From the American Academy of Ophthalmology

As expected, a 27 percent reduction in payments is included in the proposed 2013 Medicare physician fee schedule released today by the Centers for Medicare and Medicaid Services (CMS). The cut is due to continuation of the flawed sustainable growth rate (SGR) formula. Ongoing, SGR-driven uncertainty will continue into the upcoming elections. If the SGR cut is halted as in past years, ophthalmology payments in general would increase by 1 percent in 2013, according to CMS.

In the rule, CMS also proposes that the AMA Specialty Society Relative Value Scale Update Committee (RUC) continue to review the value of codes they recommended from 2012. Both the Academy and the American Society of Cataract and Refractive Surgery reviewed cataract code 66984 and its companion complex code 66982 this year due to CMS’ 2012 mandate. No final decision on the RUC-recommended value will be made until this year's final rule.

Finally, the rule proposes the methodology by which CMS will determine a new value-based modifier that would reward physicians for providing higher quality and more efficient care beginning in 2015. CMS will initially apply the value-based modifier methodology to groups of 25 or more physicians. The maximum penalty under the value-based modifier would be 1 percent in 2015.

CMS has fact sheets available on the 2013 proposed rule.

ASCs to Receive Increase
In the ASC rule, CMS proposes a required productivity adjustment that was mandated in the 2010 health care reform law. Based on that calculation, ASCs would receive an increase of 1.3 percent beginning on Jan 1. The rule proposes an ASC conversion factor of $43.190 and includes more details about CMS' new ASC quality-reporting program, which begins this year. Details will follow in next week's Washington Report Express.

PQRS Becomes Mandatory in 2013; Non-Reporters Will Be Penalized
The proposed rule includes specific requirements for physicians to avoid the 1.5 percent penalty that CMS is required to levy in 2015. Against the Academy's recommendations, CMS finalized its plans to base the 2015 penalty on 2013 participation in last year's Physician Fee Schedule Final Rule. To avoid the penalty, ophthalmologists must successfully report three PQRS measures in 2013. Ophthalmologists will also be able to avoid the penalty by reporting using the Academy-advanced cataract measure group. CMS proposes to lower the threshold for reporting the measure group from 30 to 20 patients. The Academy anticipates the lower threshold will help more ophthalmologists to avoid the PQRS penalties.

New E-Prescribing Exemptions
In response to advocacy by the Academy, CMS is proposing to establish a new hardship exemption from the e-prescribing penalty for physicians who have either registered or attested for the electronic health record incentive program. This exemption would be available to physicians later this year, in time to avoid the penalty in 2013. CMS currently allows physicians to request an exemption from the penalty if they practice in a rural area, primarily prescribe controlled substances or write fewer than 100 prescriptions for their Medicare patients over a six-month period. More information on the proposals included in the proposed rule will be published in next week's Washington Report Express.

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