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What does 2021 look like for ophthalmology? In short, it’s a combination of normal annual “stuff,” COVID-19, and a new administration. Put all three factors together, and it is truly a “transition year.”
Annual stuff. Every year (usually in early November) CMS releases its final Physician Fee Schedule. The latest schedule results in an overall cut of 6% for ophthalmology. A big component of this was the decision by CMS not to apply increases in evaluation and management (E/M) payments to postoperative visits in the global period. Revaluation of the E/M codes relative to the Eye visit codes will no doubt lead many ophthalmologists to revisit coding decisions.
In one of its last major executive actions pertaining to health care, the Trump administration issued a rule scheduled to go into effect Jan. 1 under which prices paid to physicians for Medicare Part B drugs will be paid through a new, mandatory, seven-year-long payment demonstration linked to the lowest international price paid by a selected group of countries. It’s reasonable to predict that this will result in an administrative nightmare for months while intermediaries, CMS, and physicians alike try to determine its navigation.
COVID-19. We ended 2020 with several safe and effective vaccines. Despite a multitude of distribution challenges, by the third quarter of 2021 many Americans should be vaccinated. Whether the vast majority will have access to vaccines depends in part on how well additional vaccines from Johnson & Johnson and Astra Zeneca perform in phase 3 clinical trials and how effectively distribution is managed. Tragically, there are predictions for perhaps as many as another 150,000 U.S. deaths between December and July.
Immunization will not likely translate into an immediate reversion to pre-COVID behaviors. For example, after the Sept. 11, 2001 terrorism events, although air space was closed for only three days, it took 34 months for passenger traffic to reach pre-9/11 numbers. Some economists believe that the overall economy will not recover to fourth quarter 2019 levels until fourth quarter 2021. Others are more pessimistic, projecting a negative gross domestic product in 2021. The year 2021 will be one of behavioral and economic transition.
New administration. The Biden administration is not the Obama administration, but some of the important players from a decade ago will have new important policy positions. At the center of the health care team is likely to be HHS designate Xavier Becerra. As a seven-term member of Congress in office during the 2009-2010 Obamacare debates, he was a strong advocate of the Affordable Care Act (ACA). As California attorney general, he challenged in court the Trump administration’s attempts to quash the ACA, and he successfully sued the state’s largest commercial health care system.
Based on prior policy statements, the Biden administration will pursue an active health care agenda—advancing engagement in global health issues, subsidized COBRA coverage, expanded access to ACA marketplaces, automatic increases in federal matching rates for state Medicaid programs, economic initiatives in COVID response, robust pandemic preparation, advancing a public insurance option in the marketplaces, lowering the enrollment age for Medicare, and attacking high prescription drug costs.
For Academy members, this transition creates imperatives. We must actively advocate for our patients and profession in the early days of any new administration and strive to become a visible force in health policy planning in the new administration. Much will impact ophthalmology—from covered services to payment to delivery structure and consolidation.
Concomitantly, our communities and businesses will transition to some semblance of pre-COVID normality—including some in-person meetings—particularly during the second half of 2021.
As physicians, we will be more critical than ever as the national infrastructure remains damaged and vulnerable. Our ongoing support of our communities—whether through philanthropy, leadership, or just personal engagement—will be valued more than ever.