SEP 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 32 of 103

September 2012 Fly-In focus: Independent Payment Advisory Board by Francis W. Price Jr., M.D., ASCRS Government Relations Committee member firsthand from representatives from around the country. We have some excellent repre- ASCRS, Alliance continue to fight for repeal O n July 9-11, I participated in the Fly-In with the Alliance of Specialty Medicine and ASCRS. We heard a number of very good talks by members of Congress and government administrators. We had opportunities to ask questions and comment on needs of our patients and practices. Every member of ASCRS should seriously consider participating in this event next year. It allows you to see how the system works and hear sentatives in Congress. We also have representatives we need to replace— and the Fly-In helps us see this. For instance, a number of representa- tives suggested we could get rid of the SGR cuts if we just found a place to get the money to pay for it. "Washington is now all about being budget neutral" we were told, yet there has not been a federal budget for the last 4 years, just an open checkbook. One of the major issues of focus for the Fly-In was the repeal of the Independent Payment Advisory Board (IPAB). The Affordable Care Act (ACA) sets up this unelected and unaccountable 15-member review board appointed by the President charged with reducing the per capita growth rate of Medicare spending. Looking at the actual law, which is available online, is important. The original wording in the ACA is difficult reading, but the 18 pages setting up IPAB in the Social Security Act, Sec. 1899A, are readable and should be mandatory reading for anyone interested in healthcare— doctors, patients, and legislators. Key points: 1. Essentially mandates cuts in Medicare payments based on all Medicare expenses, not just ex- penses from physician payments, and there are added directives for overall reductions in Medicare payments. 2. "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums … increase Medicare beneficiary costsharing (including de- ductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria." 3. Hospitals, long-term care facili- ties, and suppliers of goods are exempt from cuts until 2020. 4. Essentially physicians, and Parts C and D of Medicare, will shoulder the cuts until 2020. 5. Board proposals for Medicare can only be changed by a 60% vote in each house of Congress and with the consent of the President. 6. The board makes recommenda- tions on the rest of healthcare (private sector, nongovernment paid services), and there is no congressional oversight of what is done outside of Medicare. 7. There is no judicial review of anything the board or Secretary continued on page 34 EW NEWS & OPINION 33 Fly-In focus: Value-based payment modifier by James A Bryan III, M.D., ASCRS Government Relations Committee member A t the recent Legislative Fly-In for the Alliance of Specialty Medicine, one of the many issues discussed was the upcoming value- based payment modifier (VBPM). For many of those in attendance, the VBPM, which is contained in the Affordable Care Act (ACA), seemed to be yet another poorly constructed method to penalize physicians. A senior advisor to the Centers for Medicare & Medicaid Services (CMS) attempted to explain both the modifier and the methods used. As I understand the current struc- ture, there will be a –1% penalty to the lowest performing 25% of physi- cians, and that –1% penalty will be given as a 1% incentive to the top 25% highest performers. The middle 50% will have a 0% adjustment. This creates a so-called "budget neu- tral" proposal, which is a very popu- lar concept in the current economic environment. This program will be based on "cost and quality" data taken during 2013, two years earlier than described in the ACA. The performance year is 2013, but the reductions do not begin until 2015. Based on the presentation by CMS, the measures could range from utilizing the Medicare Physician Quality Reporting System (PQRS) to simply applying CMS payment data if no other measures are available. Even after an in-depth presentation, the exact definition of quality performance seemed obtuse. Because of the obvious rush to implement, the lack of concrete quality measures, and the challenge to measure physician resource use, the Alliance has requested a delay in implementation of the VBPM. The Alliance message urges Congress to "enact sensible quality improve- ment programs." As calls were made on members of the House and Senate, it became evident that this penalty/incentive program was not well known to the members. During these calls our representatives were asked to consider the following: • Incentivize meaningful quality improvement rather than penalize arbitrary indicators of perform- ance. • Provide an appropriate timetable and make required investments in reforms. New payment policies targeting quality and efficiency must be carefully evaluated prior to widespread implementation. • Give careful consideration to measures of resource use and value-based payments. Payers continue to struggle with how to accurately define and measure physician resource use. Value- based payments reforms also need to recognize that some specialists focus on patients that cost more to treat. • Minimize regulatory burden. Implementation of multiple pro- grams (EHR, PQRS, e-prescribing) has resulted in overlapping docu- mentation requirements and misaligned incentives, creating financial and administrative burdens for physicians, diverting attention away from true quality improvement. Due to the efforts of the physi- cians attending the Fly-In, several members of Congress were identified as potential champions for the delay. There seems to be bipartisan support for slowing the implementa- tion of this "value-based" program. Hopefully, Congress will enact more sensible quality improvement pro- grams that recognize the needs of different patient populations and will delay the implementation of VBPM. To read more on this issue, visit the Government section of the ASCRS website. EW Editors' note: Dr. Bryan practices at Carolina Ophthalmology Associates, Chapel Hill, N.C. Contact information Bryan: jbryanmd@carolina2020.com

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