Eyeworld

DECEMBER 2022 | EYEWORLD | 23 Contact Gruehn: bgruehn@ascrs.org Winans: jwinans@ascrs.org by Brad Gruehn, ASCRS Chief of Government Relations, and Jillian Winans, ASCRS Senior Manager of Government Relations Medicare payment reform ASCRS remains concerned about the growing financial instability of the Medicare Physician Fee Schedule (MPFS) and anterior segment surgeons' reimbursement. Annual Medicare physician payment cuts are unsustainable, espe- cially for solo and small practices struggling to provide patient care due to rising inflation costs, workforce shortage issues, and the financial ef- fects of the COVID-19 public health emergency. In order to address the instability of the MPFS, ASCRS and the medical community are work- ing together, urging Congress to take action. As part of the American Medical Association (AMA) Workgroup on Medicare Reform, ASCRS helped develop a set of principles to address the systemic problems with the Medicare physician payment system to ensure continued patient access to care. The principles, in general, call on Congress to provide financial stability through an annual inflation update, reward the value of care provided to patients and encourage inno- vation, and advance health equity and reduce disparities. In September, a bipartisan group of U.S. representatives issued a request for information seeking feedback on actions Congress could take to stabilize and improve the Medicare pay- ment system. ASCRS worked with colleagues in the Alliance of Specialty Medicine to develop a response highlighting the need for an inflation update for physician payments and the need to address budget neutrality in the MPFS, as CMS does not have the authority to address this issue. Additionally, ASCRS continues to work with the medical community urging Congress to avert the roughly 8.5% cut in Medicare payment scheduled to take effect on January 1, 2023. In late September, ASCRS joined more than 100 medical organizations (representing more than 1 million healthcare professionals) expressing support for legislation in the U.S. House of Representatives (H.R. 8800) that would address the 4.5% cut to the Medicare conversion factor in calendar year 2023 and call on Congress and the administration to ensure financial stability authorization policies that threaten patients' access to timely care. ASCRS continues to work on addressing the Aetna prior authorization pol- icy in the remaining two states and is pushing to stop other prior authorization policies impacting anterior segment surgeons. On Capitol Hill, bipartisan legislation supported by ASCRS, the "Improving Seniors' Timely Access to Care Act of 2021" (H.R.3173), was approved by voice vote in the U.S. House of Representatives on September 14. The House bill, sponsored by Representative Suzan DelBene (D-WA), had 326 bipartisan cosponsors at the time of its passage. The Senate compan- ion bill (S. 3018), sponsored by Senator Roger Marshall, MD (R-KS), had 45 bipartisan cospon- sors as of October 11. H.R. 3173/S. 3018 would establish require- ments that would modernize and streamline the prior authorization processes under Medi- care Advantage plans. Specifically, Medicare Advantage plans would have to: (1) establish an electronic prior authorization program that meets specified standards, including the ability to provide real-time decisions in response to requests for items and services that are routine- ly approved; (2) annually publish specified prior authorization information, including the per- centage of requests approved and the average response time; and (3) meet other standards, as set by CMS, relating to the quality and timeli- ness of prior authorization determinations. ASCRS and its colleagues in the medical community are advocating for this bill to be approved by the Senate and enacted into law before the end of the year. ASCRS continues to urge CMS to increase its oversight of Medicare Advantage plans to ensure they are not unnecessarily delaying or denying beneficiaries' access to care through prior authorization policies. ASCRS maintains that prior authorization should not be required for cataract surgery, given that it is one of the most common and efficacious Medicare surgical procedures, and most Medicare beneficiaries will require it at some point to maintain func- tional vision. update: prior authorization success and more continued on page 24

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