WASHINGTON – The American Academy of Ophthalmology today released its 2006 Advocacy Agenda for ophthalmology.  Not surprisingly, three Medicare physician reimbursement issues have been designated as top issues of emphasis for the Academy’s attention and resources. Rounding out the priority list are a new Children’s Vision Screening campaign and continuation of the Academy’s commitment to ensuring the highest quality vision care for patients in federal health care facilities such as the Veterans Health Administration.

The Academy’s Secretariat for Federal Affairs met in Washington to determine the Academy’s annual agenda at its Jan 14 meeting. A wide array of interests are represented on the Federal Secretariat, including health policy, congressional advocacy, OPHTHPAC, and research and regulatory matters, among others. 

“We are confident that the 2006 Agenda reflects the most critical issues affecting ophthalmology at this time,” said Michael X. Repka, MD, secretary of Federal Affairs. “Of course, Medicare reimbursement policy has a significant impact on ophthalmology because so many of our patients are Medicare beneficiaries. This year we are faced with a number of reimbursement challenges, many of which could affect the viability of our practices and the quality of patient care, including the SGR, pay for performance, practice expense and the Five Year Review of work values. The Academy is prepared to again play a successful leadership role in solving these issues over the next year.”

Medicare reimbursement issues, which require significant time and resources, include efforts to impact what seems to be the inevitable development of a “value-based purchasing” system so ophthalmology can receive its fair share.

“The reality is that Medicare payment tied to quality measures is no longer the question and physician leadership on this will be key to positive payment reform discussions with policy makers, particularly Congress and the Administration,” said William Rich, MD, the Academy’s medical director of Health Policy. “The Academy must be at the table when these issues are discussed in order to protect ophthalmology’s interests as we move forward on Medicare’s use of quality measures for physicians.”

The Academy has played a leadership role in developing appropriate measures for ophthalmology based on its Preferred Practice Patterns. While ophthalmology’s measures were not included in the short list to be used by CMS in its new Physician Voluntary Reporting Program, the Academy is working with CMS to ensure that ophthalmology will have the opportunity to participate in the program should financial incentives be included in 2007 or 2008. The Academy will also continue to work to affect legislation on this critical issue.

Fixing the SGR is now an even greater challenge because of the growing price tag for a fix and the increasing federal deficit. As both the SGR and pay for performance (P4P) are debated, the Academy will carry the message that a viable P4P system is incompatible with the continuation of the Sustainable Growth Rate (SGR).

Another reimbursement challenge is CMS’s policy on Medicare physician practice expenses (PE). While we were able to persuade CMS to halt a disastrous proposal for the calculation of PE last year, CMS will revisit the issue this year. The Academy will work to ensure that the new PE policy is fair to ophthalmology and that any PE calculation proposals are based on appropriate survey data.

The Academy elevated Children’s Vision Screening to a priority in response to an aggressive campaign waged by optometry and the eyeglass frame manufacturers to discredit screening of pre-Kindergarten and school age children in favor of complete eye examinations for all. We are partnering with pediatric ophthalmology, pediatricians and family physicians in this effort to bring about regular screening intervals and referrals for children identified in 18 states with no children’s vision requirements.

The issue of quality of patient care in federal health care facilities continues to be a critical issue for the Academy since its efforts to ensure surgery by surgeons in Veterans Affairs facilities. The disproportionately high rate of serious, often debilitating, eye injury and vision impairment suffered by veterans of Iraq and Afghanistan makes this priority all the more important to ophthalmology.