Advocacy & Practice Updates — Advocacy & Practice

ASRS Cautions Patients Against Making Treatment Decisions Based Solely on CMS Payment Data

The American Society of Retina Specialists (ASRS) supports the Centers for Medicare and Medicaid Services' (CMS) efforts to make the Medicare program more patient-centered, transparent and competitive. We believe, however, releasing physician payment data without adequate tools to interpret it has the potential of misleading patients into making inappropriate and potentially harmful treatment decisions. 

At the very least, patients need to receive information about fixed costs of care, particularly Medicare Part B covered drug costs. In the case of retina specialists, these drugs are essential for treating patients with retinal diseases and preventing blindness. 

Retina specialists effectively utilize highly advanced, sophisticated technology for diagnostic testing and treatment and use expensive pharmacologic agents. Because the reimbursement data will not reflect the substantial expenses associated with operating a retina specialist clinic, ASRS is concerned that the claims data alone will offer a distorted view of the revenue generated by retina specialist practices.   

To fully appreciate the costs of care, patients need guidance on how to interpret the data to take into account the fixed cost of care, such as Medicare Part B drugs and imaging equipment, as well as patient demographics and the complexity of care. 

For example, retina specialists must purchase on behalf of the patient and then be paid by CMS for high-cost, FDA-approved anti-VEGF drugs used to treat wet age-related macular degeneration (AMD), macular edema following retinal vein occlusion and diabetic macular edema (DME).

Patient factors also must be taken into consideration. The complexity of the typical diabetic patient seen by a retina specialist will be greater than the typical diabetic patient seen by a general ophthalmologist, so utilization of imaging such as optical coherence tomography, as well as laser treatments and other costly services, will be justifiably higher.

It requires more information than is being released by CMS to compare the cost of a retina specialist treating diabetic retinopathy in an affluent suburb, where patients have reasonably good glucose control, with the cost of another retina specialist who practices in a predominantly lower-income, urban locale where patients have poor glucose control and many missed appointments.

The American Society of Retina Specialists is the premier international medical specialty society for ophthalmologists who have completed a retinal fellowship, with more than 2,500 members. The mission of the ASRS is to provide a collegial, open forum for education, to advance the understanding and treatment of vitreoretinal diseases, and to enhance the ability of its members to provide the highest quality of patient care.

Updated: April 8, 2014