From the American Academy of Ophthalmology

The U.S. Senate Committee on Finance and the U.S. House Committee on Ways and Means are set to consider legislation this week to reform Medicare physician pay. The bipartisan bill would repeal the flawed sustainable growth rate formula currently used to calculate physician reimbursement, an Academy legislative priority, as well as reform the Medicare fee-for-service system. However, the Academy objects to key provisions in the legislation – including a 10-year freeze in Medicare physician pay – and notified lawmakers today that it must oppose the bill in its current form. Academy members are urged to use Academy resources to write to their U.S. senators and representatives to advocate for changes to the bill before it moves forward that would ensure fair Medicare reimbursement for all physicians.

In response to the Academy’s advocacy efforts, the bill preserves a Medicare fee-for-service option. The legislation would reform the fee-for-service system by creating a new Value-Based Performance Program that consolidates existing Medicare quality improvement programs into one. Penalties doctors would experience if they do not participate in the quality measurement program would be capped. Despite these successes in driving changes to the original proposal, remaining issues are driving the Academy’s opposition to the legislation, including the 10-year pay freeze that would hinder physicians’ ability to keep their practices open and place patients’ access to services at risk. While the legislation would provide a 5 percent bonus to physicians who move from the fee-for-service system to an alternative payment model from 2017 to 2022, ophthalmologists have relatively no way to participate.

In addition, the Value-Based Performance Program that would be created by the bill is underfunded. The legislation would establish a budget-neutral pool whereby bonus payments to high-performing physician would only be possible by cutting payments to low-performing or non-participating physicians. The Academy asserts that such a tournament style threatens physician collaboration and sharing of best practices, and therefore is not in patients’ best interest.

The Academy, along with the American College of Surgeons and 15 other surgical and specialty organizations, urge the committees to continue working to revise the legislation to ensure the SGR formula is replaced with a more sustainable, fair and efficient Medicare physician payment system.

For more information, contact the Academy’s Governmental Affairs division at 202.737.6662.