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  • Congress Passes Year-End Deal That Will Mitigate 2023 Medicare Payment Cuts


    Physician Payment

    Congress passed legislation in late-December to substantially reduce the nearly 8.5% cut to Medicare physician payment scheduled for 2023, though the bill fell far short of requests from the physician community.

    • Instead of stopping the entire scheduled 4.5% cut to the Medicare conversion factor, Congress opted to ease the cut to 2% in 2023.
    • Lawmakers also delayed an additional payment cut of 4%, which had been triggered by the passage of COVID-19 relief legislation in 2021, from going into effect for at least two years.

    Because changes to the conversion factor affect each specialty differently, ophthalmology faced an 8% cut for 2023 before Congress acted, slightly better than the 8.5% cut all of medicine faced. The latest change to the Medicare conversion factor means ophthalmology overall will experience a 1.5% payment cut for 2023. The effect on individual ophthalmologists will be determined by the mix of procedures they perform. 

    As a result of these congressional actions, the Centers for Medicare & Medicaid Services will need to release an updated 2023 Medicare Physician Fee Schedule. That action is likely to occur in mid-January, which may temporarily delay payment to practices.

    Other health care-related provisions in the bill include:

    • Extending the Alternative Payment Model bonus at 3.5% for one year
    • Extending current telehealth waivers and flexibilities related to the COVID-19 public health emergency for two years through calendar year 2024
    • Extending funding for the Children’s Health Insurance Program for two years from fiscal year 2027 to fiscal year 2029

    Getting Congress to act on your and your patients’ behalf was a key priority for the Academy. We recently joined the Surgical Care Coalition in a week of action, calling on Congress to fully stop the planned 8.5% cut to Medicare physician payments for 2023. Thank you for joining the Academy in this effort. Ophthalmology sent nearly 2,000 emails to Capitol Hill.

    The Academy is disappointed that despite support from 270 members of the House of Representatives and Senate to stop the full cut, Congress could not come together to do that on behalf of physicians and their patients.

    After Congress released its year-end legislative package, we immediately signed a Surgical Coalition letter to congressional leadership expressing our extreme disappointment with their failure to act as we requested. This decision will threaten the financial viability of some practices as well as their patients’ access to care. We will work with lawmakers to find long-term solutions and finally bring stability for your practice and your patients when the new 118th Congress convenes in January.

    Prior Authorization

    Although Congress did not include our legislation — the Improving Seniors’ Timely Access to Care Act (which unanimously passed the House in September) — to reform prior authorization requirements in Medicare Advantage programs, we are proud of our work to build strong bipartisan support for the legislation and the resulting movement of many of these changes through the regulatory process.

    Working with congressional leadership, the legislation’s lead sponsors and our fellow members of the Regulatory Relief Coalition, we were instrumental in pushing the Biden administration to release a proposed rule earlier this month that would achieve many of the bill’s same goals, such as requiring Medicare Advantage plans to speed approvals and establish electronic prior authorization.

    Pediatric Loan Program

    Congress included $10 million to fund the Pediatric Subspecialty Loan Repayment Program, doubling the amount of funding over last year.

    The Pediatric Subspecialty Loan Repayment Program provides qualifying child health professionals with up to $35,000 in loan repayment annually in exchange for practicing in an underserved area for at least two years.

    We worked with American Association for Pediatric Ophthalmology and Strabismus, along with our congressional champions, U.S. Reps. Kim Schrier, MD, D-Wash., a pediatrician, and John Joyce, MD, R-Pa., a dermatologist, to garner support for additional funding for the program in the 2023 fiscal year appropriations bill.

    We will continue to stress to lawmakers the importance of this program to address critical shortages of pediatric ophthalmologists in rural and underserved parts of the country.

    We will have a full analysis of what is included in this end-of-year legislation and what it means for your practice in the Jan. 5 issue of the Academy’s Washington Report Express newsletter. Next year will bring new challenges, and we look forward to working with you to continue our mission of protecting sight and empowering lives.