ASCRS and Surgical Community Continue to Advocate for Increased Post-Operative Visit E/M Values in 10- and 90-Day Global Codes and Withdrawal of E/M Add-On Code; RAND Corporation Publishes Article on Global Codes Based on CMS Study
As we have previously reported, ASCRS and the surgical community continue to oppose CMS’ policy in the 2020 Medicare Physician Fee Schedule final rule that would increase the value of standalone E/M codes in 2021, but not apply the increase to post-operative E/M visits included in 10- and 90-day global surgical codes. We argue that failing to apply the E/M increase to global codes disrupts the relativity of the physician fee schedule and violates the Medicare statute that requires all physicians be paid the same amount for providing the same services, thereby creating an illegal specialty differential if the E/M service is furnished as part of a global surgical code. In addition, we are seeking to prevent the implementation of the E/M add-on code that is unnecessary and would lead to a significant redistribution of value in the fee schedule away from procedure-based specialties.
Global Codes Advocacy
In conjunction with the surgical community, we have sent letters and formal comments on the rule to CMS, advocated for bipartisan letters from Congress urging the increases be made to the global codes, and met with CMS directly. In addition, we are seeking advice from a law firm on a potential legal challenge to the policy and advocating that legislative language require the E/M increase for global codes and the elimination of the add-on code be included in must-pass legislation to extend certain Medicare and Medicaid programs in May. As the legislative ask comes together in the coming weeks, ASCRS and ASOA members should be on the lookout for a grassroots alert to contact their members of Congress to support this effort.
E/M Add-On Code
In addition, we are advocating for a withdrawal of the E/M add-on code CMS created for patients with complex or chronic disease. The concept of an add-on code was developed by CMS as part of its original policy to collapse E/M levels 2–4 to ensure that primary care physicians were not negatively impacted. Subsequently, the E/M codes went through the CPT and RUC revaluation process and CMS abandoned its original policy, thus eliminating the need for the add-on code.
Impact on Ophthalmology
Because of the budget neutrality of the fee schedule and the high volume of E/M services billed, the overall increase to the standalone E/M codes is expected to have a significant redistributive effect, transferring value from procedure-based specialties to primary care. The addition of the add-on code further erodes value away from surgical specialties. Based on analysis conducted by the surgical coalition, ophthalmology is among the most negatively impacted specialties from the policies in the final rule. However, if the post-operative E/M visits are increased in the global codes and add-on code is withdrawn, ophthalmology would see a slight increase in Medicare payments for 2021.
CMS states it cannot increase the value of post-operative E/M visits in global codes because of its ongoing study of the codes. In conjunction with the 2020 proposed rule, CMS released three studies developed by the RAND Corporation: one that studied the ongoing data collection on post-operative visits; one looked at post-op care for specific procedures, including cataract; and one that recommended options for reducing the value of global codes the CMS contends include post-operative visits that are not being furnished. The reports conclude that global surgery codes, for all specialties, include post-operative visits that are not being furnished, however they also found that the number of post-operative visits furnished after cataract surgery is equal to the three that were included in the recent RUC revaluation of the code. An article in the New England Journal of Medicine published this week by RAND summarized the findings of the studies and recommends that not only should the value of all global codes be reduced, but that CMS not rely solely on the RUC process to revalue codes, but use data from a range of sources including claims, quality-improvement databases, and electronic health records.
This issue is currently ASCRS and ASOA’s top advocacy priority. Members should be prepared to contact their legislators in the coming weeks to ask for their support. We will keep you updated.
Get the Inside Scoop on the 2020 Electoral Outlook: Don’t Miss ASCRS’ Government Relations Symposium, “Inside the Circus” featuring Mark McKinnon at the ASCRS Annual Meeting in Boston, MA
On Sunday May 17, from 1–2:30 p.m. join Mark McKinnon, co-creator, co-executive producer, and co-host of Showtime’s “The Circus: Inside the Greatest Political Show on Earth” at the ASCRS government relations symposium, “Inside the Circus.” McKinnon, a political advisor, reform advocate, and media columnist, will provide a non-partisan take on the electoral landscape and its impact on ophthalmology.
McKinnon has helped engineer five winning presidential primary and general elections including former President George W. Bush, Senator John McCain, and former Governor Ann Richards. He is co-founder of No Labels, a nonprofit organization dedicated to bipartisanship.
Don’t miss this exciting session to hear how the current political climate may impact you!
Advocate for Your Patients and Profession; Attend the 2020 Alliance of Specialty Medicine Legislative Fly-In in Washington, D.C. June 15-17
YES Members Should Apply for the Annual Legislative Fly-In Scholarship
ASCRS ASOA members are encouraged to attend the 2020 Alliance of Specialty Medicine Fly-In, which will be held June 15–17 in Washington, D.C. ASCRS and ASOA members who attend the Fly-In will receive in-depth training on policy issues important to ophthalmology and the specialty medicine community—and will have the opportunity to meet with their Representative and Senators to lobby for those legislative issues. Your participation in this event has a direct, positive impact on your profession and patients!
Not familiar with the Fly-In? See what past attendees have to say about the experience in this brief video.
Because of its increased popularity and the rising costs associated with the Fly-In, we will reimburse up to $1,000 in travel expenses. The complete agenda is still being developed, but attendees are asked to arrive in Washington by Monday afternoon, June 15, and not to depart until Wednesday afternoon, June 17, following conclusion of the conference.
If you are interested in attending the 2020 Fly-In, please complete this form at your earliest convenience. We understand that you need advanced notice to arrange your schedule, so you will be notified ASAP when your participation is confirmed and provided with additional details to make your travel arrangements. Keep your eye on the Washington Watch for more information.
YES Fly-In Scholarship
ASCRS and Young Eye Surgeons (YES) are pleased to announce the return of the ASCRS/YES Legislative Fly-In Scholarship Program to encourage U.S. resident and fellow members to attend the Fly-In.
Five applicants will be chosen to receive a full scholarship (registration, travel, hotel accommodations, and meals) to join their peers in the nation’s capital and meet with their members of Congress to advocate for policies that will impact their careers and help their patients. This event not only helps residents and fellows develop their understanding of policy issues, but it provides an opportunity to network with established members and ASCRS leadership. For more information and to apply online, please click here. The application deadline is March 31, 2020.
Any questions regarding the Fly-In or YES scholarships may be directed to Allison Madson, manager of regulatory affairs, at email@example.com or 703-591-2220.
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 firstname.lastname@example.org. We hope to see you there so we can thank you for your support of eyePAC—the PAC for anterior segment specialists!