CMS approves physician fee schedule, including Medicare cuts to ophthalmology

The Centers for Medicare and Medicaid Services (CMS) has released its final physician fee schedule for 2021, and it is not good news for ophthalmologists.

In a statement, the American Academy of Ophthalmology (AAO) noted that despite its objections, the CMS’ final 2021 Physician Fee Schedule policy on evaluation and management/office (E/M) visits still results in an overall cut of 6% to ophthalmology.

According to the Academy, the cut is a result of the significant boost to the E/M code values and the creation of a new add-on code in a budget-neutral environment (i.e., all codes are paying for the increase to office visits).

In a statement, the Academy pointed out that increases in these E/M payments will not be applied to post-operative visits surgeons provide in the global surgical payment. Giving equity to the E/M in the global surgical payments could have softened the impact to surgical codes but CMS refused to do so.

The Academy pointed out that the cuts will be a blow to ophthalmologists. In its statement, the AAO noted that “CMS’ unwillingness to provide equity to surgical specialties after an outcry from surgeons and the American Medical Association is an affront to providers.”

Moreover, the Academy noted that the decisions CMSS made in the 2021 Physician Fee Schedule could pose a threat to ophthalmologists’ financial viability and ability to run a successful ophthalmology practice. Amid the financial stress of the COVID-19 pandemic, thee cuts could prove to have a more devastating impact.

“Our practice has already suffered greatly this year, and this final rule adds salt to the wound. It appears that CMS is tone deaf to the plight of private surgical practices,” John T. McAllister, MD, a cataract surgeon who operates the Northern Virginia Ophthalmology Associates with 14 physicians and surgeons, said in a statement. “Even despite congressional and CMS efforts to help us through the pandemic earlier this year, physicians in my practice have needed to take severe self-imposed salary cuts for most of 2020 in order to have the resources necessary to care for our patients.”

McAllister noted that the physicians and surgeons all voluntarily took a 50% pay cut for almost half of the year and worked at 75% for months afterwards.

“At the same time, each of our physicians have families to feed and care for,” he added in the statement.

The Academy noted that ophthalmology practices are only now returning to their pre-pandemic clinical or surgical volumes, but may face setbacks with current surges in COVID-19 cases in many parts of the country.

In the statement, the Academy noted that should the cuts be allowed to take effect, patient care would be compromised. As a result, the final rule may likely force ophthalmologists to restructure their practices and take fewer Medicare patients. This could result in longer wait times and reduced access to care for older Americans. It could force more ophthalmologists, who already have the highest overhead in medicine, to back out of Medicare participation entirely.

According to Daniel Briceland, MD, who runs a small private group practice in Arizona, the COVID-19 pandemic has resulted in severe economic strain on his practice and his ability to maintain four employees while caring for the vision impaired geriatric population.

“The early CMS shut down, followed by a gradual return to clinical visits in an entirely new reconfigured office, has drastically limited my ability to practice,” he explained. “Further CMS cuts will severely impact our already strained practice’s economic recovery with the potential risk of practice closures and loss of employees.”

Amid the CMS decision, the Academy said in the statement that it will continue to work with partner societies and the American College of Surgeons (ACS) to press Congress to stop the finalized drastic cuts to ophthalmologists and other surgeons before implementation.

The ACS is calling on Congress to work swiftly to reverse the cuts to protect patients and their providers before they recess for the year.

“If implemented, the Medicare Physician Fee Schedule will have drastic consequences for Medicare patients seeking surgical services,” David B. Hoyt, MD, FACS, ACS Executive Director, said in a statement. “Without congressional intervention, these policies will result in significant cuts to physician payment for most surgical services delivered to Medicare patients, exacerbate surgical workforce shortages, and worsen the crisis of rural hospital closures.”

According to the ACS, congressional action is needed before the end of the year As a result, groups like the AAO, ACS, along with the Surgical Care Coalition, will continue to advocate Congress to stop the Medicare payment cuts and protect patients access to surgical care.

“Surgeons and patients have been advocating against these cuts when CMS initially proposed them. No healthcare providers should be facing cuts, especially during a pandemic,” said Dr. Hoyt. “We strongly urge Congress to support the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, which was introduced by Representatives Bera and Bucshon, to ensure patients can access the care they need when and where they need it.”

American Medical Association President Susan R. Bailey, MD said in a statement the fee schedule his will result in a reduction to Medicare payment rates in the midst of the worsening COVID-19 pandemic “while physicians are continuing to care for record numbers of patients diagnosed with COVID-19 and trying to keep the lights on in their practices.”

Dr. Bailey added that the cuts will hurt all Medicare patients, including patients seeking care for COVID-19 because payments for critical care, hospital visits and nursing-home visits will be cut dramatically.

The AMA is strongly urging Congress “to prevent or postpone the payment reductions resulting from Medicare’s budget neutrality requirement,” Dr. Bailey said. “Physicians are already experiencing substantial economic hardships due to COVID-19, so these payment cuts could not come at a worse time.”