Here are seven key points:
1. Healthcare policy experts report presidential candidates’ bold healthcare plans won’t come to pass, in full. They argue Congress will not repeal the Affordable Care Act or institute a single-payer model.
2. However, Republicans and Democrats have reached across the aisle to pass the Medicare Access and CHIP Reauthorization Act of 2015, which will impact ophthalmologists as MACRA rewards physicians for good patient outcomes.
3. In 2019, CMS will introduce the Merit-Based Incentive Payment System which will score physicians based on quality, resource use, clinical practice improvement and meaningful use of electronic health records.
4. MIPS may negatively impact ophthalmologists if no outlined distinctions among types of patients and types of treated conditions exist. Retina physicians, for example, utilize more resources because of expensive drugs.
5. Ophthalmologists may opt to participate in accountable care organizations under MACRA, instead. However, experts argue this model is designed for primary care physicians instead of specialists.
6. Ophthalmologists will also experience the effects of Medicare Part B drug reimbursement rules, specifically when prescribing bevacizumab, ranibizumab and aflibercept.
7. CMS plans to assign providers in certain zip codes a drug’s average sales price plus 2.5 percent plus $16.80. The idea is to encourage physicians to use less-expensive drugs, which won’t bode well for retina specialties, as they use drugs costing about $2,000 per dose, and will probably lose out on money.
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