Help Enlist Congress in Fight Against Medicare Fee Cuts

The Academy is enlisting Congress to keep the pressure on the Centers for Medicare and Medicaid Services to walk back its cuts to retina and glaucoma procedure fees. Rep. Peter Roskam, R-Ill., and Rep. John Lewis, D-Ga., are circulating a letter for Congress to send to the Centers for Medicare and Medicaid Services urging reconsideration of the decision to cut fees beyond what was recommended by the AMA/Specialty Society Relative Value-Scale Update Committee ("the RUC"). Hundreds of ophthalmologists already told CMS how these cuts would negatively impact patient care. Tell your representative to sign the Roskam-Lewis letter.

Background

When CMS released its final Medicare Fee Schedule for 2016, it enacted significant cuts for specific retina and glaucoma procedures (PDF), which we are now fighting. These critical sight-saving procedures are experiencing double-digit reductions this year, with additional cuts scheduled for 2017. The Academy, the American Glaucoma Society, the Retina Society, the American Society of Retina Specialists and the American Society for Cataract and Refractive Surgery are outraged by CMS’ decision, which went beyond what was recommended by the RUC.

The Medicare Physician Fee Schedule interim final rule for 2016 imposed cuts of 25 and 33 percent for two glaucoma surgical procedures. Two procedures for repairing retinal detachments experienced cuts of 34 and 16 percent. There were also additional significant cuts made to other ophthalmology treatments.  

The agency based its decision on a flawed methodology that focused solely on time. In doing so, CMS ignored other critical factors, such as intensity of the services. In fact, CMS’ methodology violates current requirements that physician work values be based on time and intensity. CMS also did not afford stakeholders the opportunity to comment on these cuts prior to them taking effect. CMS must revisit its decision. When it does, the agency should adopt the RUC’s recommendation. 

What has been done so far

The Academy and others mobilized to push back on this issue immediately following the release of the final fee schedule rule in November. Representatives from the Academy and glaucoma and retina subspecialties took our case directly to CMS in an emergency meeting in December. These efforts were bolstered by nearly 300 comment letters from the physician community submitted before the formal comment period expired. The message remains clear: this failure to recognize the full scope of physician work and cutting fees beyond what the RUC recommended will have a negative and far reaching impact. 

Now we’re launching our next wave, with Reps. Roskam and Lewis leading their congressional colleagues in to battle. We need to keep the pressure on CMS to reconsider these cuts. Make certain your representative joins them today!

What you can do

• Write your representative asking for their support of the Roskam-Lewis letter using our online tool.
• Tell your colleagues in our profession why this issue matters. Urge them to reach out to their member of Congress!