Washington, D.C. – Fair Medicare reimbursement for physicians remains among the top priorities for 2008 set by the American Academy of Ophthalmology at its Secretariat for Federal Affairs Meeting in Washington on Jan. 26, 2008. The Academy's Federal Secretariat comes together once a year to discuss a wide range of issues of concern to ophthalmologists and to set its Washington agenda.

"Ophthalmologists are facing significant reimbursement challenges in 2008, and we remain committed to advocating for a multi-year solution that will bring stability to the profession,” said Michael X. Repka, MD, secretary for federal affairs. “We will continue to build on our successes in 2007 by focusing our efforts on other legislative and policy issues, including children’s vision and pay-for-performance, which affect our members and their patients.”

Among the issues that the Academy has established as priorities:

The Sustainable Growth Rate (SGR)  

The Academy, along with other organizations such as the American Medical Association (AMA), was successful in temporarily halting a scheduled 10.1 percent Medicare fee cut scheduled to take effect on January 1, 2008, while providing a positive 0.5 percent update to the conversion factor. This 0.5 percent update helped to defray other reductions brought about by CMS’ budget neutrality adjustments and changes to practice expenses. However, Congress must revisit the issue again before July 1, 2008, when the cut will take effect if there is no further Congressional action. In addition, a 15 percent Medicare reimbursement cut is scheduled to take effect on January 1, 2009. Physicians have not had an update related to the cost of practice, with the result that their purchasing power has been significantly reduced over the past five years. Threats this year for ophthalmologists and other physicians include possible mandates under Medicate for adoption of health information technology and accreditation of imaging and ultrasound equipment.

Pay-for-Performance

In 2008, ophthalmologists have five quality measures for reporting as part of the Physician Quality Reporting Initiative (PQRI) under Medicare. PQRI provides a 1.5 percent bonus for physicians who voluntarily report. The Academy, along with ophthalmic specialties, developed six new eye care measures and will work together to get them added to PQRI in 2009.  In addition, the Academy is working to ensure that PQRI remains voluntary, with a positive incentive for physicians who elect to report on quality measures. The Academy has been educating ophthalmologists about the bonus program by holding a series of conference calls, writing extensively on the issue in member publications and putting together a PQRI educational Web site. This effort resulted in ophthalmology having the largest percent of physician participation for any specialty. Physicians will see a bonus payout for 2007 participation in mid 2008.

Coding

Ophthalmologists have benefited from the Academy’s work to obtain changes in the Center for Medicare and Medicaid Services’ (CMS) 2008 Medicare Physician Fee Schedule that improved payments for eye visit codes. That change increases payments to ophthalmologists by $154 million annually. However, reacting to concerns from Congress and MedPAC about overvalued codes, the American Medical Relative-value Update Committee has identified several ophthalmology codes as being potentially misvalued. The Academy will fight to defend those codes, while at the same time advocating for a new code to cover Endothelial Keratoplasty (previously called DSEK).

Patient Access and Care

The Vision Care for Kids Act of 2007 was passed last October by the full House — an accomplishment unprecedented in the last six years — and now awaits consideration by the Senate, where the Academy will advocate for its passage. The Academy was instrumental in developing language for this legislation, which would complement existing state efforts by authorizing $65 million in grants over five years for comprehensive eye examinations and treatment for uninsured children who fail a vision screening. In addition, the Academy will continue to advocate for quality eye care for veterans and military service members, including funding for the Military Eye Trauma measure, which will improve tracking, diagnosis and treatment for service members injured on active duty.

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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. To find an Eye M.D. in your area, visit the Academy's Web site at www.aao.org.