EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78788
18 EW NEWS & OPINION August 2012 Chief medical editor's corner of the world Can the ACA still be stopped or modified? Dr. Chang: Now that the ACA L ast month, the members of the ASCRS Government Relations Committee and several Govern- ing Board members flew to Washington, D.C., to attend the Alliance of Specialty Medicine Legislative Fly-In. For a description of the Alliance and the event, please see the accompanying article on page 3. This was an exciting meeting because it followed immediately on the heels of the Supreme Court decision essentially upholding the Affordable Care Act (ACA). I personally learned a lot from attending the Fly-In. Besides meeting with our own legislators on the Hill, we heard from nine different senators and represen- tatives who made time in their busy sched- ules to speak to our group. Several of them are physicians. As a result, I have a better understanding of the issues and a greater appreciation of preferable solutions pro- posed by legislators who understand the harm of governmental overregulation of healthcare. As demoralized as we might feel, physicians have some true friends on both sides of the aisle, and they need our support, collaboration, and encouragement. I cannot say enough about the dedication of our Government Relations Committee members, under the leadership of Chairman Brock Bakewell, M.D., and Nancey McCann. Their work is largely unsung and underappreciated, but I can assure you that our committee is well versed in the political process, well informed on the issues, and committed to representing our membership to the best of its ability. They need our thanks, but more importantly, our interest and our support. Our readers are undoubt- edly wondering what will happen next with the ACA bill, and I asked Dr. Bakewell to comment on what might happen and what we, as a group, can impact. David F. Chang, M.D., chief medical editor has survived the Supreme Court challenge, what happens next? What are the prospects for repealing or reversing the legislation now? Dr. Bakewell: The ACA is now the law of the land, and its provi- sions will continue to be imple- mented unless the law is repealed. Even though the U.S. House voted in favor of repeal of the ACA for the 31st time on July 11, the Senate doesn't have enough votes to pass repeal, and even if they did, President Obama would veto the repeal legislation. The House vote was largely along party lines, but a few Democrats do support repeal. Dr. Chang: How will the No- vember elections affect the survival and implementation of the ACA? Dr. Bakewell: The eventual out- come of the ACA is, to a large ex- tent, dependent on the upcoming general election. If the Republicans win the Senate and the presidency, and the House maintains its Republican majority, then there is a chance that the ACA could be re- pealed. If the ACA is not repealed, Congress can still mitigate some of the provisions harmful to physicians by repealing certain provisions of the law. Dr. Chang: What are the prospects for a permanent sustain- able growth rate (SGR) fix? How will the elections affect this? Dr. Bakewell: The prospects for a permanent SGR fix are still not good due to the federal budget deficit/debt. To fix the SGR, it would currently cost more than $300 bil- lion, and lawmakers feel that this has to be offset by a savings in some other aspect of the budget. I believe that a majority of legislators are in Latest continued from page 17 Ophthalmology 2011 Jan;118(1):209-218. 2. Anwar M, Teichmann KD. Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty. J Cataract Refract Surg 2002 Mar;28:398-403. 3. Chan CC, Ritenour RJ, Kumar NL, et al. Femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty. Cornea 2010 Mar;29:290-295. 4. Buzzonetti L, Petrocelli G, Valente P. Fem- tosecond laser and big-bubble deep anterior lamellar keratoplasty: a new chance. J Oph- thalmol 2012;2012:264590. Epub 2012 Feb 9. 5. Riss S, Heindl LM, Bachmann BO et al. Pentacam-based big bubble deep anterior lamellar keratoplasty in patients with keratoconus. Cornea 2012 Jun:31:627-632. 6. Goshe J, Terry MA, Shamie N, Li J. Oph- thalmic viscosurgical device-assisted incision modification for the big-bubble technique in deep anterior lamellar keratoplasty. J Cataract Refract Surg 2011 Nov;37:1923-1927. Editors' note: Dr. Chan is clinical lecturer, Department of Ophthalmology and Vision Sciences, University of Toronto. She has no financial interests related to this article. Contact information Chan: clarachanmd@gmail.com Sen. Rand Paul (left) and Dr. Bakewell at the Alliance of Specialty Medicine Legislative Fly-In agreement that the SGR needs to be permanently fixed, but until the federal budget picture improves, physicians are most likely going to continue to get temporary fixes. This is irrespective of the outcome of the general election. On the contrary, I think that the likelihood of Con- gress allowing one of these SGR cuts to occur is low, but they have al- lowed this once in the past in 2002 when physicians sustained a 5.4% cut. The unfortunate result of Congress' failure to act is that the cost to fix the SGR continues to climb exponentially. It is also impor- tant to realize that Congress is not going to continue to grant us tem- porary SGR fixes without changing the current reimbursement system that is based on volume. There is bipartisan support to base physician payment on quality, outcomes, and efficiencies. Dr. Chang: What are the legislative priorities for ASCRS? Dr. Bakewell: The legislative priorities for ASCRS are as follows: 1. Obtain Medicare Physician Payment Reform. This includes eliminating the SGR debt and re- placing the flawed SGR formula with a system that ensures adequate reim- bursement for specialists, not just primary care. A new system should pay physicians based on the actual cost of practicing medicine and should maintain a fee-for-service option. ASCRS would like to see physicians be able to privately con- tract with patients on a case-by-case basis without penalty to patients or physicians. Patients should be able to use their Medicare benefits, and the physician should be able to bill the patients for all amounts not cov- ered by Medicare (Medicare Patient Empowerment Act – S.1042/H.R. 1700). 2. Eliminate the Independent Payment Advisory Board (IPAB). The ACA created IPAB to control Source: ASCRS/EyeWorld