Eyeworld

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For more information about our Pre-Loaded CTRs, please call us at 800-932-4202 Exclusively from H.R. 2: What does it mean for ophthalmology and where do we go from here? by Brock Bakewell, MD continued on page 12 Brock Bakewell, MD W hen H.R. 2, or the Medicare Access and CHIP Reauthorization ACT (MACRA), was signed into law in April, it addressed one major issue, among others, that the ophthalmo- logical and medical communities have been working toward for some time: the repeal of the flawed Medi- care Sustainable Growth Rate (SGR) formula. This bipartisan legislation helped eliminate the SGR formula, which limited the growth in spend- ing for physicians' services and threatened significant cuts in Medi- care physician payments annually. As with any law, it is not perfect and represents a bipartisan compro- mise, factoring in opinions from different committees and other in- terested groups. It not only address- es the SGR, but a number of other issues important to ophthalmology. It is not the exact bill ASCRS would have drafted, and therefore, ASCRS intends to advocate for further changes in the future, such as higher positive updates. This may be achievable since it will be less ex- pensive to increase payments from the positive baseline that MACRA provides, compared to paying for updates on top of the significant cuts that were threatened by the SGR. The SGR Though there was bipartisan support for many years for repeal of the SGR, the delay in fixing the under- lying problem and short-term fixes resulted in higher potential cuts and a higher cost of complete repeal, which further delayed the long-over- due resolution. There were 17 short- term "fixes," which never addressed the problem and created deeper cuts as the years went by, and an actual 5.4% reduction in Medicare reim- bursement in 2002 as a result of the flawed formula. This new law, which ASCRS and the entire medical community sup- ported, permanently repeals the SGR and replaces it with 5 years of annu- al 0.5% positive payment updates from 2015 to 2019. Additionally, from 2020 through 2025 there will be a 0% update, and for 2026 and on, physicians choosing the fee-for- service option will receive a 0.25% annual update while alternative payment model (APM) participants will receive a 0.75% update. Without this repeal, a 21% cut would have gone into effect on April 1, 2015, with the possibility of fu- ture cuts to exceed 25%. In addition to these huge cuts, the SGR formu- la threatened physicians with the uncertainty of not knowing whether the cuts would go into effect or if a short-term fix would be enacted in time. The new law permanently re- solves these uncertainties, enabling physicians and practices to develop longer-range plans. 10- and 90-day global codes MACRA also addresses a number of other key issues impacting ophthal- mology, most importantly pre- venting CMS from transitioning all 10- and 90-day global codes to 0-day codes. This provision was a major priority for ASCRS and other advo- cates in the surgical community. CMS' policy would have tran- sitioned all 10- and 90-day global codes to 0-day codes in 2017 and 2018, respectively. When the policy was finalized, CMS indicated they had not developed a methodology for unbundling the codes and that they did not have accurate data to remove postoperative visits and practice expense from the global codes. This would have had a nega- tive impact on surgical codes, and in particular ophthalmology, because there are a number of postoperative services included in the global codes that cannot be reimbursed for using the current separately billable E/M codes because there are no codes for the services, such as dressing changes, removing sutures, or local incision care. Also, there would be no way to account for postopera- tive direct practice expenses such as supplies and equipment, further im- pacting reimbursements, especially for specialties such as ophthalmolo- gy with our high practice expenses. CMS would also have had to develop new postoperative visit codes that would have likely been reimbursed at a lower level and capped in num- ber. Finally, the policy would have increased the financial burden for patients or discouraged them from seeking postoperative care because they would have had to pay separate copays for each visit. In fact, the policy would have most adversely affected the sickest patients, since the global bundles are based on the typical patient. MIPS Though some think that MACRA will eliminate fee-for-service, this is

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