EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/176967
22 EW NEWS & OPINION September 2013 The Alliance of Specialty Medicine Fly-In: Advocacy does make a difference Brock K. Bakewell, MD The Alliance of Specialty Medicine, of which ASCRS is one of 11 member specialty societies, had its annual Legislative Fly-In in Washington, D.C., in early July. We had 17 ASCRS members participate, more than any other specialty, and more ophthalmologists than any prior year. We heard from multiple congressmen and senators who are sympathetic to ophthalmology and organized medicine prior to meeting with the legislators or their health legislative assistants from our respective states. We were in Washington at a very opportune time, seeing that both the House Ways and Means and the Energy and Commerce Committees have put forth draft frameworks, and the Energy and Commerce Committee actually released legislation to repeal the flawed sustainable growth rate (SGR). The ophthalmologists and other specialty physicians who were in attendance at the Fly-In were able to educate, discuss, and likely influence the SGR repeal proposals that Congress will reconcile into a final bill. We saw significant changes, reflecting our input, in the Energy and Commerce draft bill that ultimately passed the full Energy and Commerce Committee. If we hadn't been there to weigh in with our viewpoints and opinions, then legislators may think that we don't care and policy is made without our input, usually to our detriment. This time, the legislation actually did change as a result of our input and meetings. The other issues that we focused on in this Fly-In were the Medicare Patient Empowerment Act (H.R. 1310/S. 236) and IPAB repeal (H.R. 351/S. 351). Three illustrious members of the ASCRS Government Relations Committee, Robert Lehmann, MD, Paul Arnold, MD, and Priscilla Arnold, MD, discuss these topics in-depth. As chairman of the Government Relations Committee, I would ask that you read and understand this article that discusses the issues germane to our practice of ophthalmology and that you consider par- ticipating in next year's Fly-In. Even if you feel ill-equipped to talk about the issues, we will coach you to make it easy. If you don't want to take the time to come to Washington, you can impact our issues by talking to your legislators when they are back in their home districts. Taking the time to advocate for our specialty is all of our responsibility, not just the ASCRS leadership and the Government Relations Committee. At the very least, please consider becoming an eyeContact and making a contribution to the ASCRS eyePAC so that we can continue to financially support the congressmen and senators who endorse our issues. If you would like to participate in next year's Fly-In, please contact Allison Dickert, manager of PAC and grassroots, at adickert@ascrs.org or 703-591-2220. Information about the eyeContact program and communicating with elected officials is available at www.ascrsgrassroots.org . –Brock K. Bakewell, MD, chair of the ASCRS Government Relations Committee SGR on the way out? Robert Lehmann, MD Nacogdoches, Texas For years now, it has been apparent that the sustainable growth rate (SGR) formula is a flawed mechanism for determining Medicare physician payment. We are all familiar with the yearly threat of substantial cuts to reimbursements—last year it would have been more than 25%— and the accompanying limbo Congress puts physicians and patients in when they cannot agree on getting the "fix" enacted. Some doctors may be tempted to shrug and ignore the ongoing political circus, assuming that the pattern of threatened cuts and eleventh hour reprieves are just the realities of practicing medicine. I believe we must not be complacent and have pushed for a real solution. After this year's Alliance of Specialty Medicine Fly-In, I am starting to see the results of our efforts. As in other years, a repeal and replacement of the SGR was the top agenda point. This year, we have been following the development of legislation to repeal the SGR and replace it with a payment system based on quality. As the House Energy and Commerce and Ways and Means Committees continued to issue draft frameworks, it became apparent real change was closer than ever. Like all legislation, there were still some aspects of the draft that needed to be addressed. When my colleagues and I came to Washington, we expressed the need for repeal and voiced our concerns with some of the earlier draft legislation. In discussions with our representatives and senators and professional committee staff tasked with writing the legislative language, we successfully persuaded lawmakers to make substantial changes to the bill. For instance, we stressed the need to preserve the fee-for-service option for ophthalmology and other specialties since many alternative payment models are primary care focused. Additionally, we had serious concerns with a proposal to link quality and pay that would have reduced base payment from the current level and mandated certain quality goals to increase payments back to current levels. We argued that Medicare physician payment is already below market value and so cutting payments further and instituting new goals could hinder the treatment of Medicare patients. Shortly after we returned home, the Energy and Commerce Committee released a new bill, H.R. 2810, and several of our recommendations were incorporated. This version, which passed the full Energy and Commerce Committee on July 31, repeals the SGR and replaces it with a five-year period of 0.5% annual updates. Starting in 2019, physicians will receive the 0.5% update, have the option to stay in a fee-for-service model and will begin participating in a new Update Incentive Program, a modified version of the existing Physician Quality Reporting System (PQRS), to be eligible to receive an additional 1% for meeting certain quality goals. Poor performance will result in a decrease of 1%. During the transition time, new alternative payment models will be developed and physicians may opt to participate in those at any time. Development of new quality measures will be physician led. While there are still issues ASCRS will be working to have changed—such as a provision that allows CMS to identify misvalued codes, creating a "shadow" Relative Value Update Committee—it was gratifying to realize tangible results from this year's visit. The bill still has many steps to go through in the process, and we may have to live with the SGR a while longer, but I am confident that our efforts at the Fly-In made it a better piece of legislation and helped move it forward. I hope that all my colleagues at ASCRS will continue to monitor this important issue and let your legislators know how critical this is to our ability to care for patients. Decreased reimbursements under Medicare remain a threat Paul Arnold, MD Bettendorf, Iowa I have had the privilege of attending many meetings in Washington, D.C. over the past 20 years with the purpose of lobbying our national legislators regarding physician payment for caring for Medicare patients. We all know the trajectory of our "Medicare allowable" for cataract surgery over that period of time. (Please resist the temptation to conclude that this decline is due to my lousy lobbying capability!) There is reason to believe the allowables would be significantly worse were it not for the skill of ASCRS specialty staff members, such as Government Relations Director Nancey McCann, who regularly interact with Capitol Hill staff and members of Congress. The Alliance of Specialty Medicine provides a wonderful forum for the leaders of many specialties to come together and work in unison on the key issues presented by the federal government affecting our practice of medicine. For cataract