House advances SGR fix, AOA secures key role for doctors of optometry in sweeping Medicare changes
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 email@example.com.
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.
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.