Eyeworld

WINTER 2025 | EYEWORLD | 15 GOVERNMENT RETIONS UPDATE ASCRS Government Relations: wrapping up a busy year and preparing for 2026 by Susanne Hewitt, MD ASCRS Government Relations Committee Chair A s 2025 concludes, ASCRS Govern- ment Relations staff and the ASCRS Govern- ment Relations Committee remain actively engaged in legislative and regulatory ad- vocacy impacting cataract surgery, ophthalmolo- gy, and broader healthcare policy. Key issues this year included cuts to physician reimbursement under Medicare, regulatory restructuring, and insurer-driven expansions of prior authorization and scope of practice. Looking ahead to 2026, ASCRS antici- pates continued challenges, including further Medicare payment reductions, refinements to the Quality Payment Program, and ongoing scope of practice debates. ASCRS will continue advocating for fair reimbursement, including support for same-day bilateral cataract surgery and coverage for innovative technologies and procedures. With healthcare policy continuing to shape the delivery of ophthalmic care, ASCRS Government Relations, the ASCRS political action committee (eyePAC), and our members' engagement in advocacy will be important to protect your practice and ensure access for all patients to high-quality eyecare. Medicare reimbursement As the year began, physicians experienced a 2.8% cut to the physician fee schedule. ASCRS worked with Congress to address this cut, but unfortunately, a year-end continuing resolution to fund the government failed, and language providing a partial physician pay fix was re- moved, allowing the full 2.8% cut to take effect on January 1. Despite ASCRS efforts, including support for the Medicare Patient Access and Practice Stabilization Act of 2025, legislation that would fully offset the 2.8% Medicare reim- bursement cut, the cut remains in effect due to stalled legislative negotiations. Language addressing the cut was included in the House-passed reconciliation package but was removed by the Senate before final passage in July. While not addressing the 2.8% cut to the Medicare Physician Fee Schedule conversion factor that went into effect on January 1 of 2025, the Medicare provisions approved by the House committee provided a positive payment update of 75% of the Medi- care Economic Index for 2026. This is the first time Congress acknowledged the need for an inflation update for physician pay under Medi- care, an important precedent. We continue to pressure Congress to address the current cut and to reform Medicare physician pay moving forward. MPFS Proposed Rule In July, CMS released the CY 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule. The rule proposes major changes in reimburse- ment for physicians. ASCRS, joined by the Out- patient Ophthalmic Surgery Society (OOSS), submitted comments on the proposal. Most concerning to ASCRS is that cataract surgery, CPT code 66984, is facing an 11% cut, driven by a flawed 2.5% efficiency adjustment to the Work RVUs and changes to the indirect practice expense methodology. ASCRS maintains that the RUC provides fair and accurate valuations for procedure codes, especially those related to cataract and other ophthalmic surgeries. In addition, CMS' proposed changes to the indirect practice expense methodology overlook critical specialty-specific data. While CMS cites a broad shift toward hospital-based care, ophthalmolo- gy remains an outlier, with 70.4% of ophthal- mologists still in private practice, according to the AMA's 2024 Policy Research Perspectives. ASCRS is working with other specialty societies on a strategy to approach Congress should these proposals remain in the final rule. ASC Payment Proposed Rule CMS also released the CY 2026 Hospital Out- patient Prospective Payment and Ambulatory Surgical Center (ASC) Payment Proposed Rule. ASCRS, AAO, ASRS, OOSS, and SEE submitted joint comments on the proposal. The chief con- cern addressed in the comments is the proposed reduction in the ASC payment rate for cataract surgery, CPT 66984. Payment for this procedure is estimated to decrease by 5% of the CY 2025 continued on page 16

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