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BLOG: Comment on the Medicare Access and CHIP Reauthorization Act
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This summer, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015. (MACRA). The president signed this into law on April 14.
In this latest law related to health care reform, the Physician Quality Reporting System, value-based payment modifier, the electronic health records incentive program and the Sustainable Growth Rate formula will come to an end. These programs will be replaced by the merit-based incentive payment systems, alternative payment models and a physician-focused payment model.
These new programs will bring an end to the traditional “fee-for-service” payment system for Medicare and will likely affect payment models of Medicaid and other government-sponsored programs.
Medicare is a significant source of payment for most optometrists. Since our inclusion in the system in the late 1980s, our profession has taken an expanding role in the care of these patients. Starting with our unique services for low vision rehabilitation and the long-term management of pseudophakic patients and evolving into comprehensive medical eye including care for glaucoma and other chronic medical eye problems, this segment of optometric care continues to grow. Likewise, the Medicare population, currently at about 60 million people, continues to expand, as 10,000 more people become eligible each day.
So, what will all this mean for the day-to-day practice of optometry? As with many of the changes related to health care reform, we too often ignore these issues until health systems, hospitals, physician groups and politicians work out all the details, and then we complain that the effect on eye care services is unfair, disjointed or unmanageable.
Maybe this time it can be different. In this digital age of instant access to information and communication, optometrists, ophthalmologists and those of us involved with the delivery of eye, vision and primary health care can have a voice in the making of health policy.
The Centers for Medicare & Medicaid Services (CMS) has released a request for information to seek public comment related to the new provisions of MACRA. Responding to this request will give us the opportunity to express our thoughts and opinions on the dysfunction of the payment and billing system for patients who have overlapping vision and health insurance with huge differences in copayments, deductibles and covered services. It will give us the opportunity to become involved with medical homes and accountable care organizations. It will give us the opportunity to explain our role in primary health care and offer alternatives to the programs that relegate our services to ancillary add-on benefits rather than a core primary care service.
I have discussed two critical issues related to futuristic changes in the delivery and payment for eye care services in my blogs. The first is the evolution from primary eye care to primary health care. Although several of my blogs have referred to this theme, perhaps the most relevant was the one that discussed moving your eye examination to primary care. This piece talked about upgrading your exam, with compensation to follow. Today we are now talking about setting up that compensation.
The other relevant blog discussed disease management programs for eye care. Here we talked about managing and collaborating the care for chronic eye diseases. I mentioned that this type of care is due for an update in reimbursement that aligns the incentives of providers with an emphasis on outcomes rather than procedures and office visits. Today we are talking about addressing that payment system.
So, today, the CMS is asking for our direct feedback on these very issues. Do we want to provide primary health care and get paid for it? Should the eye exam requirements be expanded with higher payments, or should these services be independently recognized and reimbursed? Should glaucoma encounters be packaged with all related testing and be reimbursed once a year? Should the collaboration with glaucoma surgeons be included in a comprehensive package?
Do we want to integrate the healthy eye examination and refraction with medical eye or systemic problems that might be revealed in this comprehensive encounter? Should an eye examination on a known diabetic have a different reimbursement than an exam on a healthy patient? Do we want to continue having vision insurance that does not include medical eye care and medical insurance that does not include vision care?
This is our time to speak up. You may want to contact your state association and pool your thoughts with other optometrists in your state and submit a group response. You may be part of an integrated ophthalmic network that includes ophthalmologists and surgical facilities; perhaps you want to work with them to craft a comprehensive response. You may be an independent thinker and want to respond personally. No matter how you chose to respond, I encourage you do so.
As I have said throughout this blog series, health care reform is a group effort, and we have a unique opportunity to create our own future. Click here for the link to the Federal Register where you can access the request for information and respond.