasing vision research funding for the NIH and the NEI is a key Academy priority, and our advocacy is paying off. 

    Where We Are Today

    The Academy is advocating for Congress to support NIH funding of at least $49 billion and NEI funding at $950 million for fiscal year 2023.

                   

    VA National Standards of Practice

    The Academy continues to closely watch for the publication of proposed national standards of practice for Veterans Affairs’ (VA) health care professionals as part of the U.S. Department of Veterans Affairs Federal Supremacy Project. While we expect the first standards to be for VA ophthalmology technicians, the standard for VA optometrists is most concerning because it could lower the standard of care for our nation’s veterans.

    Where We Are Today

    The Academy urges the VA to involve stakeholders in the development of these draft national standards and is educating members of Congress on how the VA’s initiative could lower the standard of care at veterans’ facilities.

                   

    State Scope of Practice

    Although we continue to win more battles than we lose, the number of states with harmful optometric scope laws is growing. The Surgical Scope Fund plays a critical role in our effort to prevent a snowball effect. This fund helps states facing dangerous scope legislation preserve surgery by surgeons and protect patient safety

    Where We Are Today

    This year we have seen optometric surgery bills introduced in eight states and have had great success in blocking them from advancing. In Alabama and Minnesota, bills that would have expanded optometry's ability to perform surgeries and administer injections could not gain enough traction and, thanks to ophthalmology advocacy, died in committee when the legislators adjourned.

                   

    Low Vision Aids

    The Academy continues to push for Medicare coverage of low-vision devices such as handheld monitors, video monitors and magnifiers that allow people with low vision to perform everyday activities. A statutory exclusion of “eyeglasses” under Medicare has been broadly interpreted to exclude all devices that aid vision. We developed a campaign to fight CMS’ restrictive interpretation. Working with our partners in the Independence Through Enhancement of Medicare and Medicaid Coalition, we are pursuing regulatory change while continuing to lobby Congress. According to the National Health and Nutrition Examination Survey, there were nearly 1.85 million individuals with low or no vision in the United States in 2017.

    Where We Are Today

    This year, our coalition submitted written testimony to the U.S. House Ways and Means Health Subcommittee in advance of its hearing “Bridging Health Equity Gaps for People with Disabilities and Chronic Conditions.” Our testimony urged the subcommittee to encourage CMS to lift the low-vision aid exclusion. We also met with CMS, urging the agency to reconsider its policy.

                   

    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 (EHRs) are integrated with the IRIS Registry tend to have higher MIPS scores. The IRIS Registry provides additional non-MIPS related benefits for benchmarking, metrics for other payers and scientific advancement.

    Where We Are Today

    For the 2020 MIPS submissions, we estimate that 83% of total IRIS Registry participants — and 87% of the IRIS Registry’s EHR participants — achieved an exceptional performance score. About 3,000 ophthalmologists who submitted with the IRIS Registry received a 100 score and should see the maximum bonus of 1.87% applied to all their Medicare payments in 2022.