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Washington Watch

Washington Watch Weekly - February 28, 2020

ASCRS and Surgical Coalition Continue Advocacy to Increase Payment for Post-Operative E/M Office Visits Included in 10- and 90-Day Global Codes and Eliminate the Add-On Code; Meet with Key Congressional Committees

This week, ASCRS and the surgical coalition continued our advocacy efforts on Capitol Hill related to CMS’ flawed E/M policies for 2021 by meeting with key committees of jurisdiction, such as the House Ways and Means and Energy and Commerce Committees and the Senate Finance Committee. As we have reported, we oppose CMS’ 2021 policy that would not apply increased values for standalone E/M codes to post-operative E/M office visits bundled into 10- and 90-day global surgery codes. In addition, we oppose CMS’ E/M add-on code because it was developed as part of the now-abandoned E/M code collapse proposal to ensure primary care physicians would not be negatively impacted. Now that the codes are not collapsing and the values of standalone codes are increasing, primary care will get a significant payment increase and, therefore, the add-on code is no longer necessary. In addition to meeting with key committees to urge Congressional action that would require CMS to apply the increases to post-operative E/M codes and eliminate the add-on code, ASCRS was instrumental in advocating for Sen. Rand Paul, MD (R-KY), an ophthalmologist, to meet with CMS Administrator Seema Verma regarding applying the increases to post-operative visits for the 10 and 90 day global surgical codes in its upcoming 2021 rulemaking. We will keep you updated.

Noridian to Correct Payment Error for Combined Cataract and ECP Codes

As we reported last week, ASCRS and ASOA members across the country are reporting a variety of issues related to payment for new CPT codes 66987 and 66988 for combined cataract surgery and endoscopic cyclophotocoagulation (ECP). CMS designated these codes as “carrier priced,” which has led to some disparity between carriers in how they are reimbursing for the codes. This week, Noridian acknowledged that it had made an error with these codes in its fee schedule and said it would correct the mistake and retroactively correct impacted claims. ASCRS and the American Academy of Ophthalmology continue to work to address issues related to these codes through other MACs. We will keep you updated.

ASCRS Sends Letter of Support in Response to FDA Proposal to Exclude Intraocular and Biologic Products from Canadian Importation; Opposes PBMs From Being Included in the Importation Process

This week, ASCRS submitted a letter to the FDA in response to its proposed rule, “Importation of Prescription Drugs,” supporting its proposal to exclude intraocular and biologic products from importation from Canada to ensure patient safety and quality assurance of these drugs. For drugs that are not injected intraocularly and where the risk of contamination is significantly less, we support the proposal to have all other ophthalmic and sterile drugs reviewed on a product-by-product basis. However, in the letter we expressed concerns that developing yet another complicated review system could create an unnecessary burden on the agency’s limited resources.

Lastly, we encourage the FDA to use caution when determining who can participate as co-sponsor of an authorized Section 804 Importation Program (SIP), the entities that would import the drugs from Canada. We strongly oppose pharmacy benefit managers (PBMs) participating as SIPs. We note that PBMs act as the middleman in negotiating cost with drug manufactures and pharmacies, yet they often fail to pass down rebate and discount savings to patients. Furthermore, PBMs limit their formularies, ultimately denying patients access to the medications they need.

CMS Responds to ASCRS and Medical Community Letter on Prior Authorization Burdens; CMS is Considering Additional Reforms Outside of Automation

This week, CMS responded to a letter from ASCRS and over 100 organizations within the medical community that was submitted last September 2019 urging CMS to address all aspects of prior authorization (PA) burdens and to not rely on automation as the only solution. CMS notes that it has identified various opportunities for improvement in PA, beyond automation, and is currently examining these potential solutions. Additionally, CMS addressed our concerns that payers may have unprecedented access to providers’ EHRs by relying on automation processes to address PA. CMS noted that any technology solution that was implemented would ensure the security of providers’ and would only permit access to certain defined data elements in their EHR systems.

We will continue to work with the medical community and the Administration on how to promote broad prior authorization reforms.

CMS Hosts Webinar on MIPS Value Pathways (MVPs)

On Tuesday, March 3, from 2:00 to 3:00 p.m. ET, CMS is hosting a webinar to provide an overview of the MIPS Value Pathways (MVPs) participation framework, which was outlined in the 2020 Quality Payment Program (QPP) Final Rule, for implementation in 2021. During the webinar, CMS will review the MVPs framework and discuss the goals of the MVPs. Following the presentation, CMS plans to answer participant questions and receive stakeholder feedback. To register, please click here.

As a reminder, ASCRS submitted comments on the QPP final rule and expressed opposition for mandatory MVPs since they would eliminate a physician’s ability to choose the measures and activities that are the most relevant to his or her practice. In addition, MVPs would include problematic population-health measures. CMS is still determining whether it will make its MVPs mandatory or voluntary.

Reminder: The MIPS 2019 Data Submission Deadline is Next Month

MIPS Eligible Clinicians Have Until March 31 to Submit Data for 2019
The data submission deadline for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2019 performance period of the Quality Payment Program (QPP) is next month. Data may be submitted and updated any time until 8:00 p.m. ET on March 31, 2020.

Please note, if you use the IRIS registry, you do not need to submit your data directly to CMS. However, IRIS and other third-party vendors may have earlier submission deadlines than CMS does.

Quality measures reported via Medicare Part B claims have been submitted throughout the 2019 performance period. You may review your preliminary feedback on Part B claims measure data by signing in to qpp.cms.gov. CMS will update this feedback at the end of the submission period with claims processed by your Medicare Administrative Contractor.  Additionally, the data submission period through the CMS Web Interface for ACOs and pre-registered groups and virtual groups also closes on March 31, 2020 at 8:00 p.m. ET.

How to Submit Your 2019 MIPS Data and For Additional Resources
To learn how to submit data, please review the 2019 Data Submission FAQs. Additional resources are available in the QPP Resource Library.

For questions or comments on data submission, please contact CMS QPP staff at 866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov.

HHS Releases Final EHR Burden Reduction Strategy; Focuses on Reducing Documentation and Improving Usability

This week, the US Department of Health and Human Services (HHS) released the final “Strategy on Reducing Burden Relating to the Use of Health IT and EHRs”, a report mandated by the 21st Century Cures Act. The strategy broadly aims to reduce the burden of HHS’ Health IT programs, some of which are administered by the National Coordinator for Health IT (ONC) and others by the Centers for Medicare and Medicaid Services (CMS). ASCRS provided comments on the draft version of the strategy in early 2019. In the original draft version, ONC and CMS touted its now-abandoned evaluation and management (E/M) proposal for 2021 to collapse the visit levels and pay a blended rate. Physicians would only have been required to document to level 2 for the collapsed codes, as key to burden reduction. ASCRS agreed in our comments that the proposal would reduce documentation burden but reiterated our overall opposition to the code collapse concept. In the final strategy released this week, CMS and ONC noted that CMS had instead finalized changes to the E/M codes recommended by the CPT and RUC, with reduced documentation burden.


The final strategy also notes that in addition to the comments on the draft strategy, ONC has long heard complaints from physicians that EHRs were difficult to use, information cannot be exchanged seamlessly, and many measures are not clinically relevant. ASCRS echoed those concerns in our comments on the draft strategy and recommended that ONC and CMS focus on requiring systems to exchange specialty-specific clinical data, such as post-operative visual acuity or IOP, and provide credit in MIPS for alternative uses of health IT, such as integrating EHR with a QCDR like IRIS. In the final strategy, CMS and ONC do not address these recommendations directly but noted it would explore the use of alternate health IT and would encourage standards organizations to facilitate the exchange of clinical data.

CMS to Host Overview of Open Payments Call on March 19

On Thursday, March 19 from 2:00–3:00 p.m. ET, CMS will host a call on the Open Payments program. CMS will provide an overview of the Open Payments program, registration process, and will review critical deadlines for physicians and teaching hospitals to review and dispute data. A question and answer session will follow the presentation. Register for the call here.

As a reminder, the data on Open Payments is submitted by manufacturers and group purchasing organizations regarding payments made to physicians. Each year, Open Payments data is updated at least once to include information from disputes and other data corrections. The data is published to the Open Payments website for the public.

Register Now: ASCRS/ASOA U.S. Domestic Members and ASCRS YES Program Members are Invited to Attend the Annual Alliance of Specialty Medicine Legislative Fly-In in Washington, D.C., June 15-17

Event Info: June 15-17, 2020; Liaison Hotel Capitol Hill; Washington, D.C.

We welcome all U.S. domestic ASCRS and ASOA members to join their colleagues from other specialties in Washington, D.C. this summer for another great Legislative Fly-In event! During this event, you will experience first-hand the importance of meeting with your members of congress and staff. You will learn how to become an effective advocate and then turn that knowledge into action in-person on Capitol Hill. Please plan to join us for this year’s Fly-In, June 15-17 in Washington, D.C.  Up to $1,000 in travel expenses will be reimbursed to each member who attends the Fly-In.


Scholarship Alert: ASCRS/YES Alliance of Specialty Medicine Legislative Fly-In Scholarship

Are you currently or know of any ASCRS Young Eye Surgeon (YES) members whom might be interested in attending the annual fly-in event? ASCRS and the Young Eye Surgeons (YES) program are excited to announce a full-scholarship opportunity for U.S. resident and fellow members of ASCRS who want to effect positive change for their profession and patients. Please feel free to forward this announcement! For more information, or to apply for this opportunity, please use the links below:

Download:  YES Legislative Fly-In Scholarship Flyer
Apply Now: YES Legislative Fly-In Online Application

Legislative Fly-In Background Information:
Each year, members from ASCRS and ASOA make their way to Washington, DC to join the Alliance of Specialty Medicine, a coalition of 14 “like-minded” specialty medical groups that focus on preserving access to specialty care, for legislative “Fly-In” days. All participants will participate in an advocacy briefing session, where you will learn the proper techniques to become effective advocates with your members of congress and their staff. You will then travel to Capitol Hill to meet with your legislators and lobby for shared priority issues. During these meetings, ASCRS and ASOA members will have the opportunities to share personal stories that help illustrate the effect of policies in Washington, and to thank your elected officials for their support on key legislative issues and to encourage their continued support. Traveling to Washington to meet with your members of congress is also a great way to offer yourself as a resource to make sure that accurate information is used in making public policy decisions. We hope that you will consider this opportunity!

Take a Trip to Exotic Waters: Register Now for the 2020 eyePAC Reception at the New England Aquarium

Now that registration is officially open for next year’s ASCRS Annual Meeting, eyePAC is excited to announce that the 2020 eyePAC Reception will be held at the New England Aquarium. Overlooking Boston Harbor, the Aquarium features more than 20,000 fish and aquatic animals representing 550 species from around the world. It truly is one of Boston’s most unique event venues!

On Friday evening, May 15, from 7-9:00 p.m., eyePAC donors and their guests will enjoy drinks and substantial hors d’hoeuvres surrounded by penguins, sharks, sea turtles, moray eels, and thousands of exotic, colorful fish. You’ll have private access to all four levels of the aquarium’s stunning Main Exhibit Gallery. The four-story Giant Ocean Tank creates a fascinating centerpiece that will long be remembered by you and your guests!

To donate and register for the eyePAC Reception, use your member credentials to log onto www.ascrs.org. Then go to the official registration page. If you have any questions, please contact Chris Hughes, manager of PAC & Grassroots at 703-591-2220 or chughes@ascrs.org. We hope to see you there so we can thank you for your support of eyePAC—the PAC for anterior segment specialists!

ASCRS Calls on Members to Assist with FTC Request to Provide Examples of Incomprehensible Prescription Verification Messages

We are calling on ASCRS and ASOA to help with a recent request from the Federal Trade Commission (FTC) staff in regard to the Contact Lens Rule. Recently, ASCRS joined with the American Optometric Association (AOA) and the American Academy of Ophthalmology (AAO), in a meeting with FTC staff to discuss the contact lens market. During the meeting, we reiterated our members' complaints of online retailer violations, especially robocalls that leave incomprehensible verification messages. As a result, the FTC has requested audio files of these prescription verification messages.

Please send any audio examples of incomprehensible prescription verification messages to Jillian Winans at jwinans@ascrs.org. We appreciate your assistance.

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