Academy Responds to Call for Medicare Physician Payment Reform Ideas

The Academy suggested several ways to reform the Medicare physician payment system this week, responding to a request from a bipartisan congressional group. Six of the eight legislators championing this effort are physicians.

The request responds to growing pressure from groups like the American Medical Association and Academy-led Surgical Care Coalition. Reps. Ami Bera, D-Calif., and Larry Bucshon, R-Ind., led the call for feedback on a 2015 law that represents the last overhaul of Medicare physician payments.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended almost two decades of recurring cuts from the sustainable growth rate (SGR). MACRA eliminated the SGR and moved to a system in which physicians see updates based on quality performance. But updates too quickly turned to more recurring cuts.

Any significant reforms will take years, if history is any judge. Medicare is ophthalmology’s major payer. That makes it all the more important for us to have a voice from the start.

In addition to reminding legislators of the need for yet another short-term fix to avert cuts in 2023, we addressed several issues that need long-term change. These include:

• Flawed payment calculations
  • The conversion factor, a complex formula used to determine physician reimbursement rates, doesn’t account for inflation.
  • Budget neutrality requires Medicare to cut payments to services when it raises reimbursement for other services or start covering a new treatment. Yet, the trigger for budget neutrality cuts, which has not been updated in 30 years, has not kept pace with the rise in the cost of practicing medicine..
• Barriers and disincentives to participating in the Quality Payment Program
  • The low-volume exclusion prevents too many providers from participating. This disadvantages Ophthalmology and reduces medicine’s interest in getting the program right.
  • Bonuses aren’t timely or large enough to encourage meaningful performance change and the top performers bonus ends this year.
  • Participation in a qualified clinical data registry is the best way to comply with MIPS, but current policies don’t do enough to recognize/reward this option.

As we note, Quality Clinical Data Registry “participation is the only way providers can receive the prompt feedback that Congress intended to improve quality and patient outcomes.”

The Academy’s leadership in developing relevant outcome measures for our specialty and widespread participation in the Academy’s IRIS^® Registry has made it a success. Congress should give you more credit for your participation in that registry than on alternative, flawed cost measures or the unproven Merit-Based Incentive Payment System Value Pathways program.

The Academy is actively collaborating with other physician groups to lead efforts to reform the Medicare physician payment system. In the meantime, remind your legislators that they must address 2023 cuts in the Medicare physician fee schedule before the end of the year.