- Aetna and Humana collaborate with AOA to exempt optometrists from auto- downcoding edits
- Superior Vision auto-enrollment with Davis Vision
- Zelis lawsuit highlights broader optometrist payment concerns
- Anthem Health fined for violations in Maine
- AOA, affiliates take on VBM lobby’s attacks on optometry
- Surveys say patient and doctor concerns about health industry middlemen on the rise
- Town hall draws hundreds as AOA and affiliate advocacy earns back millions
- AOA to update profession on health, vision plan advocacy efforts
- VSP warned on campus misinformation, efforts to divide the profession
- Talk of the townhall: Doctors view plan abuses as threat to doctor-patient relationship and quality care
- Don’t miss how AOA and affiliates are fighting against vision plan abuses
- AOA, state affiliate tracking California lawsuit alleging VSP monopolistic practices
- When getting paid will cost you
- Optometry’s wins over abusive vision plans stacking up
- What defines the value of care we provide?
- AOA survey finds discrimination by health and vision plans
- Aetna Prior Authorization
- Medicare Advantage claim denials
- AOA, affiliates prompt changes to MAC claims processing
- Payer issues hot topic at AOA on Capitol Hill
- AOA and state associations target plan abuses
- Be a better negotiator on payer issues
- Anthem stops unilateral downcoding of eye codes
- Congress probes vision plan policies
- vision plan reimbursment
- aoa challenges VSP plan
- AOA fights back against discriminatory vision plans
- SGRC-TPC-Conference
- AOA affiliates assemble advocates to address evolving payer issues
- NAVCP Patients doctors come out ahead in states vision plan fights
- VSP spells doom gloom
- AOA never stronger takes issue with VSP practices
- Health plans changing tone vision plans not so much
- SGR TPC 2017 Conference
- Conference delivers vital advocacy tools knowledge
- Vision plan advocacy What doctors need to know
- State third party conference offers advocacy essentials
- AOA backed DOC Access Act targets health and vision plan abuses
- AOA secures important wins in historic SGR reform legislation
- AOA continues fight for permanent SGR fix advises members to hold claims
- House advances SGR fix AOA secures key role for ODs in sweeping Medicare changes
AOA and Congress work toward permanent SGR fix
March 20, 2015
Doctors of optometry could face a 20% Medicare pay cut
Tag(s): Advocacy, Third Party
With doctors of optometry and other physicians facing a roughly 20% scheduled Medicare pay cut beginning April 1, momentum has been building on Capitol Hill for an effort aimed at scrapping the program's flawed sustainable growth rate (SGR) pay formula once and for all.
Details emerged of renewed negotiations on a plan that would repeal and replace the SGR, introduce small and time-limited pay updates, and create a consolidated system of existing and new avenues for providers to earn significant payment incentives for delivering high-quality care.
The AOA has anticipated that bipartisan progress made on this issue in the previous Congress would lead to a renewed push and possibly to the eventual replacement of the flawed payment formula this year. Since significant AOA activity to seek and win key changes reversing flawed physician definitions in three separate SGR reform bills being considered by three different committees last year, AOA and its Federal Keyperson Network have kept active by reaching out on an ongoing basis to key players on Capitol Hill to reaffirm optometry's top SGR repeal and replace priorities, including safeguarding optometry's Medicare physician status and ensuring that doctors of optometry are fully eligible for all major new physician-level initiatives going forward.
The SGR replacement bill is expected to cost more than $200 billion and is reported to be only partially paid for, leaving an estimated $130 billion price tag. It is also said to include some beneficiary cuts, including means-testing for high-income beneficiaries. With the most recent negotiations having been almost exclusively between House Speaker Rep. John Boehner (R-Ohio) and Democratic Leader Rep. Nancy Pelosi (D-California), as recently as March 13, 2015, AOA again focused these leaders' attention on important physician definition issues while reaffirming the key role that doctors of optometry play in the Medicare program for seniors.
While details of the legislative package have yet to be confirmed, the AOA remains focused on preserving gains made in preventing the creation of a two-tiered physician payment system, as originally existed under previous versions of this SGR reform bill. The AOA also remains on the lookout for any needed improvements, including reversing unnecessarily restrictive language. Stay tuned to aoa.org and aoa.org/news for the latest. In the meantime, concerned doctors of optometry and students can use the AOA's Online Legislative Action Center to support ongoing efforts on Capitol Hill to convince Congress and the Obama administration to fix Medicare, stabilize the physician payment system, and safeguard seniors' access to vision and eye health care they need and deserve by preserving and promoting optometry's long-recognized physician status under Medicare.
AOA members with questions and those seeking more information should contact AOA advocacy at advocacy@aoa.org.