The Centers for Medicare and Medicaid Services (CMS) today released the 2012 Medicare Physician Fee Schedule. The rule reflects a 1 percent increase in Medicare reimbursement for ophthalmologists as a result of a scheduled increase in practice expenses, advanced by the Academy and first implemented in 2010. The increase, however, will be eclipsed by a 30 percent cut driven by the sustainable growth rate (SGR) formula on Jan. 1, unless Congress takes action to stop it.

Academy members urged to act to protect physician payment
The Academy is waging an advocacy campaign on Capitol Hill to repeal the SGR, which is widely considered to be faulty. Member participation is essential to the success of the campaign for fair payments. The Academy provides tools for members to contact their legislators to advocate for a permanent SGR fix.

Conversion factor reflects SGR cut
If Congress fails to halt the SGR cut, the 2012 conversion factor will be 24.6712, according to CMS. Thursday's Washington Report Express will include a chart detailing the impact of the conversion factor on key ophthalmology codes.

Ophthalmology pay affected by other payment changes

• Despite multiple appeals by the Academy, CMS will maintain a reduced work value of 1.44 for CPT code 67028 intravitreal injection, which was implemented in 2011.
• An increased work value was won by the Academy for the CPT code 65825 globe trauma procedure.
• Although CMS agreed to a slight improvement in payments for CPT code 92228 remote diabetic screening when done by a physician, which raises the work value to .37 from .3, payment for the code remains inequitable when compared to CPT code 92250 fundus photography.
• CMS retracted its recommendation that all evaluation and management services, including the eye-visit codes, be surveyed. Instead, the agency will monitor the work of the AMA/Specialty Society Relative Value Scale Update Committee and its own technical expert panel.

CMS implements new measures for PQRS
CMS has included a new, Academy-advanced cataract measure group in the 2012 Physician Quality Reporting System (PQRS) that will make it easier for ophthalmologists to successfully participate in PQRS. Physicians only have to report measure groups for 30 patients to qualify for the PQRS incentive bonus. The new measure group is for registry reporting only.

• Measure 191: Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery
• Measure 192: Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures
• Measure to be determined: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery
• Measure to be determined: Cataracts: Patient Satisfaction within 90 Days Following Cataract Surgery

The 2012 fee schedule also includes a new measure for biopsy follow-up that will be reportable by oculoplastic specialists. Final specifications for the measure group and existing PQRS measures will be published later this year.

Fee schedule includes changes in e-prescribing, PQRS penalties
Despite Academy objections, CMS announced that penalties for non-participation in PQRS that begin in 2015 will be based on measures reported in 2013. The Academy is working with the AMA and other medical associations to fight this approach.

CMS provides some relief from its e-prescribing penalty, announcing changes for 2013 and 2014 that give physicians more time and ways to comply with e-prescribing requirements.

2012 ASC final rule incorporates Academy recommendation to delay quality reporting
CMS announced in the 2012 Ambulatory Surgery Center (ASC) Final Rule, also released today, that it will delay implementation of a quality-reporting program for ASCs until Oct. 1. Beginning in October, ASCs will be required to report on up to five quality measures to avoid a reduction in their 2014 payments.At the Academy's Annual Meeting, John McInnes, MD, an ophthalmologist and director of the CMS Division of Outpatient Care for the Hospital and Ambulatory Policy Group, emphasized that ophthalmic ASCs would not need to report on measures that are not relevant to eye procedures.

CMS also announced it has increased the ASC update for 2012 to 1.6 percent from the proposed update of 0.9 percent, resulting in a conversion factor of 42.627.The Academy is continuing review of the 2012 Medicare Physician Fee Schedule and the 2012 ASC Final Rule. Watch for more details in this week’s Washington Report Express.

If you have questions, contact the Academy's Governmental Affairs office at 202.737.6662.