Of interest to ophthalmologists
There also are other issues that could find their way to the Hill that may pique the interest of ophthalmologists.
“There is a growing consensus that we need to separate the payment to the physician from the price of the drug,” Cohen said. “This includes the ASP Plus 6 or the ASP Plus 4.3. While we were open to that, it is of high risk, for ophthalmology in particular because of our high costs of dealing with complex biologics.”
Cohen said the FDA is proposing some new lighter manufacturing standards so that it would be easier for some traditional compounders to become the outsourcing facilities.
“We have some hope that this will give us a lot more options,” she said. Drug shortages also remain a challenge and Cohen said discussions are ongoing. “The FDA will tell you that they cannot make a manufacturer make the drug,” she said. “We are talking to other manufacturers trying to get others to make drugs that are in shortage.”
Cohen also cited continuing efforts for Evaluation and Management Code changes that would reduce the burdens on physicians to simplify documentation.
CMS set in motion, according to Cohen, a collapse of the current system of five levels of codes to just two codes. They also included a $12 add-on for certain specialties that supposedly see more complex patients, but they initially excluded ophthalmology from that list.
“We had to fight to get that changed,” she noted. “The good news is that they have decided to put off any collapse for a few years and are open to a different approach. They did give us the immediate documentation reduction.”
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Cathy Grealy Cohen, CAE, MHSA
P: 415/561.8500 E: [email protected]
This article was adapted from Ms. Cohen’s presentation at the American Glaucoma Society annual meeting. She has no financial interests to disclose.