• Planned Medicare Cuts Deal Heavy Blow to Nation’s Ophthalmologists

    Specialty hardest hit by the pandemic asked to absorb a 6 percent cut, jeopardizing patient care

    SAN FRANCISCO, Calif. –  Ophthalmology lost more patient volume due to the COVID-19 pandemic than any other medical specialty. Many practices furloughed or laid off staff; some ophthalmologists themselves were furloughed by their employers. As ophthalmologists struggle to return to “normal”, working to rehire staff, if they’re still available, managing a backlog of delayed care and instituting costly new safety procedures to protect their patients and staff from the virus, the Centers for Medicare & Medicaid Services (CMS) has proposed that ophthalmologists take a 6 percent pay cut for 2021. Our already weakened health care system can’t take anymore. The American Academy of Ophthalmology is working with the Surgical Care Coalition, a group of 12 medical associations representing more than 150,000 surgeons across the country, to urge Congress to fix this problem.

    The cuts, set to take place Jan. 1, 2021, will reduce payments to nearly all surgical specialties, with ophthalmology among the top specialties affected. Medicare payments would be cut by 9 percent for cardiac surgery, 8 percent for thoracic surgery, and 6 percent for ophthalmology.

    “It’s as if the last five months didn’t happen,” said David Glasser, MD, secretary for federal affairs of the American Academy of Ophthalmology. “CMS is asking the specialty that took the economic brunt of the pandemic and took massive code decreases this year to also take the brunt of planned pay cuts in 2021. There is no way that these pay cuts won’t affect Medicare patients’ access to timely surgical care.”

    The payment cuts were triggered by CMS’ decision to change policy on evaluation and management (E/M) coding and to selectively apply it to certain specialties. Congress can fix the problem by:

    • Waiving Medicare’s budget neutrality requirements to allow CMS to implement increases in payment for E/M visits but avoid drastic payment cuts to other physician services to offset it; and
    • Requiring CMS to apply the increased E/M payment to 10- and 90-day global surgical post-operative visits as they have always done in the past.

    Without these changes, patient care will be compromised. The proposed rule will likely force ophthalmologists to take fewer Medicare patients leading to longer wait times and reduced access to care for older Americans. It may also force more ophthalmologists, who already have the highest overhead in medicine, to back out of Medicare participation entirely.

    A recent survey of Academy members and other coalition members found that one-in-three private surgical practices state that they are already at risk of closing permanently due to the financial strain of the COVID-19 crisis. In the same survey, it was found that nearly half of surgeons face more difficult financial decisions and are responding by either cutting their own pay or paying employees in the face of declining revenues.

    Coronavirus upended the professional world of ophthalmologists and that of our patients. As we exit the acute phase of the pandemic, we need to reimagine a health care system that provides more patient access, not less. A pandemic is no time to reduce health care funding and force ophthalmology small businesses to face the choice of restricting access to Medicare patients, selling their practices or retiring.

     

    About the American Academy of Ophthalmology
    The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org.

     

    About the Surgical Care Coalition

    The Surgical Care Coalition advocates for access to quality surgical care for all Americans. The Surgical Care Coalition is comprised of 12 surgical professional associations that proudly represent more than 150,000 surgeons working across the country with a common goal of improving the quality of care, and quality of life, for all patients. The founding members have worked together for nearly three decades to promote sound policy solutions to the U.S. Congress and federal regulatory agencies to solve the biggest challenges in health care.