Eyeworld

FOCUSING ON THE THREE PILLARS OF THE SOCIETY 34 | SUPPLEMENT TO EYEWORLD Punching above its weight ASCRS amps up advocacy on behalf of surgeons Prior to ASCRS' move to its headquarters in Fair- fax, Virginia, Mr. Karcher traveled from California to Washington, D.C., to attend FDA hearings. When the organization moved to Virginia, he registered as a lobby- ist, and ASCRS hired an outside lobbying firm. With the organization growing and a need to focus more on advocacy for cataract reimbursement, he hired Nancey McCann to develop and lead ASCRS advocacy. "I underestimated the time we would need for lobbying. Nancey was absolutely the perfect person, the type of in- dividual we needed," he said. Ms. McCann started with ASCRS in February 1993. "at was at the time when Medicare physician payment was going through major changes, as the gov- ernment had enacted several cost containment measures prior to implementing the resource-based relative val- ue scale (RBRVS) and the Medicare Fee Schedule," she said, which in addition to controlling rising costs, was an effort to develop a national fee schedule that was based on resources or input costs and to redistrib- ute money from surgical and specialty care to primary care. e new system, which is essentially a ranking of each Medicare-covered physician service based on total resources, including values for work, practice expense, and malpractice, also included a statutory requirement of budget neutrality, as well as balance billing limita- tions and expenditure targets. e budget neutrality provision, which states that changes in RVUs cannot cause Medicare expenditures to increase or decrease by more than $20 million, results in adjustments to the conversion factor (turns the RVUs into dollar amounts). Budget neutrality and the absence of an update factor based on inflation continue to have a negative impact on Medicare physician payment. Prior to that, the system was charge-based (customary, prevailing, and reasonable methodolog y), and due to mounting feder- al budget deficits, Congress began instituting a series of cost-containment provisions aimed at slowing the growth of Medicare. Beginning in 1984, federal legisla- tion in almost every year contained provisions to reduce Part B physician payments (ophthalmic procedures and IOLs were targeted) while maintaining the struc- ture of the "customary" reimbursement system. is included freezes in payments, limiting payments, and across-the-board reductions. e 1989 Omnibus spend- ing bill limited the payment update for non-primary care services and "overpriced services," which included cataract surgery. "By the time I started, the work relative value units (RVUs) of RBRVS, which are based on time and intensity of a procedure, were already implement- ed," Ms. McCann said. "I came in when we were facing the transition and implementation of practice expense RVUs (direct and indirect)." In anticipation of the significant reductions to special- ty and surgical care that would occur when the practice Ms. McCann led the ASCRS government relations depart- ment for nearly 30 years. She presented courses at the Annual Meeting to keep ASCRS and ASOA members informed. Source: ASCRS " We engage ophthalmologists in grassroots efforts and partner with like-minded surgical and specialty coalitions…" — NANCEY MCCANN

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