Advocacy & Practice Updates — Advocacy & Practice
ASRS, Ophthalmic Societies Press for Access to Retina Surgery in Comments on 2027 ASC/HOPD Proposed Rule
This week, ASRS joined with the Ophthalmic Outpatient Surgery Society (OOS), AAO and ASCRS in joint comments on the 2027 Outpatient Prospective Payment and ASC proposed rule. In our comments, we expressed concern that CMS did not address the national trend of reduced ASC access to retina surgery despite acknowledging the growing crisis in the final 2026 OPPS/ASC payment rule. While the proposed rule will provide a modest payment increase for retina cases performed in the HOPD, reimbursement for the same surgeries in the ASC will be further cut due to budget neutrality rules. We argue that ASCs cannot afford to allocate time to retina procedures, particularly emergency surgeries, when they are losing several hundred dollars per case. And, when community-based ASCs are unable to provide emergency ophthalmic care, patients are forced to travel significant distances to academic centers—that are already overwhelmed—to receive care.
As a remedy to this situation, we continue to recommend CMS implement an ophthalmic emergency activation (OEA) code system that would reimburse facilities for the additional resources required to provide emergency retinal care in community-based facilities. ASRS continues to advocate separately to CMS and Congress for this policy as well.
Beyond retina OR access, the comment letter reiterates the shared concerns of the groups that budget neutrality methodologies CMS uses to calculate ASC payment rates are contributing to inadequate reimbursement in general. This situation risks more access challenges in community-based facilities that are more cost-efficient for Medicare and beneficiaries. The final rule is expected to be released in early November.
(Published 9.1.26)