AOA pushes for parity in Medicare payment bills

AOA members spoke out—and got results—on gaining parity for optometrists in legislation designed to overhaul Medicare's payment formula.

"Optometrists, along with other physicians, will have new obligations and opportunities."

Two key committees recently approved legislation to repeal and replace the sustainable growth rate (SGR) formula, which has threatened automatic payments to Medicare doctors for more than a decade. Both bills aim to freeze or marginally increase Medicare physician payments over the next five years. They also seek to replace the formula with a value-based system of reimbursement.

In a Dec. 12 letter to doctor and student advocates, AOA President Mitchell T. Munson, O.D., described optometry's wide-sweeping grassroots efforts to secure a key change in the Senate Finance Committee's Medicare payment reform bill.

The revision clearly affirms "ODs will be fully eligible participants in a newly created quality care incentive program designed to launch in 2017 as a successor to existing quality improvement efforts," Dr. Munson wrote. Such a distinction was not included in a bill approved by the House Ways and Means Committee.

It's up to AOA members to see the Ways and Means bill is fixed before it's considered on the House floor in early 2014, Dr. Munson urged.

More protection for optometrists

The AOA continues to endorse a third bill approved in mid-2013 by the House Energy and Commerce Committee. The legislation includes protections for optometrists similar to what's in the Senate Finance Committee bill.

From the AOA's perspective, it's not surprising to see Congress move to replace the SGR with more value-based reimbursement, said Rodney Peele, J.D., the AOA's assistant director for regulatory policy and outreach.

"Optometrists, along with other physicians, will have new obligations and opportunities to demonstrate the quality and value of the services provided to patients," Peele said. Under this proposed value-based program, doctors would receive bonuses or payment reductions depending on how well they perform on meeting certain clinical practice improvement targets.

The Senate bill's recognition of optometry as part of the health care team means quality patient care, not just medical eye care "will improve with optometry being more involved in total care such as diabetes, hypertension and other systemic disease diagnosis and monitoring," said Roger L. Jordan, O.D., the AOA's Federal Relations Committee chair.

Temporary fix in the works

As lawmakers seek a permanent solution to SGR repeal, a provision in Congress' bipartisan budget agreement buys them some additional time to achieve this goal. The legislation, approved by the House Dec. 12, offers a temporary 0.5 percent increase to Medicare physicians from Jan. 1 through March 31, 2014.

"The law also extends some provisions that benefit optometrists, such as preventing Medicare from paying less for services provided in relatively low-cost areas and continuing to allow exceptions to therapy caps," Peele said.

The Congressional Budget Office, which recently lowered its price tag again on SGR repeal, estimates it would cost $8.3 billion through 2018 to implement this three-month fix.

Doctors would have faced a 24 percent payment reduction to their Medicare payments Jan. 1, unless Congress stepped in to avert such cuts.

December 17, 2013

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