Eyeworld Daily News

EW SHOW DAILY 14 ASCRS News Monday, April 16, 2018 by Ellen Stodola EyeWorld Senior Staff Writer Legislative and regulatory update highlights accomplishments and ongoing issues O n Sunday morning, Nancey McCann, ASCRS director of government relations, and Allison Madson, ASCRS manager of regulatory affairs, Fairfax, Virgin- ia, gave a legislative and regulatory update, highlighting issues impact- ing ophthalmology. Ms. McCann spoke about some of the key ASCRS•ASOA legislative accomplishments. These include a continued transition period for the quality payment program (MACRA) and additional program reforms; legisla- tion to extend the transition period for 3 additional years, keep the Cost category from going up to 30% in 2019, and exclusion of Part B drugs; repeal of IPAB; a 2-year delay of the Medical Device Tax; and pass- through status extended for 2 years for drugs that went off pass-through on Dec. 31, 2017. Ms. McCann went into more detail on some of these accomplish- ments and the budget package key provisions. There are a series of MACRA technical corrections: CMS authority to extend the MIPS transition period for an additional 3 years; CMS authority to continue to weigh the Cost category at less than 30% for 3 additional years; and exclusion of Medicare Part B drugs from MIPS eli- gibility determinations and payment adjustments. "We think there needs to con- tinue to be this transition as phy- sicians continue to get used to it," Ms. McCann said. She stressed that ophthalmology was the most suc- cessful specialty in terms of MIPS in the first year. The specialty has the most measures and has also done a lot with education. She added that the Cost category is problematic, and she thinks CMS recognizes that. They determined in the first year it was 0%, and for the second year, it went up to 10% (which helps physi- cians get used to it). In terms of IPAB repeal, Ms. McCann said this was an issue that was worked on with the entire medical community, as well as a lot of consumer groups. The 2-year complishments, including accom- plishments in regulatory relief, drug compounding, efforts with the FDA, and ophthalmic cleaning and steril- ization guidelines. Ms. McCann stressed that there were accommodations particularly for small practices with MIPS, which is important because many ASCRS members are part of small practices (15 or fewer). These small practice considerations included a 5-point MIPS bonus, an Advancing Care In- formation hardship exemption, and Quality and Improvement Activities category scoring accommodating. She discussed the reorganization of the FDA Transplant and Ophthal- mic Drug Division and noted ongo- ing priority regulatory issues. "We're going to continue to advocate for regulatory relief to alleviate financial and administrative burden," she said. She noted leading the Oph- thalmic Pharmaceutical Coalition regarding the issue of bundled drugs in the facility payment, requesting that CMS change the current policy so that FDA-approved drugs that have a postoperative indication and are administered during the proce- dure are paid for separately under Part B. Other ongoing issues are con- tinuing to advocate for extending pass-through status for 5 years to all new drugs, monitoring regulations to protect physicians and patients from abusive practices by contact lens retailers, and continuing to ad- vocate for lifting restrictions on the dissemination of off-label informa- tion to ensure open lines of commu- nication between manufacturers and practitioners. She again stressed the efforts in ophthalmic cleaning and sterilization guidelines, which is a huge issue. ASCRS led the effort to develop specific guidelines for clean- ing and sterilization of ophthalmic instruments, she said. EW Editors' note: Ms. McCann has no financial interests related to her comments. Ms. McCann gives a legislative and regulatory update. delay of the medical device tax was included in the ACA, she said, but "we've been able to delay that over the years." In lieu of the extension of the misvalued code provision, Ms. McCann said the reduction in the MACRA update for 2019 will now be 0.25% rather than 0.5%. She added that the extension of the 2% sequestration cuts through 2017 is "probably here to stay." Ms. McCann mentioned some ongoing legislative issues. "Regula- tory relief is a hot item right now on Capitol Hill," she said, highlight- ing several recent efforts on this, including participating in the Ways and Means Committee "Cut the Red Tape" Effort, as well as a private meeting with Health Subcommittee Chairman Peter Roskam (R-IL) with the Alliance of Specialty Medicine. Another issue is working with the medical community to modify the Drug Quality and Security Act to allow physicians immediate access to obtain compounded medications for office-use from traditional 503A compounders, as opposed to out- sourcing facilities. One important ongoing issue Ms. McCann highlighted is pre- serving a viable Medicare fee-for- service option, which she said is "going to be the number one issue in coming years." A recent MedPAC proposal recommends eliminating MIPS, which would force physicians into APMs or to join virtual groups measured on problematic "popu- lation health" measures. "This is primary care focused, and they have to understand that we're not all in the same bucket," Ms. McCann said. Alex Azar, the new HHS secretary, is prioritizing moving physicians out of fee-for-service to value-based payment models. ASCRS and the Al- liance of Specialty Medicine oppose efforts to eliminate fee-for-service, particularly because there are few options for specialty participation in APMs, there are no ophthalmology specific APMs, and ophthalmologists and other specialists do not coor- dinate care with other providers, so they may not be well-suited to APMs. There have also been a number of key ASCRS•ASOA regulatory ac-

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