As we reported several weeks ago, CMS is considering establishing a payment mechanism for office cataract surgery. Citing advancements in technology, patient convenience, flexibility in scheduling surgery, and, of course, lower Medicare expenditures, CMS states that “we believe that there are advantages for all parties to furnishing appropriate cataract surgery cases in the non-facility setting.” Click here for CMS Request for Information
WHAT WILL OOSS DO?
OOSS will be the only ophthalmology organization submitting formal comments to CMS strenuously objecting to the government providing financial incentives for cataract surgery to be performed in the office. In our view, the critical consideration is not cost savings or surgeon convenience, but rather, whether patient health and safety can be ensured in the essentially unregulated office environment.
WHAT CAN YOU, THE OOSS MEMBER, DO?
We are requesting that each OOSS facility submit comments to CMS by September 8, 2015, expressing your concerns about office cataract surgery. Your comments can be brief. They should reflect your experience as a surgeon, nurse or administrator performing in an ASC. The idea is to provide a reasoned argument for providing cataract surgery in settings that comply with rigorous federal and state requirements for patient health and safety. The following are ideas for what might be included in your comments:
- CMS suggests that “routine cases in patients with no comorbidities” could be performed in the office surgical suite. Describe your typical patient. Our recent OOSS survey indicated that virtually all (92% in the survey) of our facilities’ patients have 2 or more comorbidities with around half suffering with hypertension and cardiovascular disease. Less than 6% had no comorbidities. 60% are taking five or more medications and 84% are taking three or more. Only 10% of patients are under sixty years of age and 55% are over 70.
- Cataract patients are vulnerable and should be treated in an appropriately regulated environment to minimize complications like TASS, endophthalmitis, unplanned vitrectomies and serious systemic events. ASCs, like hospitals, are heavily regulated. Virtually all of our facilities are Medicare certified, 81% are state-licensed as ASCs, and over 85% are accredited by a CMS-approved organization. ASCs must comply with rigorous requirements for infection control, facilities and environment and equipment, life safety code, quality of care, agreements for transfer of patients to a hospital, anesthesia, governance, patient rights, to name a few.
- Regulation of office surgery at the state level is non-existent at worst and inadequate and inconsistent at best. Only about half of the states license office surgical facilities, typically for non-sterile procedures such as pain management, plastics, and GI surgery and only a few even require inspections. In order to ensure patient health and safety, any facility that is conducting sterile intraocular procedures – hospital, ASC, or office – should be subject to rigorous standards like those required for Medicare certification or accreditation as an ASC.
- CMS should not provide payment incentives for physicians to perform surgery in any facility that does not meet Medicare ASC Conditions for Coverage. Nor should the agency implement such a program before it has been subject to trials or demonstration projects involving a limited number of patients.
HOW DO I SUBMIT COMMENTS TO CMS?
I recommend that you submit comments electronically to CMS. Go to this link: Comment to CMS. Paste in your comment and follow the submission instructions. Comments must be submitted by 5:00pm (EDT) on Tuesday, September 8.
Your comments are a vital component of our campaign to ensure that our patients are treated in the appropriate surgical environment. Please submit your views to CMS. Should you have any questions, please contact Michael Romansky, OOSS WashingtonCounsel, at mromansky@OOSS.org.