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ASCRS is the cataract and refractive surgeon’s voice on Capitol Hill. We are actively engaged in a variety of policy proposals to ensure that our members can continue to provide quality care to their patients. ASCRS urges its members to stay informed on key legislative developments and join in the process by becoming an eyeContact grassroots advocate or participating in our annual legislative fly-in. Use this section for information on priority issues. For more detailed information about each issue, download our issue briefs.

Current Issues:

MACRA Regulatory and Legislative Reforms

In April 2015, Congress passed, and the president signed into law, the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA replaced the flawed sustainable growth rate (SGR) formula with the Quality Payment Program (QPP), which represents a more streamlined approach to paying providers for the value and quality of their care through the Merit-Based Incentive Payment System (MIPS) and other Advanced Alternative Payment Models (APMs). ASCRS supports the goals of MACRA and successfully advocated that Congress make limited changes to the statute to help clinicians successfully participate in the Merit-Based Incentive Payment System (MIPS). This pathway is essential for ASCRS members, as there are no ophthalmology specific Alternative Payment Models (APMs) available at this time.

In comments on the 2017 Quality Payment Program final rule and 2018 proposed rule, ASCRS made recommendations to CMS for the 2018 performance year/2020 payment year. The 2018 Year 2 final rule included several of our recommended changes. CMS is prioritizing policy changes that reduce provider regulatory and administrative burden as part of its “Patients Over Paperwork” initiative. We will continue to work with the medical community to advocate for necessary changes and improvements in future rulemaking. For more information, download the MACRA Regulatory and Legislative Reforms Issue Brief.

Regulatory Relief

ASCRS•ASOA continually advocates for regulatory changes that will alleviate the administrative burden on practices, so that physicians can focus on providing high-quality care to patients. For more information, download the Regulatory Relief Issue Brief.

Medicare Patient Shared Responsibility

ASCRS supports a patient's right to obtain medical services from the physician of his or her choice by adopting additional Medicare payment options. Under the current system, physicians must opt out of Medicare for two years if they enter into a private contract with a Medicare patient. Therefore, ASCRS supports passage of the Medicare Patient Empowerment Act in the 115th Congress. For more information, download the Medicare Patient Shared Responsibility issue brief.

Off-Label Communication

ASCRS supports efforts to ensure that ophthalmologists have access to truthful and non-misleading information about off-label uses of medical products. We support the free flow of information between physicians and drug and device manufacturers. For more information, download the Off-Label Communication issue brief.

Drug Compounding

ASCRS supports efforts to ensure the safety and sterility of compounded and repackaged drugs. We are concerned that the Food and Drug Administration (FDA) regulation of compounded drugs for office-use may limit patient access. While we have been successful in advocating for continued access to repackaged biologics, such as Avastin, we continue to monitor FDA’s oversight. ASCRS will continue to work with the medical community to advocate for our recommended changes to ensure physicians have access to essential drugs. For more information, download the Drug Compounding issue brief.

Accountable Care Organizations (ACOs)

Accountable Care Organizations (ACOs) are alternative payment models designed to lower total overall healthcare-associated expenditures while improving quality of care. They are entities operated by a group of physicians or hospitals and physicians that would be paid to manage and coordinate the care of a defined population of Medicare fee-for-service beneficiaries. Originally authorized under the Patient Protection and Affordable Care Act, CMS created two voluntary initiatives in 2011 to increase participation in and adoption of ACOs: the Medicare Shared Savings Program (MSSP) and the Advance Payment Model.

In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) increased incentives for physicians participating in certain Advanced Alternative Payment Models (APMs) that incorporate two-sided risk, which include some ACOs.

In its MACRA final rule, CMS listed MSSP Track 2 and 3 and Next Generation ACO as advanced APMs eligible for additional bonus payments. CMS excluded Track 1 ACO models from incentives because they do not meet the MACRA criteria to incorporate down-side risk. However, physicians participating in Track 1 ACOs will receive credit under the Merit-Based Incentive Payment System (MIPS) by reporting quality measures through the ACO and receiving full credit for improvement activities. Track 1 ACO participants will be required to report EHR measures for the Advancing Care Information category individually. More information, including details for participation, are discussed in the Accountable Care Organizations issue brief.

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