• AMA Will Back Academy Effort to Eliminate Methodology Used to Cut Retina, Glaucoma Reimbursements


    The American Medical Association’s members are joining the Academy in seeking a broader methodology for setting Medicare reimbursements. The AMA House of Delegates voted to take action against the Centers for Medicare & Medicaid Services’ reliance on time as the sole determining factor for Medicare fees. We’ve been fighting for this change since November, when CMS used this methodology to cut retina and glaucoma fees. In doing so, the agency ignored the recommendations of the AMA/Specialty Society Relative Value Scale Update Committee. We’re demanding that the agency consider other factors, such as intensity. 

    Organized medicine is acknowledging our warning that this could impact other specialties’ reimbursements. The new AMA initiative will seek the creation of new checks and balances on how CMS determines fees. It will force the agency to consider intensity along with time. We will also advocate for an appeals process that includes the agency and the courts, alongside the existing refinement panel pathway.