From the American Academy of Ophthalmology

The Centers for Medicare and Medicaid Services today issued the 2014 Medicare Physician Fee Schedule. The fee schedule includes a 20 percent cut in Medicare physician pay on Jan. 1, caused by the problematic sustainable growth rate formula used to calculate reimbursement, and an additional 4 percent budget-neutrality adjustment. The final rule conversion factor is set for $27.2006, unless Congress acts to derail the SGR cut. The Academy is mobilizing members to urge lawmakers to derail the SGR cut when they return to Washington. Member activism is key as there are less than 10 legislative days left in this congressional session. The Academy provides online tools for members to contact their representative and senators to encourage swift action. If the SGR cut is halted, ophthalmology payments will remain relatively stable for 2014. Following are main takeaways from the Academy’s initial review of the rule.

Academy Arguments Prevail: CMS withdraws Proposal to Pay for the Lowest Practice Expense Regardless of Site of Service
CMS is not implementing its proposal to adjust practice-expense values in 2014 to effectively cap the payment for procedures furnished in a physician’s office at the total payment rate when furnished in a facility setting. Instead, the agency will take additional time to consider issues raised by the Academy and other physician groups and will address the issue in future rulemaking. While few ophthalmic codes would have been affected by the proposal, the Academy strongly opposed it asserting that it would set a dangerous precedent for practice-expense payments in the future.

Value-Based Modifier to Impact Groups of 10 or More Physicians
CMS will apply the value-based modifier, a program to adjust physician payments based on cost and quality performance, to groups of 10 or more eligible physicians in 2016. Value-based modifier assessments will be based on cost and quality data collected in 2014, however, groups of 10-99 eligible professionals will not be subject to negative penalties as long as they participate in the Physician Quality Reporting System. CMS is required the phase in the modifier so that it impacts all physicians by 2017. The maximum negative penalty associated with the modifier will increase from 1 percent to 2 percent in 2016.

CMS Dramatically Increases PQRS Requirements
In a move strongly opposed by the Academy, CMS is finalizing its proposal to raise the threshold necessary for physicians to successfully participate in PQRS. Physicians must participate in PQRS in 2014 to avoid a 2 percent penalty in 2016. They currently must report just one PQRS measure one time to avoid a penalty in 2015. Physicians who participate in PQRS to avoid the penalty must now report three PQRS measures correctly at least 50 percent of the time either on claims or through a qualified clinical data registry. They must report nine measures next year to earn an incentive payment in 2014. Ophthalmologists who have fewer than the required number of measures available to them will be able to report on fewer measures, but will be subject to evaluation by CMS to ensure that they reported on all available measures.

CMS has also finalized requirements for a new program that will enable physicians who participate in a qualified clinical data registry to qualify for a 2014 PQRS incentive payment and avoid the penalty in 2016. The Academy plans to seek the agency’s approval for the IRIS™ Registry so that participants can take advantage of this new reporting option. This option would ensure that ophthalmology subspecialties that currently struggle to participate in PQRS would be able to avoid penalties. Physicians who participate in PQRS through a qualified registry would in addition meet some meaningful-use requirements of the Medicare Electronic Health Record Incentive Program.

ASC Reporting Quality Measures to See Small 2014 Update
CMS announced in the 2014 ASC final rule, also released today, that the conversion factor for ambulatory surgery centers that meet quality-reporting requirements will increase 1.2 percent, to $43.471 next year. The conversion factor for ASCs that do not meet the quality reporting requirements will be $42.612.

CMS Finalizes Burdensome Visual Function Survey Requirement for ASCs
Despite a vigorous lobbying effort by the Academy, the American Society of Cataract and Refractive Surgery and the Outpatient Ophthalmic Surgery Society, CMS has finalized its proposal to require all ASCs to report on the improvement of visual function in patients following cataract surgery. This measure, which was developed by the Academy for use with a limited sample of patients for the PQRS program, requires that patients complete a visual function survey both before and after their surgery. The Academy submitted extensive comments on the inappropriateness of the measure to the facility setting and met with CMS officials to discourage inclusion of the measure in the ASC program. Though the agency ignored these concerns, they will allow ASCs to report on a limited sample of patients in lieu of reporting the measure on all of their cataract patients, in an attempt to minimize the burden. CMS did follow the Academy’s recommendation to remove a second measure of cataract complications from the program.

For more information, contact the Academy’s Governmental Affairs Division at 202.787.6662.