In 1983, the government allowed only a dozen eye procedures to be performed in the Medicare-certified ASC. Today, virtually every ophthalmic service is reimbursed in our centers. Our facility fee for cataract surgery was about $300; presently, it is more than $1,000. For a couple of decades, we received a lower annual update than hospitals. Starting this year, however, we are afforded the same cost-of-living adjustment as the HOPD. For years, policymakers have threatened to disallow surgeons from treating patients in the facilities they own; we have thwarted all of those efforts.
These successes in the Nation’s Capital have created a burgeoning industry; there are now more ASCs in the U.S. than hospitals. In 1983, there were about two dozen ophthalmic ASCs in operation; today, there are roughly 1,400 ASCs serving patients with eye diseases and conditions.
OOSS has had a remarkable track record in Washington. For almost four decades, your officers have devoted many thousands of hours to developing, articulating, and implementing our mission and our policy positions. This column is focused on what you, the OOSS member, have contributed — and, hopefully, the efforts that you will bring to this herculean effort in the seasons ahead. The reality is that without your commitment to the cause — which involves a few bucks and a few hours of grassroots support each year — we will have to carve back our endeavors in Washington at a time when our potential to seriously and favorably promote policies that are good for our facilities and our patients is at an all-time high.
Help Us Set Our Priorities
Please come along for the ride! You may not realize it, but the OOSS participates at the very start of our government relations policymaking process. As our outgoing executive director Kent Jackson articulates in his column, every 3 years we survey our membership to identify your concerns and to obtain your guidance regarding our priorities for the 3 years ahead in several areas: economic outlook; ASC structure and affiliations; facility demographics; market picture; management functions and strategies; investment and succession; area competition; regulation; OOSS services and benefits, to name a few.
With respect to federal legislation and regulation, how would you prioritize (low, moderate, high) the following?
- Improving Medicare ASC facility reimbursement. We are delighted that after a decade of lobbying, ASCs now receive the same annual update (Hospital Market Basket) as HOPDs. (Indeed, our COLA this year, after adjustments, exceeded that of the hospitals.) However, our base rates are still about half that of the hospital, in part because CMS sets these rates based on unfair and irrational budget neutrality adjustments. Fixing this problem would meaningfully increase our facility fees. This should be our major payment policy objective moving forward.
- Leveling the playing field in rates paid to hospitals and ASCs. Hospitals are paid about twice as much as ASCs to furnish a service, despite both having similar patients and costs. Reducing hospital rates to the ASC level is one of the few initiatives available to Congress with the potential to generate significant Medicare savings. Why should the ASC care about this development if our rates might not increase? It’s a volume and share-of-market proposition: services will undoubtedly migrate from the HOPD to surgery centers. Many hospitals are already less than enamored about ophthalmic surgery, and this concern will be heightened if payment rates are substantially reduced.
- Combating CMS incentives for cataract surgery to be furnished in physician offices. Two years ago, CMS commenced an examination regarding the advisability of providing a facility fee for cataract surgery performed in the physician’s office. Based upon your very strong opinions on the issue, our response was unequivocal: This is bad policy, one that, if implemented without adequate regulatory safeguards, potentially threatens the health and safety of our patients. OOSS has been the lone voice amongst the major ophthalmology organizations to unalterably oppose treating cataracts in the unregulated office setting. CMS has not yet implemented this policy, and OOSS will remain vigilant in representing our members and ensuring that this misguided and imprudent initiative never sees the light of day.
- Ameliorating infection control/sterilization requirements not applicable to ophthalmic ASCs. CMS continues to articulate policies that unnecessarily complicate our facilities’ abilities to utilize safe and effective sterilization practices. Several years ago, the agency banned the use of flash sterilization on a routine basis and has since authored requirements that ASCs rigidly follow manufacturers’ directions for use, even though some of these instructions jeopardize the health and safety of our patients, e.g., the use of enzymatic cleaners.
- Ensuring that ASC quality reporting is implemented using reasonable measures and in consultation with the ophthalmic ASC community. ASCs have done an awesome job complying with quality reporting mandates — more than 98% of facilities are in reporting compliance. However, OOSS has had to thwart multiple efforts by CMS to implement measures that are impracticable for the ophthalmic ASC. We should continue to develop our own measures, e.g., reporting TASS events in the facility, that relate to the episode of care in the ASC, generate data that is collectible by the ASC, and embody results that are actionable by the ASC.
- Preserving the ability of physicians to own ophthalmic ASCs and refer their patients to them.
- Eliminating history and physical requirements, as well as other unnecessary and burdensome regulatory mandates.
- Ensuring against adverse actions by Congress and CMS regarding payment for IOLs, supplies, and equipment.
- Facilitating mechanisms for Medicare to pay for drugs used intracamerally during ophthalmic surgery.
- Promoting passage of “The ASC Quality and Access Act of 2019.”
- Enhancing Medicare patients’ access to new ophthalmic technologies/procedures.
- Combating state efforts to tax ASCs or limit development of ASCs via onerous Certificate-of-Need, licensure, or self-referral restrictions.
Help Us Accomplish Our Objectives
If history is any guide, you will have identified many of our initiatives as top priority. OOSS is a lean and mean organization. We have been effective in advancing our legislative and regulatory objectives to enhance your ability, not just to survive, but to thrive in a competitive, budget-conscious, and regulatory environment. However, as our priorities grow, OOSS will require the finances and manpower (yes, you) to advance our position in the healthcare marketplace.
OOSS is the only organization dedicated exclusively to the interests of the ophthalmic ASC and its patients. Yet, remarkably, only about a third of these facilities are members of our Society. Without OOSS, where would your facilities be now? Could surgeons even own and refer their patients to their ASCs? Would our facility fees have increased by 350%, or would they have diminished like your professional reimbursements? Would you be able to secure facility payments for virtually every surgical procedure in the ASC? Would you be facing competition from office-based cataract centers? Would Medicare have regulated us out of business?
Our agenda is broad and deep, and I suspect that your responses to our triennial survey will broaden and deepen it further. Without your support as members we simply cannot address all of your concerns. Here are ways to support OOSS:
- If you are not a member of OOSS, please join. And if you haven’t renewed, please do so now. And, consider joining our President’s Council. The personal contributions and strategic guidance of Council members enables OOSS to go above and beyond in advocating on behalf of the ophthalmic ASC community. Join now by visiting ooss.org/join .
- Use our new grassroots Advocacy Center and build relationships with your elected officials so that we can continue making progress on our issues in the Nation’s Capital. With a couple of clicks of the keyboard, you can be in direct contact with your Senators and Representatives.
- On the handful of occasions that we make such a request, contact your legislators and CMS to advocate for our positions. I can think of innumerable instances where your grassroots lobbying efforts have made the difference — in increasing our rates, reducing regulation, and thwarting misguided proposals like office cataract surgery.
- Consider inviting your elected officials to visit your facility. Nothing sells our “product” like a firsthand view. Through the Advocacy Center, we will provide you with all the tools you need to enlighten federal policymakers.
- Contribute to the Outpatient Ophthalmic Surgery PAC. I realize that you are inundated with requests to participate in multiple organizations’ political action programs. Ours is unique — we advocate solely for you and your surgery center. We ask that you make a contribution of $1,000 to $2,000, the equivalent of one or two cataract facility fee payments. And, unlike the other requests you receive, once you contribute, we don’t seek another donation to our PAC for two more years. Be watching for your invitation to contribute.
I have the greatest job in the world and I thank you for your support over the years. Let’s make it a big 2020 and beyond. Reinvigorate your commitment to the Outpatient Ophthalmic Surgery Society’s government relations program. ■