December 2020


ASCRS and ASOA join the Alliance of Specialty Medicine in Virtual Legislative Fly-in

This year, 15 ASCRS and ASOA members joined more than 100 specialty physicians from around the country, representing the 14 members of the Alliance of Specialty Medicine, in a Virtual Legislative Fly-in, which was held on November 19. Key senators and representatives focused on the healthcare priority issues for the Alliance, followed by a Q&A session. The members of Congress were briefed in detail on the key priority issues and possible solutions, including pending legislation, prior to the Fly-in. The pending Medicare physician payment cuts and possible legislation solutions were key issues for ASCRS and ASOA. Below are details on some of the key issues.

Medicare Physician Fee Schedule cuts

This is one of the most important issues potentially impacting ophthalmology, and action is needed to prevent significant provider cuts. These cuts will go into effect on Jan. 1, 2021, as a result of the increases in Evaluation and Management codes (E/M), creation of the add-on code (GPC1X), and no increases to postop visits in the 10- and 90-day global surgical codes. The majority of these policies increase Medicare spending by $10.2 billion and are offset by a budget neutrality adjustment to the conversion factor of –10.6%.
In terms of the impact, the 2021 conversion factor will see a $3.83 decrease from the 2020 conversion factor, which is the lowest since 1993. Some specialties in the Alliance are facing cuts as high as 7%, with ophthalmology facing about a 6% cut overall. This could cause serious consequences for practices already struggling from the COVID-19 pandemic.
In response to this, the Alliance has urged congressional leaders to prevent the cuts by the end of the year and has also commented on the CY 2020 Medicare Physician Payment Final Rule, urging CMS to reverse the decision to exclude updated E/M values in codes with 10- and 90-day global surgical periods and, along with ASCRS and the Surgical Coalition, is seeking congressional relief. The Alliance also recognized Rep. Michael Burgess, MD (R-TX), who introduced H.R. 8505, which waives budget neutrality for 1 year by using the Provider Relief Fund, and issued support for H.R. 8702, led by Representatives Ami Bera, MD (D-CA), and Larry Bucshon, MD (R-IN), the Holding Providers Harmless From Medicare Cuts During COVID-19 Act. The Alliance is urging representatives to cosponsor H.R. 8702 and is asking for action before the end of the year to prevent significant Medicare physician payment cuts.

COVID-19 relief

Lawsuits: Because of the current situation with the pandemic, some patients may be treated by practitioners outside the scope of their specialty/practice area. Lack of protective safety gear and lack of essential medical equipment could also impact care. Though 35 states have some protections in place, these may vary.
There is currently federal legislation to halt COVID-19 lawsuits in the form of H.R. 7059, the Coronavirus Provider Protection Act, which has 37 cosponsors. This would provide liability protection for healthcare providers for harm caused by an act or omission in the course of arranging for or providing healthcare services during the COVID-19 PHE period plus 60 days. The provider must be acting in good faith to benefit from the liability protections.
Another bill, S. 4317, the Safe to Work Act, has 24 cosponsors and offers similar protections, but immunity from the suit extends from December 1, 2019, through October 1, 2024 (or later if the PHE remains in effect).
Financial support: There are efforts to extend the Paycheck Protection Program to allow small businesses to take advantage of the remaining $138 billion in allocated funds and to expand the expenses eligible for loan forgiveness to include COVID-19 prevention and retrofitting expenses.
There are also requests for members of Congress to cosponsor the Small Business PPE Tax Credit Act (H.R. 7216), which would allow a tax credit of up to $25,000 for the cost of qualified PPE (gloves, facial masks, protective gear, and cleaning supplies).
Additionally, there are efforts to extend sequestration cut relief. The CARES Act provided relief from reimbursement cuts pursuant to sequestration, but relief only goes through the end of 2020.
Student loan forgiveness: Members of Congress are being asked to cosponsor H.R. 5924, the Rural Physician Student Loan Forgiveness bill, which would repay student loan debt for specialty physicians practicing in a rural setting. It would include payment of 1/6 principal and interest paid annually for each year of full-time service in a practice in a rural setting. Payments total up to $250,000.

Prior authorization

Another priority issue for the Alliance is regulatory hassle, costs, and delays and denials of care. H.R. 3107, the Improving Patients’ Timely Access to Care Act, seeks to establish an electronic prior authorization process, to minimize the use of prior authorization for services that are routinely approved, to prohibit additional prior authorization for medically necessary services performed during a surgical or invasive procedure that already received or did not initially require prior authorization, to require plans to report on the extent of their use of prior authorization and the rate of delays and denials, to ensure prior authorization requests are reviewed by qualified medical personnel, and to ensure that plans adhere to evidence-based medicine guidelines.

Step therapy

Step therapy can delay effective treatments to patients, but there are bills in both the House and Senate to establish exceptions to step therapy protocols. The Alliance is encouraging members of Congress to cosponsor the Safe Step Act (H.R. 2279/S. 2546).

Surprise medical bills

Insured patients can get hit with unanticipated medical bills. There is currently legislation, with four committees taking action in Congress, to prevent surprise medical bills. These include: the Senate Health, Education, Labor & Pensions Committee’s S. 1895, the Lower Health Care Costs Act; the House Energy and Commerce Committee’s H.R. 3630, the No Surprises Act; the House Education and Labor Committee’s H.R. 5800, the Ban Surprise Billing Act; and the House Ways and Means Committee’s H.R. 5826, the Consumer Protections Against Surprise Medical Bills Act. The medical community prefers the option from the House Ways and Means Committee.
Efforts will continue to include SMB legislation in any year-end omnibus spending and/or COVID-19 relief package.

ASCRS and ASOA join the Alliance of Specialty Medicine in Virtual Legislative Fly-in ASCRS and ASOA join the Alliance of Specialty Medicine in Virtual Legislative Fly-in
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