As Congress Works to Keep Government Open, Academy Advocacy Victories Looms

At time of publication, Congress is finalizing legislation to fund the government. This bill is proving to be the much-needed vehicle for advancing the Academy’s top federal advocacy priorities.

For months, the Academy has led ophthalmology’s advocacy for changes to each of the below issues. We leveraged every opportunity to spur Congress to action and brought together effective coalitions to amplify these efforts. These victories are a credit to every Academy member who contributed to the Academy’s OPHTHPAC® fund or contacted their members of Congress. 

Part B Drug Payments Protected from MIPS Penalties

Ophthalmologists no longer face a six-figure Medicare cut stemming from how the Centers for Medicare & Medicaid Services was going to apply quality-program penalties. By making a necessary statutory change to the Medicare Access and CHIPS Reauthorization Act, Congress clarifies that physicians’ Part B drug payments are exempt from MIPS penalties. Retina specialists will welcome this relief. They faced a 20-30 percent cut to their Medicare revenue if they failed the MIPS program. 

Misvalued-Code Targets Dropped from Final Legislation

Federal lawmakers dropped plans to use misvalued code targets to pay for Medicare fixes. This avoids a potential $1 billion cut to Medicare that these targets would’ve triggered — primarily to specialists. The Academy fought this proposal, with our members sending more than 1,800 messages to Congress this week alone to urge lawmakers to find another way to pay for Medicare programs. Congress instead reduced the expected 0.5 percent update in the 2019 Medicare physician fee schedule. It will now be a 0.25 percent update. 

Congress to Finally Repeal IPAB

After years of Academy advocacy, Congress will finally repeal the Independent Payment Advisory Board. IPAB was meant as a 15-member agency tasked with achieving specified savings in Medicare without affecting coverage or quality — but with no accountability. This will end the threat of arbitrary, across-the-board cuts to Medicare payments to physicians and other providers. The Academy supported numerous congressional attempts at this repeal, which will protect every physician who sees Medicare patients. 

Cost Flexibility Coming to MIPS to Better Support Ophthalmologists

Congress is giving CMS the flexibility the agency needs to reduce the Merit-Based Incentive Payment System’s mandated cost component. Instead of weighting cost at 30 percent by 2019 (vs. 0 percent in 2017, 10 percent in 2018), CMS can now maintain the current 10 percent weight for three more years. CMS will also have more flexibility to adjust the MIPS pass-rate threshold. This will let more physicians succeed under the program.