Eyeworld

ASCRS NEWS schedule beginning in 2021. ASCRS is working with the AMA and the surgical community to advocate that CMS extend the E/M increases to those 10- and 90-day global codes to ameliorate some of the impact. If this change is made, it would increase the RVUs for the cataract code to 8.23, restoring almost all of the value lost as a result of this revaluation. We are cautiously optimistic that CMS will make this change when the final rule is released in November. In addition, we are seeking congressional action to extend positive updates to the con- version factor originally enacted as part of the Medicare Access and CHIP Reauthorization Act (MACRA) that are set to expire beginning in 2020. Dr. Mamalis: What resources has ASCRS developed to help members understand this change in reimbursement? Dr. Parekh: ASCRS has provided several resources on its website, such as additional background information, tools to help under- stand the impact on practices, as well as a video and a webinar. postoperative visit (accounting for about $75 of the reduction), ASCRS and AAO were success- ful in presenting the intensity argument. To do this, we took an incremental approach and iden- tified a retina code with a similar work RVU but slightly shorter time. We calculated the intensity per minute of intra-service time for the retina procedure, then used that intensity per-minute value for each of the 5 additional minutes of intra-service work for cataract surgery. There- fore, we were able to prevent a much deeper cut of perhaps 40–50% that would have aligned the value with other less intense surgical codes with similar operative time and number of postop- erative visits. While we certainly do not want to diminish the significance of the cut in 2020, we were pleased that RUC recommended the value it did and that CMS accepted it. Dr. Mamalis: Why didn't ASCRS or AAO inform members of this reduction previously? Dr. Parekh: All participants at the RUC— members, presenters, observers, and staff— must sign a confidentiality agreement and may not discuss the deliberations of the meeting until CMS publishes the proposed rule in the Federal Register. In addition, CMS is under no obligation to accept the RUC's recommenda- tions; CMS can cut services more than what the RUC suggests and, in fact, for many services CMS did just that. Therefore, we did not know what the proposed value would be. Despite those limitations, the RUC-approved messag- es sent by both ASCRS and AAO alerted our members that the cataract code was being reval- ued and encouraged members who received the survey to complete it. Dr. Mamalis: What are the next steps? Dr. Parekh: CMS is also proposing to increase the values of office visit E/M codes beginning in 2021. However, it is not proposing to in- crease the value of postoperative visits included in global surgery codes, even though the RUC values them equally to standalone E/M codes. Because E/M services are by far the most billed physician services and the system is budget neutral, the increased value is expected to have a negative impact on all other services in the fee continued from page 10 Contact information Mamalis: nick.mamalis@hsc.utah.edu Parekh: parag2020@gmail.com 12 | EYEWORLD | OCTOBER 2019 For more information visit: ascrs.org/2020- medicare-physician- fee-schedule-mpfs- proposed-rule Watch Nancey McCann, ASCRS Government Relations, discuss the proposed rule on EyeWorld TV at bit.ly/2lifLar

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