AAO tackles Medicare, Medicaid in multiple ways

Washington, DC-The American Academy of Ophthalmology (AAO) sent a letter to the Centers for Medicare and Medicaid Services (CMS) supporting reimbursement for intravitreal injections of bevacizumab (Avastin, Genentech) in patients with age-related macular degeneration (AMD) whose disease has not responded to other therapies.

The two FDA-approved and CMS-covered drug therapies are ocular photodynamic therapy with verteporfin (Visudyne, Novartis Ophthalmics) or intravitreal pegaptanib sodium (Macugen, OSI/Eyetech Pharmaceuticals/Pfizer).

"This is not an endorsement of intra-vitreal bevacizumab," explained AAO Executive Vice President H. Dunbar Hoskins Jr., MD. "It is a recommendation that those physicians who choose to use it should be reimbursed as they are with other off-label therapies."

In March, the American Society of Retinal Specialists completed a membership survey, which found 92% of 289 respondents felt intravitreal bevacizumab was "somewhat better" or "much better" than other approved or covered therapies.

The academy will continue to monitor new information regarding the safety and efficacy of these treatments and will release new position statements when appropriate.

Advocacy Day

In related news, more than 240 AAO ophthalmologists and ophthalmic surgeons plus more than 40 residents and fellows visited Congressional members and their staffs during the academy's annual Congressional Advocacy Day this past April. The ophthalmologists educated Congress on significant issues, including Medicare physician pay cuts and the need to find a long-term solution to the sustainable growth rate formula law.

This year, Congress halted a 4.4% cut in physician Medicare reimbursement, but another 4.6% cut is projected for 2007.

Ophthalmologists also spoke about payment reform that rewards physicians for reaching quality measures. The academy is specifically pursuing the development of simple, easily reported quality performance measures that are evidence-based and derived from the academy's Preferred Practice Patterns.

Congressional members and staffs learned about broadening patient access to services provided by ambulatory surgery centers and were encouraged to cosponsor the Ambulatory Surgical Center Payment Modernization Act (HR 4042/S 1884). Ophthalmologists also encouraged members to cosponsor the Children's Access to Vision Care Act (HR 2328). This act provides grants to states for eye exams and subsequent treatment for uninsured children who have failed a vision screening.

With the FY 2007 Budget Resolution at the House, ophthalmologists urged support only if the resolution included an additional $7 billion for health and education programs that would ensure continued research resulting in treatments and therapies to slow the progression of vision loss.

As part of Congressional Advocacy Day, the Ohio Ophthalmological Society received an award for sponsoring four residents and the Washington, DC, Metropolitan Ophthalmological Society received an award for supporting seven. The American Glaucoma Society, the American Society of Ophthalmic Plastic and Reconstructive Surgery, and the American Association for Pediatric Ophthalmology and Strabismus were acknowledged for sponsoring ophthalmologists who are undergoing fellowship training.