AOA scores important wins in 2015 Medicare fee schedule

AOA scores important wins in 2015 Medicare fee schedule

Medicare's 2015 physician fee schedule includes critical changes the AOA has fought for—provisions that will have a long-lasting impact on optometry and the delivery of medical eye care to Medicare patients.

"These are significant wins for the AOA, our members and patients."

The Centers for Medicare & Medicaid Services (CMS) issues the fee schedule rule each year. The schedule sets payments for physicians under the Medicare program. The 2015 rulemaking appeared in the Nov. 13 Federal Register.

Provisions in the 2015 rule will affect eye care for Medicare beneficiaries with diabetes, sponsors of continuing medical education (CME) for ODs, and measures of quality and value. "These are significant wins for the AOA, our members, and patients," says Roger Jordan, O.D., chair of the AOA Federal Relations Committee.

Anticipating that Congress will prevent any cuts to Medicare's sustainable growth rate formula in 2015, CMS expects to pay ODs approximately $1.16 billion in 2015, nearly $50 million more than in 2014.

Rule contains AOA-backed changes
A number of AOA-backed changes appear in the final rule. For example, Accountable Care Organizations (ACOs) participating in CMS' Medicare Shared Savings Program must now make sure that Medicare patients with diabetes receive eye exams, something the AOA has worked for over the past four years. The AOA had previously ensured that ACOs could include ODs. The new provision incentivizes ACOs to include or at least coordinate care with ODs.

Dr. Jordan advises that every OD "should seize on this opportunity to reach out to ACOs to help them meet this newly required measure."

In addition, many claims-based measures that ODs report under the Physician Quality Reporting System will continue in 2015. CMS had originally proposed eliminating this reporting option for most measures in favor of registry reporting. AOA plans to introduce a registry in 2015 that would eventually enable reporting for ODs.

CMS also added the diabetic eye exam measure in PQRS to the Group Practice Reporting Option (GPRO). CMS estimates that 200 large group practices (representing 135,000 eligible professionals) use the GPRO web interface. According to the AOA, this represents an opportunity for ODs to reach out to large group practices to help them meet this measure by ensuring Medicare patients with diabetes see an OD for an annual eye exam.

ODs need to report PQRS measures in 2015 to avoid a penalty in 2017.

The AOA also worked hard on a change to the federal Open Payments Program, or "Sunshine Act," convincing CMS that the program gave an unfair advantage to certain CME programs for medical doctors because their manufacturer sponsors were exempt from reporting payments to speakers. As a result, CMS eliminated the exemption that applied only to some CME programs.

A detailed advocacy update on the final rule is available to AOA members.

Watch for upcoming guidance from the AOA on reporting PQRS measures and navigating Medicare policies and requirements in 2015.

November 14, 2014

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