Eyeworld

SUPPLEMENT TO EYEWORLD | 39 ASCR S advocates for Alternative Payment Model option for cataract surgery T he ASCRS Government Relations department has developed, in conjunction with the ASCRS and ASOA leadership and membership, an alternative payment model relating to immediate sequential bilateral cataract surgery (ISBCS), working with the AMA and Harold Miller, the President and CEO of the Center for Healthcare Quality and Payment Reform. "While there is an effort by CMS to move away from Medicare fee-for-service and toward alternative pay- ment models, it is not necessarily the best option for ophthalmolog y," Ms. McCann said. ere are currently no alternative payment models that are specialty fo- cused, and as such, Ms. McCann said it was important for ASCRS to be proactive in developing an attractive model for ophthalmolog y, beginning with cataract sur- gery. is led ASCRS, with input and direction from ASCRS and ASOA membership, to develop a dra for an alternative payment model based on ISBCS. With improved algorithms and technolog y to determine the appropriate IOL in the second eye and less risk for endophthalmitis, ophthalmologists are increasingly willing to do same-day cataract surgery in both eyes, and patients ask for it, but reimbursement remains a barrier. "If you do another procedure in the same day, you get a 50% reduction in physician payment and facility payment, so it's just not a viable option for most ophthalmologists and practices," Ms. McCann said. ASCRS, along with Mr. Miller and the AMA, have met with the key staff at the Centers for Medicare and Medicaid Innovation (CMMI), the group tasked with developing and approving alternative payment models, as well as with the Center for Medicare to discuss the proposal. While CMMI indicated at the time that it was not planning to implement specialty-specific epi- sode-based models (because it wanted all patients and physicians participating in Accountable Care Orga- nization [ACOs]), it was supportive of the approach and expressed interest in a revised proposed plan. is revised proposed plan is based on a Cataract Surgery Team entering into a voluntary agreement with an ACO to perform ISBCS on appropriate patients determined by the physician. ACOs could have agreements with as many cataract surgery teams as they want, and teams can sign with as many ACOs as they want, Ms. McCann said. In addition, CMS issued a request for informa- tion regarding specialty-specific models, and ASCRS submitted comments promoting the testing and imple- mentation of its cataract surgery alternative payment model. e AMA is also supportive of specialty-specific models, in particular the ASCRS Cataract Surgery pro- posal, and included it in their comments. ASCRS has continued to pursue other options, in- cluding meeting and presenting to America's Health Insurance Plans (AHIPs) Medicare Advantage work group. Details on this dra voluntary APM for same- day, bilateral cataract surgery were shared during the ASCRS Government Relations session at the 2022 AS- CRS Annual Meeting. Mr. Miller presents at an ASCRS Annual Meeting. Source: ASCRS 1990s–2000s " While there is an effort by CMS to move … toward alternative payment models, it is not necessarily the best option for ophthalmology." —NANCEY MCCANN

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