The 2008 Medicare Physician Fee Schedule issued by the Center for Medicare and Medicaid Services (CMS) this week means an increase in payments for ophthalmology of $154 million, or approximately 2 percent over existing payments. However, the increase could be more than offset by a 10.1 percent reduction in payments under the flawed sustainable growth rate (SGR) formula unless Congress intervenes to stop the cuts.
“Convincing the AMA RUC committee and CMS about the importance of increased eye visit code payments is the result of two years of hard work that has paid off in the new rule. These increased payments more accurately reflect the value of the services provided by physicians,” said Michael X. Repka, MD, secretary for federal affairs for the American Academy of Ophthalmology. “Our focus now is on trying to convince Congress to prevent the across-the-board cuts that we are facing from the SGR formula and implement a minimum two-year positive update.”
Among the considerations that the CMS used to determine the new payments was a recommendation from the Relative-Value Update Committee (RUC) of the American Medical Association (AMA) to adjust payments for eye visit codes to reflect increases instituted in 2007 for evaluation and management services.
However, the new fee schedule would also implement a more than 10 percent reduction in physician payments, as mandated under the sustainable growth rate (SGR). SGR links Medicare reimbursement payments to the nation’s gross domestic product, which bears little correlation to the cost that physicians face in providing patient care.
The Academy is working with the AMA and other groups to press Congress to prevent the cuts from being implemented and to pass a positive rate update for a minimum of two years. The two-year update gives physicians some stability and would allow Congress time to develop a long-term solution that corrects the problems created by SGR.
Ophthalmologists are also facing another payment decrease, as CMS continues to phase in new data on practice expenses. As a result, ophthalmologists face another 1 percent decrease in 2008. The Academy has called upon CMS to update the data for all specialties in the same manner and is working with the AMA to develop a new medicine-wide survey, which is expected to improve future payments to ophthalmology.
In addition to the increase for eye visit codes and the impending cuts, the new fee schedule also implements a number of other changes of importance to ophthalmologists. These include:
– As part of the Physician Quality Reporting Initiative, CMS will provide an approximate 1.5 percent bonus for physicians who voluntarily report on quality measures during calendar 2008.
– CMS has approved five new retina codes. The codes replace or modify several existing codes.
The American Academy of Ophthalmology is the voice for ophthalmologists and their patients in Washington D.C., and is the world’s largest organization of eye physicians and surgeons, with more than 27,000 members.
aao