AAO: Planned Medicare Cuts Deal Heavy Blow to Nation’s Ophthalmologists

Source: Eyewire News

The American Academy of Ophthalmology (AAO) released a statement opposing the Centers for Medicare & Medicaid Services (CMS) proposed annual Physician Fee Schedule and Quality Payment Program rule, which sets 2021 Medicare payment rates for physicians and includes changes to the Merit-based Incentive Payment System.

“Ophthalmology lost more patient volume due to the COVID-19 pandemic than any other medical specialty. Many practices furloughed or laid off staff; some ophthalmologists themselves were furloughed by their employers. As ophthalmologists struggle to return to ‘normal,’ working to rehire staff, if they’re still available, managing a backlog of delayed care and instituting costly new safety procedures to protect their patients and staff from the virus, the Centers for Medicare & Medicaid Services (CMS) has proposed that ophthalmologists take a 6 percent pay cut for 2021. Our already weakened health care system can’t take anymore,” the AAO stated in a news release.

AAO said it is working with the Surgical Care Coalition, a group of 12 medical associations representing more than 150,000 surgeons across the country, to urge Congress to fix this problem.

The cuts, set to take place Jan. 1, 2021, will reduce payments to nearly all surgical specialties, with ophthalmology among the top specialties affected. Medicare payments would be cut by 9 percent for cardiac surgery, 8 percent for thoracic surgery, and 6 percent for ophthalmology.

“It’s as if the last five months didn’t happen,” David Glasser, MD, secretary for federal affairs of the AAO, said in the news release. “CMS is asking the specialty that took the economic brunt of the pandemic and took massive code decreases this year to also take the brunt of planned pay cuts in 2021. There is no way that these pay cuts won’t affect Medicare patients’ access to timely surgical care.”

The payment cuts were triggered by CMS’ decision to change policy on evaluation and management (E/M) coding and to selectively apply it to certain specialties.

According to AAO, Congress can fix the problem by:

  • Waiving Medicare’s budget neutrality requirements to allow CMS to implement increases in payment for E/M visits but avoid drastic payment cuts to other physician services to offset it; and
  • Requiring CMS to apply the increased E/M payment to 10- and 90-day global surgical postoperative visits as they have always done in the past.

“Without these changes, patient care will be compromised. The proposed rule will likely force ophthalmologists to take fewer Medicare patients leading to longer wait times and reduced access to care for older Americans. It may also force more ophthalmologists, who already have the highest overhead in medicine, to back out of Medicare participation entirely,” AAO stated.

A recent survey of Academy members and other coalition members found that one-in-three private surgical practices state that they are already at risk of closing permanently due to the financial strain of the COVID-19 crisis. In the same survey, it was found that nearly half of surgeons face more difficult financial decisions and are responding by either cutting their own pay or paying employees in the face of declining revenues.


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