Medicare Physician Payment Reform

In recent years, physicians have faced drastic cuts to Medicare payment, even as the costs of running a practice continue to grow. That’s why pressing Congress for Medicare payment reform is the Academy’s top advocacy priority, yet again.

Where We Are Today

In 2023, we’re pushing for several specific reforms. We particularly want to see the Medicare physician fee schedule revised to account for inflation, which the Medicare Payment Advisory Commission has also recommended.

Our efforts to work with physicians in Congress have already yielded introduction of a bill calling for this change. Those relationships will be especially critical, given the closely divided Congress.

Equitable Physician Payment

Since 2021, the Centers for Medicare & Medicaid Services has paid surgeons less for postop visits included in the 10- and 90-day global period than if they were billed as stand-alone office visits. The Academy believes this violates the Medicare statute requiring equal payment for the same service. We haven’t given up the fight.

Where We Are Today

When CMS sought input on the issue in its 2023 physician fee schedule proposed rule, we urged the agency to work with Congress for solutions. We reiterated our commitment to help CMS ensure appropriate valuation of global surgical codes. Unfortunately, the final rule did not restore equity.

Prior Authorization

Prior authorization requirements delay or deny care for millions. Reforming how insurers use prior authorization is among the Academy’s top advocacy priorities, and our efforts have borne fruit.

In July 2022, Aetna withdrew a controversial policy Physician stories played a powerful role in overturning that policy — stories we need to challenge Aetna’s policy in Georgia and Florida, where it remains. And just as Aetna was pulling back on its prior authorization policy in most parts of the country, Humana announced that it would begin requiring prior authorization for cataract surgery for its Medicare Advantage plan in Georgia starting Aug. 1, 2022.

Where We Are Today

Academy urging also helped push the Centers for Medicare & Medicaid Services to finally release a proposed rule to reform prior authorizations in Medicare Advantage plans.

Step Therapy

Since the end of a ban on step therapy in January 2019, Medicare Advantage patients have faced greater difficulty pursuing Part B drug treatment than those in fee-for-service Medicare. Ending the practice of requiring patients to fail first on the drugs that insurers prefer is one of the Academy’s top advocacy priorities.

Where We Are Today

Before the 117th Congress ended, our behind-the-scenes efforts prompted legislators to press the Centers for Medicare & Medicaid Services on its continued support for the practice. The Academy also met with the Department of Health and Human Services and pressed CMS for changes. Additionally, the Academy has been spearheading a coalition of patient and provider groups addressing the ways step therapy barriers to Part B drugs access harm Medicare Advantage beneficiaries.

Health Equity

Health disparities exist within vision and eye health. That’s why advancing equitable access to eye and vision care is one of the Academy’s top advocacy priorities.

Where We Are Today

During a March roundtable with the Congressional Black Caucus, we spoke about the importance of expanding access to underserved communities and achieving vision health equity. One of our recommendations was increasing access to eye care services in our nation’s community health centers. Expanding access in these settings was a central recommendation of the Academy’s Task Force on Disparities in Eye Care.

Academy leaders also submitted a statement to the Senate Health, Education, Labor and Pensions (HELP) Committee on the importance of this expansion.

Vision Research Funding

Strong research funding helps advance treatment and knowledge of various eye diseases and conditions. The Academy has therefore long advocated for strong and increased vision research funding within the National Institutes of Health and the National Eye Institute.

Our advocacy helped deliver three wins in the fiscal year 2023 federal funding package. The year-end spending bill increased NIH funding $2.5 billion to $47.5 billion. It also increased NEI funding $32.6 million to $896.5 million. And it provided $20 million for the Department of Defense’s Vision Research Program, which is the primary source of research funding for the prevention, diagnosis and treatment of vision loss and dysfunction resulting from combat trauma.

Where We Are Today

This year, we used our Congressional Advocacy Day meetings to seek continued support for these important research programs.

VA National Standards of Practice

Since 2021, the U.S. Department of Veterans Affairs has been developing national standards of practice for more than 50 health care professions. These standards could set dangerous scope-of-practice precedents. The VA has established a less-than-transparent process that appears to allow each profession to write its own practice standard. The release of new standards will provide our first opportunity to review what standard of care the VA is proposing for veterans across the country.

Where We Are Today

So far, only a few of the published proposed standards have related to eye care. Meanwhile, we’re working to build strong support for preserving high quality veterans’ surgical eye care. Earlier this year, multiple veterans groups joined us in calling on Congress to protect that care.

State Scope of Practice

Patients need our advocacy more than ever, as optometrists continue to push for expanded scope of practice. Thanks to member support of the Academy’s Surgical Scope Fund, we’re able to address state level and growing national challenges through advocacy efforts.

Last year, the California Legislature passed a bill to expand optometrists’ ability to perform laser surgery and other procedures. Only a gubernatorial veto stopped the bill from becoming law in this bellwether state. A well-funded Surgical Scope Fund is essential to preempt and fight these kinds of bills.

Where We Are Today

Undaunted, optometrists in California reintroduced a nearly identical bill in March 2023. While that bill is dead for the year, the issue could return in 2024. 

The IRIS Registry and MIPS Bonuses

After nearly a decade, the Academy’s IRIS^® Registry remains the best and easiest way to successfully report for the Medicare Merit-Based Incentive Payment System. For 2021 reporting — the most recent year for which data has been released — nearly 32% of Academy members who used the IRIS Registry to report for MIPS earned a 100% score. This qualified them for the maximum future bonus of 2.34%.

Where We Are Today

As the bonuses for exceptional performances, created as a part of the Medicare Access and CHIP Reauthorization Act of 2015, are ending starting with 2023, it will be harder to receive significant positive adjustment from MIPS while the risks posed by penalties remain the same.

Low Vision

Low vision aids help people with reduced vision maintain greater independence and enjoy everyday activities like reading. Under a longstanding policy, however, the Centers for Medicare & Medicaid Services treats low vision aids differently from assistive devices for other types of disability. CMS covers many types of assistive devices, but the agency has adopted a policy that prohibits coverage of low vision devices based on its interpretation of the statutory exclusion of eyeglass coverage in the Medicare program. This practice discriminates against patients with vision impairment — especially those unable to afford low vision aids on their own. The Academy has opposed CMS’ policy since it was adopted in 2008.

Where We Are Today

Before the 117th Congress ended, our behind-the-scenes advocacy spurred legislators to press CMS for coverage of low vision devices.