• Medicare's Quality Payment Program

    Issue 

    Medicare is in the first year of its new physician payment system. The Quality Payment Program is a value-based system that replaces the sustainable growth rate, which the Academy fought for years before winning its repeal in 2015. However, the Quality Payment Program relies too heavily on existing, flawed quality-measurement policies. It unfairly penalizes ophthalmologist and other specialists with overly complex, difficult-to-meet benchmarks.  

    What the Academy is doing 

    We are diligently working to ensure that this and future years are smooth for ophthalmologists. For nearly a year, we’ve worked to educate ophthalmologists and their practice managers on the program and how to succeed. We’re working with the Centers for Medicare & Medicaid Services to communicate what changes must be made for it to work for ophthalmologists and our patients. We helped secure flexibility in the program’s first year. CMS responded to our advocacy by enacting its “Pick Your Pace” program. This enables ophthalmologists to determine your level of activity in the program. It’s based on whether you hope to avoid penalties, earn a small bonus or go for a full bonus in the initial 12 months of reporting.  

    We also gained an important accommodation from CMS that will help ophthalmologists successfully report in the advancing care information category. The agency confirmed to the Academy that ophthalmologists don't have to submit things that specialists rarely provide: transition-of-care or referral summaries. CMS will instead allow specialists to send summaries of care to patients’ primary care provider. This is especially important for EHR vendors. They told us they needed official CMS confirmation on this issue before building this functionality into their products.   

    We’ve provided CMS with feedback on its proposed cost-measurement policy, known as episode groups. This particularly affects cataract surgery. We also continue to better position subspecialists in cost evaluations. We capped a two-year effort this year by securing the use of new taxonomy codes for glaucoma, oculoplastics, retina and uveitis. These codes allow subspecialist ophthalmologists to be voluntarily measured against their peers in their area of expertise.  

    Next steps

    Our goal is to ensure CMS extends the program’s first-year flexibility to protect physicians from some of the program’s more onerous requirements. When CMS releases its proposed changes for the program’s second year, the Academy will communicate problems we see to the agency. The Academy is also working with lawmakers in Congress to identify where legislation can help achieve the goals of this effort.