- 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
- AOA and Congress work toward permanent SGR fix
House advances SGR fix, AOA secures key role for doctors of optometry in sweeping Medicare changes
March 27, 2015
Bill now goes to the Senate for consideration
Tag(s): Advocacy, Third Party
The U.S. House voted overwhelmingly (392-37) on March 26 in favor of permanently scrapping Medicare's broken sustainable growth rate (SGR) formula. The bill, H.R. 2—the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act—now goes to the Senate for consideration.
Overall, H.R. 2 would permanently repeal the SGR, provide an annual update of 0.5% in each of the years 2015 through 2019, and consolidate and expand three existing incentive programs—the Physician Quality Reporting System, Value-Based Modifier, and Electronic Health Records Meaningful Use—into a new program called the Merit-Based Incentive Payment System (MIPS).
Starting in 2019, MIPS could earn physicians as much as a 12% bonus in the first year and 27% in bonuses by 2022. Physicians could earn an additional bonus of 5% each year for participating in an alternative payment model, such as an accountable care organization. Under these major portions, which encompass much of the bill and offer a pathway to growing physician payments, doctors of optometry are fully recognized as physicians.
The legislation would also extend for two years the CHIP and fund the nation's community health centers through 2017. H.R. 2 also includes an extension of the work Geographic Practice Cost Index floor, an extension of the therapy caps exceptions, and language that would hold Medicare administrative contractors more accountable.
Additionally, the bill's sweeping quality-improvement section heavily focuses on the use of clinical data registries, such as AOA's MORE (Measures and Outcomes Registry for Eyecare). The $210 billon piece of bipartisan legislation is partially paid for, with some $70 billion coming from Medigap first-dollar coverage changes, which means testing for premiums paid by wealthier Medicare beneficiaries, and other changes.
Recognized as physicians for major quality improvement and payment and delivery reforms, the changes secured by AOA over the last year prevented a two-tiered pay system, as was originally envisioned under previous SGR bills. Although, as the bill currently stands, for optometry and others the bill would delay for one year the start of a resource use measurement effort and would restrict who can bill Medicare for comprehensive care management services of patients with complex chronic conditions.
With a two-week congressional recess starting March 27, it remains unclear if senators will be able to act before the March 31 deadline in order to avert a scheduled 21% Medicare pay cut. In the event that a fix is not enacted before the April 1 deadline, the AOA will advise members regarding recommended actions. Having already gone beyond SGR deadlines twice in the recent past, lawmakers may be relying on the Centers for Medicare & Medicaid Services' ability to hold claims to allow time to complete action on the bill.
Should the Senate delay action on the SGR reform bill, 500 or so AOA members will be on Capitol Hill for the 2015 AOA Congressional Advocacy Conference as the U.S. Senate is likely considering the bill. In the meantime, concerned doctors of optometry and students can use the AOA's Online Legislative Action Center to urge their senators to keep intact the bill's recognition of doctors of optometrys as physicians for its major portions and to continue working with the AOA to fix the remaining restrictive definitions.
AOA members with questions and those seeking more information should contact AOA advocacy at advocacy@aoa.org.