• What We Want in the Next Coronavirus Relief Bill

    Republican leaders have begun discussing what to include in the next coronavirus relief bill. As they do so, the Academy is already working to ensure Senate leaders understand what you need from the bill.

    The House passed a $3 trillion relief package May 15, but Senate Majority Leader Mitch McConnell, R-Ky., called it “dead on arrival.” Republicans recognize the need for another relief package but will likely want to spend less on such aid.

    Each relief package to date has included various forms of help for health care providers — both those treating patients with COVID-19 and those trying to sustain their practices despite a widespread halt on elective procedures.

    Across specialties affected by the latter shift, ophthalmology faced the steepest decline in outpatient visits, according to a recent Commonwealth Fund analysis. And a recent Academy member survey showed that only 4% of respondents said they were seeing 75% of the pre-pandemic patient volume.

    To ensure the Senate understands the support you need to resume treating patients, the Academy wrote the top two Senate leaders this week to lay out our priorities for the next relief bill:

    1. Add more money for grants.
    2. Ensure future grants help pediatric ophthalmologists and others left out of the grants given to Medicare providers.

    Congress has repeatedly said it would help providers who don’t see Medicare patients, but both the first and second round of payments to date required at least some Medicare revenue.

    Medicare advance payment loans

    Based on what you’ve told us about the terms, we pressed Congress to ease the terms of these loans in several ways:

    1. Give you more time to start repayment: one year instead of 120 days.
    2. Reduce the per-claim recoupment to 25% instead of 100%, so you have more stable revenue during the repayment period.
    3. Give you more time to repay loans (two years, instead of 210 days).
    4. Lower the 9.625% interest rate on unpaid balances.

    Long-term assistance

    In recent surveys, you’ve told us about the long-term financial challenges you face in reopening your practice. Thus, we’re asking Congress to eliminate or reduce the almost 7% Medicare payment cuts you face in 2021.

    On its own, the Centers for Medicare & Medicaid Services cannot waive the budget-neutrality requirement that will lead to payment cuts to offset the evaluation and management (E/M) policy changes finalized in the final 2020 Medicare physician fee schedule.

    Under the changes, CMS will increase E/M payments but decrease payments for other services due to the implementation of other policies effective Jan. 1. The Academy supports the increases, but we have concerns about the policy changes that will reduce payments.

    By waiving budget neutrality for the fee schedule, Congress could act to spare you such payment disruption at a time when it matters more than ever. This action would allow CMS to implement significant new increases in payment for E/M visits but avoid drastic payment cuts to other physician services.

    We also want Congress to direct CMS to apply the increased E/M values to the post-operative visits included in the global surgical codes – something CMS has done in the past and that we believe the law requires.

    These much-needed actions by Congress would provide critical support for practices that face substantial financial challenges as you reopen your practices in the coming months.

    What comes next

    Senate leaders indicate they would like to pass a COVID-19 relief bill before the July 4 recess, which gives them just a few weeks to agree on terms. House representatives are scheduled to return to Washington, D.C., before the holiday but could return sooner if a deal is struck.

    The Academy will continue to work with physician leaders and other congressional allies to fight for the help you need to resume treating patients.