Era Of Health Care Reform Overtakes Washington

Main Category: Eye Health / Blindness
Article Date: 03 Feb 2009 - 0:00 PDT

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With an invigorated national focus on health care reform, fair Medicare reimbursement for physicians in 2009 is among the top priorities of the American Academy of Ophthalmology, as determined at its Secretariat for Federal Affairs meeting Jan. 17 in Baltimore. The Academy's Federal Secretariat meets each January to discuss a wide range of issues of concern to ophthalmologists and to set its Washington agenda for the year.

"The Academy understands 'Change' is more than a catchy campaign slogan, and health care is front-and-center for action in 2009," said Michael X. Repka, MD, secretary for federal affairs. "This is the biggest health care legislative year in more than a decade, and the Academy is committed to lead the drive for change that includes Medicare reform."

With the stage set for real health and Medicare reform, ophthalmology faces new risks and opportunities. With the AMA, the Academy will call on Congress to rebase the sustainable growth rate (SGR), eliminating the Medicare debt that is causing the scheduled 40 percent physician payment cuts. The payment cuts include a 21 percent cut on Jan. 1, 2010. Key to success is the Obama administration answering the call to step up with regulatory changes, including taking drugs out of the SGR formula (whose growth contributes to exceeding the target expenditures).

While health reform offers an opportunity for an SGR fix, there are risks for ophthalmology under physician payment changes in Medicare. Policymakers want to end a fee-for-service system that pays more for just doing more. Instead, they want to move to a system of "value-based purchasing" that differentiates among physicians based on quality and efficiency. The Academy will be ophthalmology's voice in this summer's efforts to reform Medicare payments to physicians.

Legislation that provides opportunity to advance other key components of the Academy's agenda are already being promoted by the Obama administration and considered in Congress. Chief among those are:

- The House-passed $825 billion economic stimulus package, which includes $157.5 billion for a variety of health programs, including $20 billion allocated for health-care information technology (more than $40,000 per physician) and $95 billion to state governments to bolster the Medicaid program and expand its coverage.

- Separate State Children's Health Insurance Program (SCHIP) bills that reauthorize and expand the program to insure low-income children have passed the House and are being considered by the Senate. Many states use SCHIP money for vision screenings for children.

- The Vision Care for Kids Act of 2009, which would complement existing state vision screening programs for the lowest-income children by providing funding in the form of state grants for comprehensive eye examinations and treatment for uninsured children who fail a vision screening.

In 2009 the Academy calls on CMS to accept and adopt new practice expense (PE) data for ophthalmology, with 2010 implementation. Ophthalmology currently is disadvantaged by CMS' use of out-of-date PE data. The Academy has developed new PE data with the AMA that would increase payments to ophthalmology. The Academy will also battle burdensome regulations, including threatened reintroduction of physician accreditation requirements for independent diagnostic testing facilities and providers of durable medical equipment, prosthetics, orthotics and supplies.

About the American Academy of Ophthalmology

AAO is the world's largest association of eye physicians and surgeons-Eye M.D.s-with more than 27,000 members worldwide. Eye health care is provided by the three "O's" - opticians, optometrists and ophthalmologists. It is the ophthalmologist, or Eye M.D., who can treat it all: eye diseases and injuries, and perform eye surgery.

American Academy of Ophthalmology

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