When an ASCRS email with the subject line “11% Medicare Cut Coming—Here’s How to Protect (and Grow) Your Practice Revenue” landed in my inbox on July 24, it sent shivers down my spine.
I opened it immediately.
What You Can Do
By working with professional organizations, ophthalmologists can collectively advocate for reimbursement reform.
American Academy of Ophthalmology
OPHTHPAC is the AAO’s non-partisan ophthalmology political action committee that supports candidates and policies that promote patients’ access to care, including fighting for increased Medicare reimbursement.
www.ophthpac-direct.aao.org/page/champions
Congressional Advocacy Day gathers ophthalmologists in Washington, DC, to advocate directly with lawmakers. www.aao.org/mid-year-forum/congressional-advocacy-day
Engagement with CMS The AAO works with the Centers for Medicare & Medicaid Services (CMS) to defend the value of ophthalmology codes and ensure a clear path for meeting quality reporting requirements.
The IRIS Registry for clinical data helps maximize scores in the Merit-Based Incentive Payment System (MIPS). www.aao.org/iris-registry
American Medical Association
Fix Medicare Now is a campaign urging physicians to contact Congress and share stories about the impact of Medicare cuts. The AMA strongly supports legislation like the Medicare Patient Access and Practice Stabilization Act (H.R. 879/S. 1640). www.fixmedicarenow.org
The Medicare Basics Series offers in-depth education about the Medicare physician payment system and highlights the need for reform. www.ama-assn.org/practice-management/medicare-medicaid/amas-medicare-basics-series
American Society of Cataract and Refractive Surgery
Medicare Payment Reform ASCRS urges Congress to halt impending cuts and to implement reforms, such as eliminating budget neutrality and directing CMS to adjust the values of post-operative visits in 10- and 90-day global surgical codes to reflect updated E/M code payment increases.
Prior Authorization ASCRS urges CMS to prevent Medicare Advantage plans from inappropriately delaying or denying access to cataract surgery and supports legislation to reduce prior authorization burdens.
American Society of Retina Specialists
The ASRS continually monitors the actions of federal agencies, attending briefings and hearings and providing summaries and testimony to its members.
www.asrs.org/advocacy
A proposed 11% reduction in Medicare reimbursement for cataract surgery in 2026 threatens the financial stability of ophthalmology practices nationwide. For those still navigating the daily grind of clinical care and practice management, this news was likely another gut punch in a long series of economic blows.
While I stepped away from the operational and financial responsibilities of private practice nearly 4 years ago, I haven’t forgotten the relentless pressure. Rising costs, declining reimbursements, tightening regulatory requirements, and persistent staffing shortages have become the norm, not the exception. Though I no longer carry the burden of solving these problems firsthand, I see their ripple effects across the profession.
Where Do We Stand Financially?
The average overhead cost for an ophthalmology practice typically ranges from 50% to 70% of the budget, depending on practice size, subspecialty, surgical volume, and geography. The largest expenditures—salaries and benefits, rent, utilities, medical supplies, insurance, and the ever-growing cost of advanced technology—are unavoidable. Gone are the days when we joked about $45,000 equipment purchases. Today, high-end ophthalmic technology can run into the hundreds of thousands of dollars.
Add to that a tight labor market and inflation-driven salary demands, and you’ve got a financial vise squeezing from all sides. There is virtually no area of practice management that has gotten easier, more affordable, or more efficient. Another reimbursement cut will only tighten this financial squeeze.
The Human Toll of Systemic Strain
A friend recently told me that her cardiologist had dismissed her from care—despite significant family history and ongoing health issues—claiming her case wasn’t “serious enough.” He told her that her primary care physician would have to manage her cardiac health moving forward. She was devastated and anxious. Sadly, this is not an isolated incident.
Many physicians are reaching a breaking point. In response to the pressures of declining reimbursement and rising overhead, we are being forced to:
- increase patient volume (and risk burnout);
- narrow their patient base to only the most acute cases;
- employ more non-physician providers; or
- exit the profession altogether.
In my own network, physician burnout and premature retirement are at an all-time high.
Finding a Way Forward
I commend ASCRS for its proactive stance in offering webinars, resources, and guidance to help practices adapt. These are critically important, now more than ever.
Personally, for nearly 3 decades, Ophthalmology Management has been my practice management compass. The publication continues to highlight experts and thought leaders who share practical, tested strategies for navigating change. Whether it’s improving efficiency, benchmarking performance, or implementing innovative workflows, its guidance has helped countless practices evolve without losing sight of what truly matters: our patients.
Now is the time for physicians to engage, educate, and advocate. Speak up, lean into professional networks, and use the wealth of resources available. The economics of our field may be shifting, but with resilience and adaptation, ophthalmologists can continue to thrive—and provide the quality care our patients deserve. OM
