Eyeworld

14 | EYEWORLD | FALL 2025 ASCRS NEWS GOVERNMENT RETIONS UPDATE A SCRS Government Relations contin- ues to fight for the best interests of ASCRS members in regard to Medi- care reimbursement and other key legislative and regulatory issues. ASCRS attends Legislative Fly-In Representatives from ASCRS met in Washing- ton, D.C., in July to participate in the Alliance of Specialty Medicine Legislative Fly-In. The Fly-In is organized by the Alliance to bring the 16 member medical specialty societies to Washing- ton, D.C., to learn about policy issues affecting the specialty medical community and to meet directly with their representatives and senators to lobby for policy initiatives. This was the 25th year ASCRS participated in the Fly-In. ASCRS members met with leg- islators to discuss ongoing problems with the Medicare Physician Fee Schedule, the need for prior authorization reforms, and to lobby for an increase in the number of residency slots across the country. Reimbursement updates Also in July, the 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule and the 2026 ASC Proposed Rule were released. The ASCRS Government Relations team reviewed these proposed rules and submitted comments regarding the proposals prior to the September 12 deadline. Notably, the proposed Medicare payment rate for a standard cataract procedure, 66984, is estimated to be $466.87, which is an 11% decrease from the 2025 Medicare payment of $521.75. The significant decrease is due to changes to two proposals: the newly proposed efficiency adjustment that will impact work RVUs and changes to the methodology in calcu- lating the indirect practice expense. In the rule, CMS argues that physicians providing non-time based services, particularly procedures, radiological services, and diagnostic testing, will become more efficient as they gain more experience and technology continues to advance. Therefore, CMS is proposing to apply an efficiency adjustment to work RVUs. For CY26, the proposed efficiency adjustment is –2.5%. ASCRS Government Relations news Additionally, CMS thinks the decline in the number of physician-owned practices means providers no longer need to maintain office-re- lated expenses and that the current indirect PE allocations are overstated. The equation to calculate indirect expenses is highly technical. As part of the overall equation, CMS uses work RVUs. CMS has proposed to reduce the portion of facility PE RVUs allocated based on work RVUs to half the amount allocated to non-facil- ity PE RVUs. CMS's proposal will reduce the PE RVUs for facilities. ASCRS disagrees with CMS' assumptions related to the efficiency adjustment and changes in the practice expense methodology. ASCRS continues to work with the AMA and other medical specialties in advocating for policies that accurately reimburse physicians for the services they provide and ensure patient access to these services. Under the 2026 MPFS Proposed Rule, the proposed 2026 conversion factor was $33.59 for qualifying Alternative Payment Model (APM) participants and $33.42 for nonqualifying APM participants. As required by MACRA statute, there are two conversion factors for CY26, a conversion factor update of +0.75% for qualifying alterna- tive payment model (APM) participants (QP) and a conversion factor update of +0.25% for nonqualifying APM participants (or those participating in traditional MIPS). Additionally, the One Big Beautiful Bill Act of 2025 includes by Susanne Hewitt, MD ASCRS Government Relations Committee Chair continued on page 16 ASCRS Government Relations continues to fight for the best interests of ASCRS members in regard to Medicare reimbursement and other key legislative and regulatory issues.

• Blank Page
• Blank Page (1)