This article is more than 5 years old. Information may no longer be current.
Ophthalmologists face challenges, pressure from Affordable Care Act
Click Here to Manage Email Alerts
NEW YORK — Ophthalmologists will face many regulatory mandates and structural changes under the federal health care reform law, a legal expert said here.
Additionally, a 27.4% Medicare physician payment cut and a 13.6% cut in payment for cataract surgery are on the horizon, Alan E. Reider, JD, MPH, OSN Regulatory/Legislative Section Editor, said at OSN New York 2012.
“Financial pressures will force the rescission of the prohibition against balance billing in exchange for further cuts in Medicare reimbursement,” Reider said.
Accountable care organizations (ACOs) are a key centerpiece of the Affordable Care Act (ACA). They are designed to coordinate care for Medicare beneficiaries and contain costs, Reider said.
ACOs also involve cost savings and potential risk of loss that are shared by member physicians and groups, Reider said.
In addition, the ACA devotes an additional $350 million over 10 years for regulatory enforcement. In 2012, the Office of Inspector General’s budget increased by $74 million over the 2010 earmark, Reider said.
The ACA requires compliance plans for all providers as a condition for enrollment in Medicare and Medicaid. Physicians must comply with regulations or face possible disenrollment, Reider said.
The 2013 Medicare physician fee schedule calls for a 13.6% cut in payment for cataract surgery. The Centers for Medicare and Medicaid Services has shifted its focus to postoperative care.
“You are victims of your own success,” Reider told surgeons at the meeting.
The physician payment cut will kick in Jan. 1, unless Congress intervenes. The cut stems from the sustainable growth rate (SGR), a key factor in annual Medicare payment updates designed to cap annual cost increases and drive revenue-neutral payment.
The SGR will be eliminated in 2013, Reider said.
Disclosure: Reider is a partner in the law firm Arnold & Porter. He has financial relationships with Alcon, Bausch + Lomb, OptiMedica and LensAR.