DEC 2012

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

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December 2012 EW NEWS & OPINION 19 Insights One for our side How to get involved ��� Read Washington Watch Weekly. It is published every Friday and delivered to your email inbox. I called Nancey McCann. Like old friends, we picked up where we left off: Washington, politics, politicians. Nancey is the director of government relations at ASCRS���ASOA. It���s a difficult job but somebody���s got to do it. Nancey loves her job. Nancey picks up the phone. ��� Act on Grassroot Alerts in your email. All the information to contact your representatives is included. Letters can be downloaded and forwarded. ��� Get to know your representatives. Ask them to visit your practice. Nancey and the ASCRS���ASOA government relations staff can provide advice to help you and your staff prepare. Dr. Noreika: What are ophthalmology���s hot-button issues in 2013? Mrs. McCann: Congress���both Democrats and Republicans���is determined to change the Medicare delivery and payment system to one that is based on quality, outcomes, and cost efficiencies. How doctors get paid will be radically altered. Studies such as the Dartmouth Atlas Project conducted at Dartmouth University highlighted huge regional variations in utilization, cost, and quality. The government no longer wants to pay physicians the same amount based on CPT code regardless of the outcome or the cost to provide the care delivered. Dr. Noreika: This is new? Mrs. McCann: No, the move toward rewarding physicians based on quality and outcomes began years ago. For example, the electronic health record meaningful use initiative was started under (George W.) Bush. It is not part of the Affordable Care Act and isn���t going away. It is supported by both parties and is part of the quality initiative. The push for quality reporting began as a Republican congressional effort led by former Rep. Bill Thomas (R-California), who at the time was chairman of the House Ways and Means Committee. The focus on outcomes, cost efficiencies, and electronic health records are interrelated. Dr. Noreika: This adds to practice overhead. How will it be paid for? Mrs. McCann: The government favors a move toward large, integrated delivery systems that can underwrite the resources required for data col- ACTION REQUIRED by J.C. Noreika, M.D., M.B.A. ��� Call your representatives and senators regarding key legislative issues impacting ophthalmology. These are identi���ed on the ASCRS Grassroots website. This isn���t just about ophthalmology. It���s about our patients and the care they receive. ASCRS offers a directory of toll-free numbers. ��� Write a check to the ASCRS��� eyePAC. Access doesn���t come free. lection and reporting. Accountable care organizations (ACOs), medical homes, etc. are some examples. In addition, they will be looking at bundling payments, including the facility fee and the physician payment, for example. In addition to the surgeon���s pre-op, operative, and post-op care, reimbursement for cataract surgery would include the cost of the facility, nursing and anesthesia staff, the implant, disposables, medications, and complications. The government will let others decide how the dollars are divided. Dr. Noreika: What about that perennial favorite, the sustainable growth rate (SGR)? Mrs. McCann: The first cut actually occurred in 2002. Ever since, temporary ���fixes��� have been put in place, usually at the last minute or retroactively. But the fixes are not paid for and add to the debt. No one can figure out how to offset the billions of dollars that have piled up since 2002. Politicians know that doctors can���t sustain a 27% cut in Medicare fees. On a bipartisan basis, Congress is looking at replacing the SGR with the move toward the new system based on quality, outcomes, and efficiencies and moving away from the current fee-for-service system. Dr. Noreika: What are accountable care organizations? Mrs. McCann: These are actual experiments at integration. No two are exactly alike. It isn���t clear how ophthalmology fits into these entities because it is an office-based subspecialty with little or no interaction with hospitals. One scenario is that ophthalmology will be outsourced by the ACOs. Because of this, efforts in Congress to preserve the fee-for-service system are very important. Members of Congress Tom Price (R-Georgia) and Lisa Murkowski (R-Alaska) have sponsored bills in the House and the Senate to permit private contracting between a physician and patient on a case-by-case basis without jeopardizing either���s standing with Medicare. Dr. Noreika: What do I need to know about the Value-Based Payment Modifier? Mrs. McCann: Payment under this plan must be budget neutral. The modifier rewards physicians based on quality and savings and will be tied to participation in the [Physician Quality Reporting System] PQRS. There will be winners and losers. Ophthalmology is lumped in with every other specialty and could be held accountable for things like cardiac imaging that we can���t control. It will begin in 2015 for large practices, but CMS has decided to base it on services provided beginning on January 1, 2013. It will affect all physicians by 2017. Dr. Noreika: Do you still like your job? Mrs. McCann: I love my job. I enjoy working with physicians and my colleagues in other specialties. Every day can seem like ���Groundhog Day,��� but I like the challenge and believe in what I do. EW Editors��� note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for more than 30 years. Contact information Noreika: JCNMD@aol.com

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