As health care reform takes effect, physicians in specialties such as ophthalmology face a series of challenges related to fundamental changes in the health care delivery infrastructure.
With the re-election of President Barack Obama and a Democratic majority in the U.S. Senate, the Affordable Care Act (ACA) is likely to stand largely unchallenged. Accountable care organizations (ACOs), a key component of the law, are expected to affect ophthalmologists in largely unspecified but tangible ways.
Simultaneously, outside the purview of the ACA, potential Medicare fee cuts present further challenges. Physicians faced a possible 26.5% cut in Medicare reimbursement on Jan. 1, unless Congress intervened. The payment cut stems from the sustainable growth rate (SGR), a key factor in annual Medicare payment updates. As of Dec. 21, 2012, Congress and the Obama administration had not completed a budget deal and Congress had not intervened to forestall the Medicare payment cut. Congress had intervened to delay the cut several other times in recent years.
Furthermore, the 2013 Medicare Physician Fee Schedule calls for an approximate 13.5% reduction in payments for cataract surgery and a roughly 3% cut in fees for ancillary services in ophthalmology. The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the fee schedule on Nov. 1.
Physicians and other providers face an additional 2% reduction in Medicare fees because of automatic budget cuts related to sequestration, a mechanism already in current law designed to reduce overall federal spending by imposing across-the-board cuts. As of Dec. 21, Congress had not acted on budget proposals or possible revisions to sequestration.
The AAO has called for the SGR to be altered or repealed but would accept a short-term fix, according to Michael X. Repka, MD.
Source: Dupont Photographers
At the joint meeting of the American Academy of Ophthalmology and Asia-Pacific Academy of Ophthalmology in Chicago, Michael X. Repka, MD, AAO medical director for governmental affairs, and David W. Parke II, MD, AAO executive vice president and CEO, held a news conference to discuss the ACA and Medicare payment cuts.
In a subsequent interview, Parke outlined a three-pronged strategy for physicians to reduce costs and improve quality, key goals of the ACA and other regulatory initiatives.
“Unsustainable costs drive not only health care reform but physician payment discussions. If ophthalmology can demonstrate a real concern for reduction in unnecessary system costs, our voice becomes more credible as we advocate for issues important to Academy members. Those costs do exist, such as performing routine and frequently unnecessary preoperative testing,” Parke said. “The second is having real data as to outcomes. The third is having programs, processes and technology that lead to truly demonstrable improved outcomes,” Parke said. “Only by paying attention to those three things can you drive outcomes up and drive the costs down that don’t really directly impact ophthalmologists but do impact the system.”
Affordable Care Act
During the news conference, Parke dispelled assumptions that the election of Mitt Romney would have involved the complete dismantling of the ACA.
“None of us really thought that was going to be the case unless there was control by the Republican Party of the House, the Senate and the White House — and the Senate control would have to be filibuster-proof. Even House Republicans recognized that turning back the clock to 2008 was not a reality,” Parke said.
Parke said that health care reform is inevitable, given underlying factors such as costs, quality of care and access to care.
“The drivers of change are out there. They’ve been there since the beginning,” Parke said. “If anything, they’ve only gotten more significant. And we all know that the biggest driver is cost.”
Currently, health care comprises more than 16% of the U.S. gross domestic product, and that percentage is rising, Parke said.
“That’s unsustainable, particularly when you consider that on an individual basis, which is the way many politicians and policymakers look at it, a typical American’s after Medicare health care costs, between age 65 and death, is about $300,000 to $500,000. The average American has $61,000 in his or her retirement account,” he said.