CMS Rejects Facility Reimbursement for Cataract and Other Ophthalmic Procedures in OBS

On November 1, the Center for Medicare and Medicaid Services (CMS) issued its final Medicare Fee Schedule/Physician Payment rule.  In a victory for our patients and our ASCs, CMS soundly rejected a proposal by promoters of office surgery to make facility payments for office cataract and other ophthalmic surgeries.

CMS makes reference to concerns raised by OOSS and other ophthalmology and ASC organizations about office surgery regarding infection controls. anesthesia, equipment quality and maintenance, management of patient complications, staff and surgeon experience, and the paucity of independent and peer-reviewed data supporting safety in the OBS.

OOSS has absolutely and unequivocally opposed payment for office cataract surgery since CMS first considered implementing such a program in 2015.  

• With other ophthalmology and ASC organizations, OOSS has raised our patient health and safety concerns with federal health policy makers, including a meeting with the Office of Management and Budget and CMS two weeks ago.
• We developed a comprehensive comparison of Medicare ASC requirements vs office surgery standards, leading to the conclusion that patient health and safety is potentially compromised in the office setting.
• OOSS submitted comments to CMS objecting to office cataract surgery reimbursement.  Kudos to the many OOSS members who submitted individual comments to the agency.
• OOSS conducted a comprehensive survey with input from hundreds of ophthalmic ASCs regarding the comorbidities associated with cataract patients, the results of which highlighted the need for application of rigorous patient health and safety standards, such as anesthesia and nursing care and emergency capabilities and hospital transfer arrangements. Such mandates do not generally apply of the unregulated office surgical suite. 

Where do we go from here?  We can expect promoters of office ophthalmic surgery to continue to press for facility reimbursement for cataract, retina, and glaucoma surgical services.  The final rule provides a modest respite from CMS activity in this regard.  We would expect that the earliest reconsideration of this issue by the government would be the next Relative Value Update Committee review, which commences in 2025 for payment determinations in 2027.  

OOSS will continue to be vigilant in protecting our patients and will keep you abreast of all further developments.

Should you have any questions, please contact Michael Romansky JD, OOSS Washington Counsel, at mromansky@OOSS.org.