Congress continues to seek help from AOA for Medicare pay reform

July 27, 2013

Capitol Hill leaders again turned to the AOA for help as they continue to explore legislative strategies aimed at preventing massive Medicare payment cuts and replacing the program’s flawed reimbursement system.

In late May, U.S. Sens. Max Baucus (D-Mont.) and Orrin Hatch (R-Utah) reached out to the AOA and other influential groups for input and suggestions on a plan that would avert a roughly 25 percent Medicare fee cut scheduled for Jan. 1, 2014, and make improvements to the current payment system while providing incentives for ODs and others to transition to alternative payment models over time.

The request from the leading lawmakers comes on the heels of similar outreach made by two top U.S. House committees in recent months.

With the Congressional Budget Office signaling the cost of repealing Medicare’s broken pay formula would be roughly half the cost of what it was just last year, many on Capitol Hill believe the time may at last be right for Medicare payment reform.

In a strongly worded letter delivered to the AOA and other physician groups, the U.S. Senate Finance Committee’s Chair Baucus and ranking-member Hatch condemned Medicare’s flawed sustainable growth rate (SGR) payment formula and said that it was time to once-and-for-all end the annual ritual of Congress passing short-term and often last-minute “doc fix” legislative patches.

“Almost every year now, seniors on Medicare and the doctors who serve them are left worrying whether their care will be in jeopardy if Congress doesn’t pass a temporary fix to Medicare physician payment rates. This formula is fundamentally flawed and needs to be permanently fixed,” said Sen. Hatch.

“Working together and soliciting input in an open and transparent way from across the health care community, I’m confident Chairman Baucus and I can find a reasonable path forward that puts physician payments on a sustainable footing for now and the future. That is the certainty that our seniors rightly deserve,” Sen. Hatch added.

In response to the Finance Committee request, the AOA boosted its ongoing advocacy efforts on Medicare payment issues by providing the senators and their staffs with a detailed letter supporting the overall goal of repealing the flawed SGR formula, urging the policymakers to remember the critical preventive and primary care role that optometrists play in the Medicare program, and challenging Congress to ensure that new approaches look beyond old biases and misplaced motivations.

“AOA believes that new payment and delivery models must be given the structural flexibility to ensure that the provider base matches patient need while also protecting access to care for Medicare beneficiaries and directing resources to improve quality. Most importantly, we believe that safeguards must protect against discrimination of physicians, including optometrists, and their patients. After all, important patient protections must continue to ensure that Medicare beneficiaries have the freedom to seek care from the doctor of their choosing,” the letter said.

“In the private sector, organizations have developed patient-centered medical homes but the ability of non-MD/DO practitioners to participate in these programs is continuously limited. If new payment delivery systems are not inclusive of a range of clinician types, efforts to increase quality and reduce health care costs will not be successful,” the letter added.

“Overall, too many delivery systems discriminate against optometrists based on the school they attended and the license they hold, rather than recognizing what optometrists are trained and licensed to do. This discrimination serves to reduce competition and innovation. Optometrists do not have all of the answers for fundamental delivery system reform but we should not be prohibited from providing the answers that we do have, or from contributing to solutions, merely because we are optometrists.”

As the debate over the direction of Medicare payment and delivery reform continues, the AOA will continue to engage lawmakers in both chambers and on both sides of the political aisle. To learn how you can become more involved in federal advocacy, including how you can help advocate for fair-minded Medicare reform, contact the AOA Washington Office team at 800-365-2219 or ImpactWashington@aoa.org.

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