Proposed 2021 Medicare Physician Fee Schedule includes 6% reduction for ophthalmology
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The Surgical Care Coalition plans to oppose the CMS proposal of a 10.6% decrease to its 2021 Medicare Physician Fee Schedule’s conversion factor, which includes a 6% decrease to ophthalmology payments in 2021, according to a speaker.
“Obviously, we’re not happy with these cuts. We’re fighting them through the Surgical Care Coalition that we formed with the American College of Surgeons. There are 11 surgical subspecialties involved, and the group has raised $2 million and launched a public relations campaign in the D.C. area to make our congressional representatives aware of the impact of the changes,” David B. Glasser, MD, secretary for federal affairs of the AAO, said in a press conference at the virtual American Academy of Ophthalmology meeting.
The impact of this measure is not to reduce total spending on physician reimbursements, but to redistribute spending and specifically target primary care, he said.
Due to budget neutrality, the RVS Update Committee (RUC) recommended increases in evaluation/management (E/M) payments. New CMS-created add-on complexity codes for E/M services and other CMS-approved increases necessitate a decrease in the conversion factor.
Endocrinology, rheumatology, hematology/oncology and family practice would see increases ranging from 13% to 17% in 2021. Radiology, thoracic surgery and vascular surgery would see decreases ranging from 7% to 11%. Ophthalmology would see a 6% decrease.
Every surgical procedure for ophthalmology would decrease under the proposal, including a 10% decrease in cataract surgery after a 15% cut in 2020, according to an AAO press release.
Glasser said the Surgical Care Coalition with the American College of Surgeons will support the RUC process and recommended increases to E/M values, as they can benefit ophthalmologists. The coalition’s position is to eliminate or delay complex add-on codes until RUC can evaluate, apply E/M increases to postoperative visits in the global period and support the Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020.
The bill would delay cuts for 2 years, with no effect on the values of the procedures and codes scheduled to increase. It would pay physicians separately, outside of the Physician Fee Schedule, so there is no issue with budget neutrality and the conversion factor, Glasser said.
“This is the Surgical Care Coalition’s message. It is not the time to make cuts to health care and Medicare while the U.S. health care system is under such tremendous strain and financial stress due to the pandemic and at a time when patients need high-quality care more than ever,” he said.
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Glasser DB. AAO press conference: Federal affairs. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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