March 3, 2003

Thomas A. Scully
Administrator
Centers for Medicare and Medicaid Services Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Avenue
Room 445-G
Washington, DC 20201

Re: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2003 and Inclusion of Registered Nurses in the Personnel Provision of the Critical Access Hospital Emergency Services Requirement for Frontier Areas and Remote Locations; Final Rule; CMS-1204-FC

Dear Administrator Scully:

The American Society of Cataract and Refractive Surgery (ASCRS) appreciates the opportunity to submit comments on the final rule for the 2003 Medicare physician fee schedule.

ASCRS represents over 9,000 ophthalmologists in the United States and abroad who share a particular interest in cataract and refractive surgical care. ASCRS members perform the vast majority of cataract procedures done annually in the United States.

First, ASCRS would like to thank the Centers for Medicare and Medicaid Services (CMS) for publishing the final rule updating the physician fee schedule for 2003 on February 28, 2003, which revises the estimates used to establish the sustainable growth rates (SGRs) for fiscal years 1998 and 1999 for the purposes of determining future updates to the physician fee schedule. We greatly appreciate CMS taking this action in a timely manner, which resulted in an increase of 1.6% to the 2003 conversion factor. Without the prompt action by CMS following the enactment of Public Law 108-7 which gave CMS the authority to correct the 1998 and 1999 projection errors, physicians would have been faced with a 4.4% reduction to the conversion factor effective on March 1, 2003.

ASCRS also welcomes the opportunity to comment on the Clinical Practice Expert Panel (CPEP) data refinements for ophthalmology services as well as to request that CMS reverse its decision to include a behavioral offset to the 2003 practice expense relative value units (RVUs).

CPEP Data Refinements for Ophthalmology Services

ASCRS supported CMS’ proposal included in the June 28, 2002, proposed rule to adjust rank order anomalies in ophthalmology services. We were also pleased that in the final rule, the agency announced that commenters were supportive of the proposed revisions and that the changes will be finalized in the 2003 fee schedule. However, ASCRS was concerned to learn that the necessary changes were not made to the data used to determine the practice expense RVUs in the 2003 final rule. We therefore encourage CMS to make the necessary changes in the affected RVUs in the next update to the physician fee schedule.

These anomalies were created in three specific ophthalmology families of codes during refinement by the Practice Expense Advisory Committee when the CPEP data for only certain services in each family were considered. As a result, the more complex services in a family of codes are now paid less than a less complex service. The following changes to the CPEP were proposed and accepted by CMS and must now be reflected in the practice expense RVUs:

• CPT code 67820, Revise eyelashes - remove ophthane from the supply list.
• CPT code 67825, Revise eyelashes - remove the bipolar handpiece from the supply list.
• CPT code 65220, Removal of foreign body from eye - use supply list and clinical staff time assigned to CPT code 65222. The exam lane should be the only equipment assigned.
• CPT codes 92081 and 92083, Visual field examination(s) - assign the same supplies and equipment as CPT code 92082; assign 35 minutes of clinical staff time to 92081 and 70 minutes to 92083.

In addition, ASCRS strongly believes that these refinements must be redistributed in the ophthalmology specialty specific practice expense pool to improve the accuracy of the RVUs for other ophthalmology services. When related refinements were made to the 2002 fee schedule, practice expense RVUs increased for CPT codes 66821, after cataract laser surgery, and 66984, cataract surgery as noted on table 22 of the 2002 final rule published on November 1, 2001. We urge CMS to again redistribute any changes to the CPEP data in your next update to the 2003 fee schedule to ensure that these costs are not lost from the ophthalmology practice expense pool.

Behavioral Offset to Practice Expense RVUs

ASCRS is concerned that CMS included a behavioral offset to the practice expense RVUs, and we strongly encourage the agency to reverse this decision. Specifically, in the December 31, 2002, final rule, CMS states that it will impose a 0.49% reduction in all practice expense RVUs in 2003 to “account for an anticipated increase in the volume and intensity of services in response to payment reductions from the refinement of practice expense RVUs.” The final rule includes no further explanation or data to support this reduction in practice expense RVUs.

This reduction make no sense whatsoever as the resource-based practice expense RVUs were fully phased-in in 2002 and any changes likely as a result of refinements to the practice expense RVUs are largely within a specialty. ASCRS requests that CMS reverses this unwarranted reduction to the practice expense RVUs in the next update to the 2003 physician fee schedule.

ASCRS appreciates the opportunity to submit these comments to the 2003 Medicare physician fee schedule final rule and again would like to thank CMS for quickly acting to correct the 1998 and 1999 projection errors.

Specifically, we urge CMS to:

• implement and redistribute the CPEP data refinements for ophthalmology services
• reverse the decision to include a behavioral offset to the 2003 practice expense RVUs

Should you have any questions regarding these comments, please contact Pam Johnson, ASCRS Manager of Regulatory Affairs, at (703) 591-2220, or by e-mail at pjohnson@ascrs.org.

Sincerely, Marguerite B. McDonald, MD President