AOA continues fight for permanent SGR fix, advises members to hold claims

April 2, 2015
Advancing legislation includes significant AOA-backed changes

AOA fought for and won major changes to the House's Medicare payment reform bill that would solidify optometry's central role in Medicare for decades to come.

"We can urge passage and continue fighting to keep intact the bill's overarching recognition of optometrists as physicians."

In the weeks ahead, AOA members will be lobbying senators on Capitol Hill to continue to improve and then finally pass this important legislation.

On March 26, the House voted overwhelmingly to approve H.R. 2, a bipartisan bill that would replace Medicare's sustainable growth rate (SGR) formula with a new merit-based incentive payment system that offers the only pathway to growing physician payments.

The bill recognizes doctors of optometry as physicians for all major quality improvement and payment and delivery reforms, and the changes secured by AOA over the past year prevented a two-tiered Medicare pay system, as was originally envisioned under previous versions of the SGR reform bill.

The bill's Merit-Based Incentive Payment System (MIPS)—which combines the Physician Quality Reporting System, Electronic Health Records Meaningful Use and Value-Based Payment Modifier, "fully recognizes our profession," says Roger Jordan, O.D., chairman of the AOA Federal Relations Committee. "There are opportunities for significant incentives for delivering quality care throughout the bill. While we've made major gains—we still want more."

AOA is calling for additional improvements. For instance, the bill would delay for one year the start of a resource use measurement effort and would restrict who could bill Medicare for care management of the chronically ill.

Although the House approved its bill by an overwhelming majority, the Senate decided to hold off on a vote until after its spring recess. With no congressional stopgap measure in place, a 21% cut to Medicare physician payments took effect on April 1.

AOA advises members on pay cut

ODs and other Medicare physicians are unlikely to immediately feel the impact of this cut. By law, the Centers for Medicare & Medicaid Services (CMS) may not process and pay claims any sooner than 14 days. CMS does have the option of delaying claims until the Senate acts on p/>CMS plans to update providers by April 11. In the meantime, AOA has advised members to hold off on submitting April claims for as long as practical, giving Congress time to complete the legislative process on H.R. 2 and Medicare contractors the ability to implement new payment rates.

No processing or payment delays should occur for claims submitted to Medicare that are dated March 31 or earlier, AOA informed members.

A call to action

With Senate action delayed, 2015 AOA Congressional Advocacy Conference attendees will have the opportunity to lobby the Senate on Capitol Hill as it considers the bill. This is excellent timing, Dr. Jordan says. "We can urge passage and continue fighting to keep intact the bill's overarching recognition of doctors of optometry as physicians while working to make additional improvements."

For more information on the SGR fix, contact AOA advocacy at Doctors of optometry and students may also use the AOA's Online Legislative Action Center to fight for passage of the bill.

Related News

Optometry’s wins over abusive vision plans stacking up

The AOA and affiliates in Illinois and Georgia score wins against vision plan abuses in a year in which doctors of optometry are making inroads across the country. When all else failed, including talks with the plans and appeals to one state’s insurance commissioner, affiliates did the hard work of helping push through bills in their legislatures that address the abuses.

What defines the value of care we provide?

Health and vision plans have not adapted and grown with the care we deliver but hold back optometry’s momentum.

AOA survey finds discrimination by health and vision plans

The AOA has long championed nondiscrimination against doctors of optometry. The survey of doctors of optometry and AOA affiliates gathered responses from 47 of the 50 states plus the District of Columbia.