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 email@example.com.
The prior-authorization requirement ended July 1, 2022, for all patients—except Medicare Advantage in Georgia and Florida—a year after the AOA and other groups decried Aetna’s decision.
Medicare Advantage Organizations’ denials of prior authorization requests raise flags in HHS report and prompt AOA’s third-party advocacy outreach on behalf of optometry practices.
Direct third-party advocacy remains a critical component of the AOA and affiliates’ mission, helping support practice success by ensuring patients can freely access the broadening scope of eye health and vision care delivered by optometry. But advocacy requires a team effort, and optometry’s advocates have an opportunity this spring to help bring about the payer changes the profession needs.