Perspective

COMMENTARY: SGR repeal plan lacking for specialists, needs improvement, AAO says

The Senate Committee on Finance and the House Committee on Ways and Means bills that were scheduled for a vote last week were initially identical. The American Academy of Ophthalmology felt that they were not fair to specialists, including ophthalmologists. So, we asked for a number of changes. In fact, we joined the American College of Surgeons in a letter outright opposing the draft bills as written. Then, the night before the vote, the House Committee on Ways and Means made a key adjustment to its bill. The committee developed a provision that would give 3 years of positive updates to physicians, 0.5% in 2014, 2015 and 2016. While that was just one of three or four issues that we were looking for accommodation on, we felt that it was a good-faith response and that they were willing to listen to us, that they were hearing us. So, we withdrew our opposition to the House Ways and Means bill the morning of the vote. We did not endorse the bill, but we reiterated that we would work with the House Committee on Ways and Means and House Committee on Energy and Commerce to develop a bill that could pass on the House floor.

Some of the key problems are that they offer a 5% bonus for doctors who move to an alternative payment model. Unfortunately, there really is no alternative payment model for specialists. The accountable care organization, or ACO, is a very new alternative payment model that has had kind of a rocky start, with obstacles for specialty participation. We have been trying to get some understanding from the Center for Medicare and Medicaid Innovation, the division in CMS that is conducting demonstrations and testing the new payment models, of its plans for the outpatient area and specialties such as ophthalmology. Last year, we were told that it had no plans to test anything in the outpatient area.

So, that is a problem. While we may not object to there being no alternative payment model for specialists to participate in, leaving only the fee-for-service program, Congress is making that option very unattractive. This leaves specialties kind of trapped, which is not fair. In this regard, the House Committee on Energy and Commerce bill is better on a couple of key points. One, it includes positive updates for 10 consecutive years. That is something that we would like to see.

The other thing is it would create a new fee-for-service value-based program that would allow all doctors who hit a high-performing threshold — I think it was if the score is 65% or better — to get a bonus. Alternatively, the House Committee on Ways and Means bill would create a fee-for-service value-based program in which high-performing doctors only get a bonus if a low-performing doctor gets a penalty. So, it is budget-neutral. Some high-performing doctors might initially get a bonus, but eventually, as more doctors become high-performing, the bonus would go away. So, we contend that the House Committee on Ways and Means and Senate Committee on Finance proposals really underfund the fee-for-service value-based program. That is not acceptable.

The House Republican Doctor Caucus sent a letter to the House leadership basically saying that as the SGR repeal comes to the floor, key criteria must be met to get its vote. The Doctor Caucus is quite a big voting bloc. We will be working with the caucus to make sure the changes that we seek get made.

Catherine G. Cohen

Vice president of governmental affairs, American Academy of Ophthalmology

Disclosure: Cohen has no relevant financial disclosures.

To read the original story on the SGR Senate Committee hearing, click here.

Healio.com covered the hearing live. To read the coverage, click here.

The Senate Committee on Finance and the House Committee on Ways and Means bills that were scheduled for a vote last week were initially identical. The American Academy of Ophthalmology felt that they were not fair to specialists, including ophthalmologists. So, we asked for a number of changes. In fact, we joined the American College of Surgeons in a letter outright opposing the draft bills as written. Then, the night before the vote, the House Committee on Ways and Means made a key adjustment to its bill. The committee developed a provision that would give 3 years of positive updates to physicians, 0.5% in 2014, 2015 and 2016. While that was just one of three or four issues that we were looking for accommodation on, we felt that it was a good-faith response and that they were willing to listen to us, that they were hearing us. So, we withdrew our opposition to the House Ways and Means bill the morning of the vote. We did not endorse the bill, but we reiterated that we would work with the House Committee on Ways and Means and House Committee on Energy and Commerce to develop a bill that could pass on the House floor.

Some of the key problems are that they offer a 5% bonus for doctors who move to an alternative payment model. Unfortunately, there really is no alternative payment model for specialists. The accountable care organization, or ACO, is a very new alternative payment model that has had kind of a rocky start, with obstacles for specialty participation. We have been trying to get some understanding from the Center for Medicare and Medicaid Innovation, the division in CMS that is conducting demonstrations and testing the new payment models, of its plans for the outpatient area and specialties such as ophthalmology. Last year, we were told that it had no plans to test anything in the outpatient area.

So, that is a problem. While we may not object to there being no alternative payment model for specialists to participate in, leaving only the fee-for-service program, Congress is making that option very unattractive. This leaves specialties kind of trapped, which is not fair. In this regard, the House Committee on Energy and Commerce bill is better on a couple of key points. One, it includes positive updates for 10 consecutive years. That is something that we would like to see.

The other thing is it would create a new fee-for-service value-based program that would allow all doctors who hit a high-performing threshold — I think it was if the score is 65% or better — to get a bonus. Alternatively, the House Committee on Ways and Means bill would create a fee-for-service value-based program in which high-performing doctors only get a bonus if a low-performing doctor gets a penalty. So, it is budget-neutral. Some high-performing doctors might initially get a bonus, but eventually, as more doctors become high-performing, the bonus would go away. So, we contend that the House Committee on Ways and Means and Senate Committee on Finance proposals really underfund the fee-for-service value-based program. That is not acceptable.

The House Republican Doctor Caucus sent a letter to the House leadership basically saying that as the SGR repeal comes to the floor, key criteria must be met to get its vote. The Doctor Caucus is quite a big voting bloc. We will be working with the caucus to make sure the changes that we seek get made.

Catherine G. Cohen

Vice president of governmental affairs, American Academy of Ophthalmology

Disclosure: Cohen has no relevant financial disclosures.

To read the original story on the SGR Senate Committee hearing, click here.

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Healio.com covered the hearing live. To read the coverage, click here.