Reimbursement cuts proposed for cataract surgery
If approved, the cuts would result in about $100 less in reimbursement.
By Robert Stoneback, associate editor
A proposed CMS cut to reimbursements for cataract surgery would result in approximately $100 less per case.
According to data on the ASCRS website (https://tinyurl.com/y24sbuqx ), the “potential impact” of the cuts are $97 for each filing of CPT code 66984 for non-complicated cataract surgery and $47 for each filing of 66982 for complex cataracts.
According to David Glasser, MD, secretary for federal affairs for the AAO, such codes are considered “fair game” for the CMS’ reevaluation if it has been five years since its last review. “We’re extremely disappointed at the size of the cut,” Dr. Glasser says, “but we understand it.”
Suzanne L. Corcoran, of Corcoran Consulting Group, says the proposed reimbursement reduction is part of CMS’ regular review of procedure pricing; cataract surgery was “in the line” for a while for this process.
The main pricing change, Ms. Corcoran says, is to reflect that CMS has now priced three postoperative visits into the cost for cataract surgery; several years ago, when CMS had previously set the value for the cataract surgery procedure, four post-operative visits had been calculated into the cost.
This change, and others like it done as part of the CMS’ pricing reviews, came about after surveys were sent to randomly selected physicians. The survey asked for anonymous responses to questions such as how long the cataract procedure took to complete, intensity compared to other procedures and number of postop visits.
OFFSETTING THE LOST REVENUE
With the proposed reductions set to take place at the start of 2020, the ophthalmic community is already advocating for ways to soften the incoming financial blow.
“For someone who does a lot of cataract surgery, taking close to $100 out of their income every case is a big deal,” says Ms. Corcoran.
The AAO, Dr. Glasser says, is currently “pursuing ways to increase Medicare payments and mitigate the effects [of the reimbursment reduction] where possible.”
Currently, the AAO is seeking changes to a proposal by Medicare that would increase value for Evaluation and Management (E&M) codes. These changes should also be applied to postoperative visits “bundled” in the 90-day period following cataract surgery, increasing the reimbursement rate for all such procedures, according to Dr. Glasser. The AAO is talking to legislators on Capitol Hill about negotiating with CMS for these changes; a broad coalition of surgical sub-specialties also support these changes, adds Dr. Glasser.
Additionally, the AAO is supporting the application of increases to E&M reimbursement codes related to eye exams.
“IN LINE” WITH PRIOR CUTS
It would not be possible to know the full financial effect the proposed cuts will have on practices until they go into effect, says Dr. Glasser.
“We have heard clearly from our members that this is disconcerting, and it is disconcerting to us as well; but working in the system we didn’t have a good way to attain a higher reimbursement,” he says.
The AAO is not protesting the cuts themselves, says Dr. Glasser, as they are in line with prior protocol for evaluating such medical procedures.
The AAO made a strong argument during the evaluation process, Dr. Glasser continues, that the complexity of the intraocular procedure should warrant a higher reimbursement rate. “We were successful in that argument at the AMA’s RUC (Relative-value Update Committee), which advises CMS on procedure values, where significantly greater reductions were considered,” he says. Even with the proposed cuts, says Dr. Glasser, “cataract surgery remains one of the highest valued procedures on a minute-per-minute basis paid by Medicare.” OM
HOW TO BRACE FOR THE CUTS
With the proposed Medicare reimbursement cuts for cataract surgery, practices are brainstorming how to deal with the shrunk revenue.
For practice management consultants Corinne Z. Wohl, MHSA, COE, and John B. Pinto, the future isn’t doom and gloom — in fact, “the practical solutions are abundant,” they say.
Mr. Pinto, president of J. Pinto and Associates, put the cut in perspective, saying that an approximate 15% reduction in cataract reimbursement would result in an aggregate drop of 6% in revenue collections for a typical practice. Put another way, it would be about a $60,000 drop in collection in a typical practice that collects $1 million.
Mr. Pinto recommends that practices “guard against their first instinct,” to try and make up that 6% difference by cutting costs. “That’s a slippery slope,” that can end up doing greater damage to a practice. For instance, if a practice reduces staff hours, patient care erodes and that would translate to fewer customers.
Making up this loss should not require cuts, says Mr. Pinto. “If you see two more clinical patients per clinical day, that is going to erase the impact of these slated cuts,” he says. In fact, he adds, adding a third clinical patient should result in a net pay raise.
Similarly, Ms. Wohl, president of C. Wohl and Associates, suggests opening a practice an hour earlier, closing an hour later, or adding evening or weekend hours to make up the revenue. Some practices could also shift primary-care work to optometrists, she continues, freeing up surgeons for more surgical time to help increase revenue.
Another option, says Ms. Wohl, is encouraging doctors and their staff to not make assumptions about what patients would be willing to spend on premium lenses. Ms. Wohl has seen practices assume certain patients may not want expensive IOLs and therefore not even give a presentation on them — that’s a lost opportunity for revenue, she says.
OWL sets its sights on 2020
OWL President Beth Marsh discusses accomplishments and goals for next year.
Ophthalmic World Leaders (OWL) has long championed diversity in the ophthalmic industry. With 2020 approaching, Ophthalmology Management interviewed OWL President Beth Marsh to discuss the organization’s new plans and recent accomplishments.
Ophthalmology Management: What are OWL’s goals for the coming year?
Beth Marsh: Overall, we want to continue in our mission of providing personal and professional development, centered around leadership and diversity.
One of our big projects this coming year is the start of our new mentorship program, OWL Fellows. The goal of this program is to connect rising stars in ophthalmology with more experienced leaders in their field, who can offer them guidance.
Our board is working hard now to select the first class of fellows, who will be announced, along with their mentors, at this year’s AAO.
For 2020, we will also continue offering programs at major meetings, like ASCRS and ESCRS, and initiatives such as our newly launched virtual forum, which allows members to post topics of interest and start conversations with other members beyond our conferences.
We hope to continue growing membership, as well — we’re around 1,000 members strong, which is really exciting. We’re the only organization in ophthalmology that represents the entire field, including physicians, administrators, industry and media.
OM: What are some significant changes made by OWL over the last few years?
BM: The biggest one is that, four years ago, we went from being “Ophthalmic Women Leaders” to “Ophthalmic World Leaders.” OWL believes there is power in representing diversity, and we realized that could mean race, sex, LGBTQ identity, age and many other factors.
We are also branching out with our programming. While a majority is still happening within the United States, we just had a networking event at ESCRS that was attended by more than 50 people. We were really pleased with that result. We want to do more international events but want to make sure we can do them well.
OM: OWL promotes diversity as one of its goals. Why is that important in ophthalmology?
BM: There has been a lot of research that points to diverse teams creating better outcomes. Looking at ophthalmology, there’s opportunity for more diversity, and we believe it helps those in current leadership positions to really consider what they can learn from people with a different perspective.
There’s a lot that can be learned from having multiple points of view in the same room. Having that team or group of leaders with several different backgrounds can get you better results. And data shows diverse teams are more successful. OM
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