WASHINGTON, D.C. – May 12, 2020 – More than 200 ophthalmologists from 40 states today are Zooming or teleconferencing with lawmakers and their staffs in Washington, D.C. to push for congressional support for measures that will help physician practices survive the COVID-19 pandemic and to restore patients’ timely access to sight-saving treatments. This is the American Academy of Ophthalmology’s first-ever Virtual Hill Day. Physicians, eager to share how the pandemic has affected their patients and their practices, quickly filled registration. This event replaces the Academy’s annual April visit to Capitol Hill to speak on behalf of millions of American patients.
The decision to stop routine surgical and in-office visits back in March was necessary to protect patients’ health and safety, but it had a devastating impact on ophthalmology practices, many of which are small businesses. Ophthalmologists continue to provide treatment for potentially blinding conditions, but as caseloads plummet, ophthalmology practices are unable to cover their normal operating expenses such as staff salaries, monthly lease payments, equipment maintenance, and all other overhead.
Top among our issues:
Immediate relief during the pandemic
Federal aid is critical so practices can keep employees on the payroll and appropriately treat patients who need urgent care today.
- Urge the Centers for Medicare & Medicaid Services (CMS) to reinstate the Medicare Accelerated and Advanced Payment Program to provide another resource to practices struggling financially.
- Enact needed changes to the Medicare Advanced Payment Program to help practices that have already received funds through it and for those that may do so in the future.
- Provide additional funding for the Paycheck Protection Program if the newly appropriated funds are depleted quickly.
Long-term recovery assistance
As ophthalmologists reopen offices to routine visits and elective surgery, pent-up demand for medical care will be huge. At the same time, physician practices will be working to recover from weeks or months of deep financial losses. Long-term recovery assistance will be critical.
- Reduce the financial impact of cuts related to changes to evaluation and management codes scheduled for Jan. 1, 2021.
- Apply the evaluation and management payment increases to post-op visits in the global codes.
- Extend through Dec. 31, 2021 a reprieve from a 2 percent Medicare budget sequestration cut that was included in the CARES Act to continue providing financial relief as physician practices resume normal operations.
- End the current six-year physician payment freeze by implementing a positive physician update like those that other Medicare providers received in 2020.
Suspend prior authorization and step therapy requirements during the pandemic
Under normal circumstances, requirements for prior authorization and step therapy delay medically necessary patient care. In a pandemic, these policies become an even bigger roadblock to patient care, as practices, operating with skeleton staffs, find it physically impossible to be on hold with a carrier for hours to obtain approval. And step therapy policies prevent physicians from making commonsense decisions such as switching patients to longer-acting drugs to protect them from unnecessary visits.
- Urge CMS to instruct Medicare Advantage plans to suspend prior authorization and step therapy requirements during the pandemic.
- Support H.R. 3107, the Improving Seniors’ Timely Access to Care Act. This bipartisan bill aims to increase transparency and streamline the prior authorization process in the Medicare Advantage program.
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