This month, the Centers for Medicare and Medicaid Services (CMS) has released the 2020 Medicare Physician Fee Schedule final rule, which includes the proposed drop in payments for cataract surgery.

The final work relative value unit (RVU) for complex cataracts 66982 is 10.25, compared to the current Work RVU of 11.08, a $47 reduction. For non-complicated cataracts 66984, the proposed Work RVU is 7.35, compared to the current 8.52, a $97 reduction.

Improved technology in hands of a skilled ophthalmic surgery care team have created efficiencies and, ultimately, a reduction in time. The decrease in valuation is directly connected to the decreasing time ophthalmologists spend in the surgery room and the decreased time spent on post-operative visits (especially the less frequent, fourth post-operative visit).

The American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS), meanwhile, have lobbied for a less dramatic decrease in reimbursements by highlighting on the other part of the RVU’s formula: intensity and complexity.

Cataract surgery is a complex procedure with irrefutable, life-changing outcomes.

So, what advice are the experts giving to blunt the decrease in Medicare/Medicaid reimbursements?

• Ophthalmic surgery teams should pay their dues and become more active with their professional societies. Ongoing collaboration with OAS, AAO, ASCRS, and the American Society of Ophthalmic Administrators will empower these organizations to ensure we are represented whenever RVUs are considered. RVUs are determined by a special committee formed by the American Medical Association (AMA), known as the AMA/Specialty Society RVS Update Committee. We need seats at their table!
• Reevaluate your cases. It may be prudent to audit charts more judiciously, confirm that visual criteria are clearly defined and each patient truly needs cataract surgery.
• Streamline services and diversify, where appropriate. Some patients may benefit by undergoing other procedures in conjunction with cataract surgery: glaucoma techniques, femto-LASIK surgery, multifocal lens implants, etc.  
• Continue developing relationships with your patients and delivering quality care. The reason ophthalmic surgery procedures weren’t cut as dramatically as we feared is because there is tremendous value to the care we provide. Our skills, the quality of our care and our outcomes are a factor when considering the intensity and complexity in valuation discussions.

Learn more:

https://www.federalregister.gov/documents/2019/11/15/2019-24086/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other

http://ascrs.org/2020-medicare-physician-fee-schedule-mpfs-proposed-rule

https://www.aao.org/eyenet/article/cataract-surgery-payment-in-medicare?september-2019

https://asoa.org/news/ascrs-special-report-key-information-about-2020-medicare-physician-fee-schedule-proposed-rule

https://www.reviewofophthalmology.com/article/medicare-proposes-another-cut-in-cataract-reimbursement