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1990s–2000s SUPPLEMENT TO EYEWORLD | 35 expense component of RBRVS was implemented, Con- gress instructed CMS to phase in the cuts over a 4-year period. e practice expense changes had the greatest negative impact on ophthalmolog y, as ophthalmolog y is an intensive specialty with expensive equipment and high overhead costs, Ms. McCann said. "In addition, the surgical and specialty medical community were opposed to the accounting methodolog y CMS initially used to calculate the practice expense values, which is why we formed the Practice Expense Coalition," she said. e coalition was successful in working with key members of Congress to pass and enact legislation that mandated the correct accounting methodolog y, and though practice expenses for these codes still went down, it was much less than it would have been without this advocacy. Efforts to fight reimbursement cuts and get information to members are paramount objectives for the ASCRS Government Relations department. "We engage ophthalmologists in grassroots efforts and partner with like-minded surgical and specialty coalitions, as well as encouraging ASCRS members to develop relationships with their members of Congress, focusing on those members of Congress serving on key healthcare-related committees with jurisdiction over Medicare," Ms. McCann said. As a result of RBRVS and the current Medicare phy- sician payment policy, ophthalmolog y and specialty care have faced reductions nearly every year. "However, ASCRS has been successful, working with the AMA and coalitions, such as the Alliance of Specialty Med- icine and the Surgical Coalition, in getting Congress to intervene and prevent, delay, or minimize the cuts," Ms. McCann said. ASCRS continues to work together with the medical community in an effort to reform the Medicare physician payment system so physicians are appropriately reimbursed for the care they provide to their patients. When Ms. McCann started with ASCRS, Bill Clin- ton, president at the time, was focused on healthcare reform. Physicians were beginning to get more involved in healthcare efforts from an advocacy standpoint. In particular, there was a proliferation of managed care plans at the time, limiting a patient's access to a specialist. As a result, the Patient Access Coalition, which included more than 100 physician and patient advocate groups, was formed and Ms. McCann became co-chair. e coa- lition worked with a bipartisan group of representatives and senators. Legislation requiring all plans to include an out-of-network option was introduced in both bod- ies. When George W. Bush became president, he was also interested in healthcare issues, and in particular, in the managed care issue and the legislation being consid- ered, which led to Ms. McCann, ASCRS members, and other specialty society representatives being invited to the White House to meet with him, including Priscil- la Arnold, MD, 2004–2005 ASCRS President, chair of the Government Relations Committee at the time. Working through threats of reimbursement cuts has been an ongoing effort for the ASCRS Government Relations department. While the surgical community and primary care can oen be at odds with these issues, Ms. McCann said that the Medicare sustainable growth rate (SGR) formula, which was an expenditure target in- cluded in the RBRVS system, was one area where both the surgical community and primary care were impact- ed. All physicians were facing significant reductions up to 25% as a result, and Congress had to intervene every year to prevent the cuts. It took 12 years to repeal it with the entire medical community working together. When MACRA and the Quality Payment Program essentially replaced the SGR, the ASCRS Govern- ment Relations department worked overtime to help members of both ASCRS and ASOA understand the program, including the different components. Ophthal- molog y has one of the highest specialty success rates in the program. Dr. Arnold, along with ASCRS and other specialty society representatives, was invited to the White House to meet with President Bush. Source: Priscilla Arnold, MD

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