• Academy Analysis Confirms Massive Cut to Ophthalmology Due to E/M Change


    Ophthalmology faces a nearly 7% overall cut to Medicare reimbursements in 2021, according to a new analysis commissioned by the Academy and the American College of Surgeons. 

    The Centers for Medicare & Medicaid Services announced in November that it will not apply a planned payment boost to evaluation and management services to post-operative surgical visits in the Medicare global surgical reimbursements. 

    Our extensive analysis confirms that CMS’ wrong-headed approach to overhauling E/M reimbursements will distort the resource-based relative value scale and unfairly hurt surgeons, beginning in 2021. Surgical specialties would take a double hit because the E/M increases will result in devaluing surgery due to budget neutrality in addition to withholding those increases from the underlying post-operative visits in the global surgical payment. 

    Compounding the hit, CMS retained an add-on code for complex patients and longer visits, despite increasing payments for levels 4 and 5 visits for these patient visits. Our study shows that this will have the effect of creating a double whammy for surgeons and other specialists by further devaluing all procedures other than E/M office visits. 

    Primary care physicians will be the primary beneficiaries of these new policies, with the top surgical specialties each experiencing immediate, significant, across-the-board cuts.

     

    Cardiac Surgery                                  -7.01%

    Thoracic Surgery                                -6.76%

    Ophthalmology                                 -6.57%

    Vascular Surgery                                -6.43%

    Neurosurgery                                      -6.05%

    Plastic/Reconstructive Surgery          -6.04%

    General Surgery                                 -5.67%

    Colon Rectal Surgery                         -5.43%

    Surgical Oncology                              -4.63%

    Maxillofacial Surgery                          -4.43%

    Orthopedic Surgery                            -3.88%

    Hand Surgery                                     -3.80%

    Anesthesiology                                   -2.91%

     

    Here’s how it works:

    To give a significant boost to E/M services, all other codes take a hit, because the increase is done in a budget-neutral manner, reducing the conversion factor. 

    The Academy believes that CMS’ decision to not apply an E/M payment boost to post-operative visits is illegal, unreasonable and inconsistent with past physician payment policy. 

    Since E/M codes are frequently billed, CMS’ plan results in a major redistribution of billions in Medicare dollars. This will result in a significant adjustment to all other codes. So, when CMS increases E/M for most office visit codes (99203-99205, 99212-99215), the redistribution of dollars means that specialties that perform fewer E/M visits bear the brunt of those balancing-act cuts. 

    The Academy, along with the American Society of Cataract and Refractive Surgery and others, is developing a major campaign to get Congress to intervene. Our analysis will be the centerpiece of this effort, because it presents compelling evidence of the dire effect of this change to the business side of medicine.