Ophthalmology Bands Together to Fight Medicare’s Fee Schedule Cuts

The ophthalmology community is banding together for a multifaceted campaign to minimize cuts in the 2016 Medicare fee schedule. The Academy, the American Glaucoma Society and other subspecialty groups will tell the Centers for Medicare & Medicaid Services why it should reconsider fee cuts beyond what the AMA/Specialty Society Relative Value Scale Update Committee recommended. In some cases, CMS adopted glaucoma cuts as much as 400 percent of the RUC’s recommendations. Our first step is a meeting with CMS next Friday. We are also preparing a physician outreach campaign to tell CMS how these cuts impact patient care.

Academy leaders are having high-level meetings with AGS, the Retina Society, the American Society of Retina Specialists and the American Association for Pediatric Ophthalmology and Strabismus to finalize our unified strategy. We’re employing this strategy to confront CMS on its extreme cuts to glaucoma, retina and nasolacrimal procedure fees.

There isn’t much time on the clock for physicians to mobilize for the first phase of our plan. CMS’ fee schedule rule is final, but interim. This gives us until Dec. 29 to weigh in using CMS’ comment mechanism. This is ophthalmology’s chance to sound off on these cuts before they go into effect. In order to send a cohesive, unified message to the agency, we are preparing a response for our members to send directly to CMS. This critical advocacy tool will be provided to you next week.

The strategy is to show CMS the flaws in its methodology. This year, the agency relied solely on procedure time in determining its new values. This is marked departure from how fees have been determined for years, dating back to the 1980’s. The RUC recommendations also take time into consideration. However, time is weighed against other variables, such as intensity. Furthermore, the RUC values are thoroughly discussed and debated. These recommendations are also based on survey data. By ignoring these variables, CMS is basing its decision on an imperfect approach.