Six percent cuts place financial burden on ophthalmology practices, jeopardizing timely access to care.

On Dec. 1, the Centers for Medicare & Medicaid Services (CMS) released its final physician fee schedule for 2021. Despite outcry from the American Academy of Ophthalmology and other surgical specialties, CMS' final 2021 Physician Fee Schedule policy on evaluation and management/office (E/M) visits still results in an overall cut of six percent to ophthalmology.

The cut is a result of the significant boost to the E/M code values and the creation of a new add-on code in a budget-neutral environment (i.e., all codes are paying for the increase to office visits). Increases in these E/M payments will not be applied to post-operative visits surgeons provide in the global surgical payment. Giving equity to the E/M in the global surgical payments could have softened the impact to surgical codes but CMS refused to do so. As a result, these cuts will deal a substantial blow to ophthalmologists. CMS' unwillingness to provide equity to surgical specialties after an outcry from surgeons and the American Medical Association is an affront to providers.

CMS' decisions in the 2021 Physician Fee Schedule threaten ophthalmologists' financial viability and our ability to run a successful ophthalmology practice. These cuts are even more devastating during an extremely financially stressful time due to the COVID-19 pandemic.

"Our practice has already suffered greatly this year, and this final rule adds salt to the wound. It appears that CMS is tone deaf to the plight of private surgical practices," said John T. McAllister, M.D, a cataract surgeon who operates the Northern Virginia Ophthalmology Associates with 14 physicians and surgeons. "Even despite congressional and CMS efforts to help us through the pandemic earlier this year, physicians in my practice have needed to take severe self-imposed salary cuts for most of 2020 in order to have the resources necessary to care for our patients. We all voluntarily took a 50 percent pay cut for almost half of the year and worked at 75 percent for months afterwards. At the same time, each of our physicians have families to feed and care for.

Ophthalmology practices are just returning to our pre-pandemic clinical or surgical volumes but may face setbacks with current surges in COVID-19 cases in some parts of the country. If these cuts are allowed to take effect, patient care will be compromised. The final rule may likely force ophthalmologists to restructure our practices and take fewer Medicare patients, leading to longer wait times and reduced access to care for older Americans. It may also force more ophthalmologists, who already have the highest overhead in medicine, to back out of Medicare participation entirely

"The COVID-19 crisis has placed severe economic strain on my practice and my ability to maintain four employees while caring for our vision impaired geriatric population. The early CMS shut down, followed by a gradual return to clinical visits in an entirely new reconfigured office, has drastically limited my ability to practice," said Dr. Daniel Briceland, a cataract surgeon who runs a small private group practice in Arizona. "Further CMS cuts will severely impact our already strained practice's economic recovery with the potential risk of practice closures and loss of employees."

The Academy continues to work with partner societies and the American College of Surgeons to press Congress to stop the finalized drastic cuts to ophthalmologists and other surgeons before implementation.

For more information on how this fee proposal will affect ophthalmologists and the patients they serve, visit AAO.org

The American Academy of Ophthalmology is the world's largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org.