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6 | EYEWORLD DAILY NEWS | MAY 5, 2019 ASCRS NEWS ASCRS ASOA ANNUAL MEETING by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor mic Pharmaceutical Coalition to change the current CMS policy that bundles FDA-approved drugs that are administered during sur- gery and have a postoperative indi- cation into the facility payment. ASCRS is also finalizing a biparti- san Senate letter to CMS request- ing that FDA-approved drugs with a postoperative indication admin- istered during cataract surgery should be separately covered and paid under Medicare Part B. She noted that ASCRS ASOA and the medical community op- pose step therapy and mentioned a joint effort with the American Academy of Ophthalmology to advocate for more patient pro- tections to limit it solely to new prescriptions, expedite reviews, allow for exceptions, and provide additional patient information. ASCRS will continue to advocate for reduced regulatory burden by curbing the use of prior authoriza- tion and step therapy. Ms. McCann said to be aware of E/M documentation and reimbursement changes. ASCRS and the entire medical commu- nity opposed CMS' proposal to collapse E/M levels 2–5 and pay at one rate because the payment change would be arbitrary and not resource-based and would result in an estimated 4% cut for ophthal- mology. But CMS delayed imple- menting the code collapse in the final rule until 2021 to allow time for the COT/RUC to update the codes. There are some documen- tation changes that were finalized for 2019. For established patients, documentation can focus on what has changed since the last visit rather than re-entering informa- tion into the medical record, and for new or established patients, the physician is not required to redocument elements of the chief complaint and history already en- tered by ancillary staff or patients, but they must note that it has been reviewed. Editors' note: Ms. McCann has no relevant financial interests. postoperative indications, drug compounding, opposing step therapy for Part B and Part D drugs, and E/M documentation and payment. She also touched on the President's 2020 budget proposal, which "should concern every- one." They want to eliminate pass-through payments for drugs administered during surgery and include them in the facility payment. Facilities would have to absorb the cost of new drugs, Ms. McCann said, and it potentially limits patient access to innova- tive new drugs. They also want to modify the MIPS program to focus on problematic population health measures. Additionally, they want to cut payments for specialty services to redistribute to primary care. All proposals would require legislative action but provide insight to the administration's thinking. Ms. McCann also discussed separate payment for drugs ad- ministered during the procedure replacing postop medication. ASCRS is leading the effort in conjunction with the Ophthal- ASCRS. Ophthalmology was the most successful specialty in the first year of MIPS. Other accom- plishments that ASCRS led were: • Bipartisan Senate letter to CMS requesting separate payment for FDA-approved drugs administered during cataract surgery that have a postopera- tive indication • Removing ophthalmology from the FDA's Transplant Drug Di- vision to have its own dedicated division • Developed and released spe- cialty-specific guidelines for ophthalmic instrument cleaning and sterilization • Repeal of the Independent Pay- ment Advisory Board (IPAB) • Separate J-code for Photrexa (Avedro) drug formulations used in conjunction with corneal crosslinking What are the priority issues for ASCRS moving forward? These include maintaining a viable fee-for-service option, MACRA regulatory and legislative re- forms, regulatory relief, separate payment under Medicare Part B for FDA-approved drugs with O n Saturday morning, Nancey McCann, ASCRS ASOA director of Government Rela- tions, Fairfax, Virginia, gave a legislative and regulatory update on the impact of a new Congress on healthcare delivery and ophthal- mology. Ms. McCann began by talking about the current "split govern- ment." Republicans maintain a majority in the Senate, and in the Senate, you have to pass a motion to proceed in order to move leg- islation, which requires 60 votes. This "forces compromise" in the Senate, she said. Meanwhile, Dem- ocrats will now have the majority in the House, and the House only requires a simple majority to move legislation. Ms. McCann noted that there are several issues that she thinks will be considered in a bipartisan manner: drug pricing, reforms to the ACA (individual mandates, medical device tax, and protecting pre-existing conditions), and re- forms to Medicare and Medicaid. The Administration's priorities were also discussed, and she noted recommendations on "Reform- ing America's Healthcare System Through Choice and Competi- tion." They want to move away from fee-for-service, want more step therapy and prior authori- zation, want narrower networks, want to expand scope of practice, and want the elimination of cer- tification of need. The only good issue here is the elimination of certificate of need because many members are in states with these requirements and as a result, don't have access to ambulatory sur- gery centers, and they're forced to operate in the hospital outpatient facilities, she said. Ms. McCann also highlighted some recent accomplishments for Legislative and regulatory update Ms. McCann gives a legislative and regulatory update on Saturday morning.

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