October 13, 2025
5 min read
Key takeaways:
- Reform is needed in scope of practice, prior authorization and Medicare reimbursement.
- Ophthalmologists must engage with political leaders and educate the public about access to care.
To protect patients amid a changing health care landscape, ophthalmologists must be vocal with policymakers about the barriers that prevent patients from receiving proper care.
While the Big Beautiful Bill, which was signed into law in July, offers physicians a temporary pay increase to account for exceptional circumstances, Michael X. Repka, MD, MBA, president of the American Academy of Ophthalmology, told Healio that this is not enough to address issues with access to care caused by years of Medicare cuts.
Healio spoke with Repka about how ophthalmologists can push Washington to uphold surgical standards and strengthen access to care through reforms in Medicare reimbursement and prior authorization guardrails.
Healio: When looking at the health care agenda, what are the most important developments that ophthalmologists must know about?
Repka: In terms of policy, there are several big issues that the ophthalmology community is focused on this year: upholding safe surgery standards nationwide against encroachment from mid-level practitioners who lack the appropriate training to perform eye surgery, advocating for stricter prior authorization guardrails to protect patients, and educating lawmakers about the need for permanent Medicare reimbursement system reforms that ultimately strengthen patients’ access to quality care.
Healio: What are the barriers to upholding surgical standards?
Repka: Maintaining high standards for eye surgery should be a major priority for policymakers and patients. Most states allow only ophthalmologists to perform eye surgery, but unfortunately, some legislatures have debated passing laws that would allow optometrists to operate on patients after taking a single 32-hour class. This is dangerous for patients. A single course is insufficient training for safely using a laser, scalpel or needle on a patient’s eye or eyelid.
We know that some patients who live in states that allow optometric surgery have experienced irreparable harm. That is why the AAO maintains that only medical doctors with thousands of hours of experience and training and who know when surgery is medically necessary should be allowed to operate on patients’ eyes.
Fortunately, most scope of practice bills have been rejected this year, including in Vermont, Florida, North Dakota and Missouri. In vetoing dangerous scope expansion legislation, New Mexico Gov. Michelle Lujan Grisham wrote to legislators that she rejected loosening the scope of practice because “it sets a dangerous precedent for allowing non-surgeons to perform surgical procedures.” To the dismay of patient safety advocates, West Virginia and Montana enacted bills to expand the scope of practice this year, and we will continue to monitor the impact on patient care in those states.
Scope of practice expansion bills nationwide are troubling to the ophthalmological and medical communities because of the threat posed to patient safety and must be defeated. Most Americans agree. American Medical Association survey data show that 79% of Americans oppose allowing optometrists to perform eye surgeries. By a wide margin, Americans from both parties believe optometrists should not be allowed to perform eye surgeries given their education and training.
Finally, at the federal level, proposals allowing optometrists at the Department of Veterans Affairs (VA) to perform eye surgeries for which they are unqualified should be permanently shelved to protect veterans’ vision. Our veterans deserve better. While the VA has remained quiet this year about its plans for developing national standards of practice for optometrists and other health care providers, ophthalmologists and patient advocates remain vigilant for any changes that would lower veterans’ surgical eye care standards.
Healio: How can policymakers address issues with reimbursement for ophthalmologists?
Repka: Congress should work with the physician community to enact meaningful, long-term Medicare payment reform that is critical for the physicians who treat America’s nearly 70 million Medicare beneficiaries.
Medicare is undeniably on an unsustainable path. Each year, outdated regulations lead to physician reimbursement cuts, this year by 2.8%. On top of that, persistent inflation has increased the cost of providing care, paying staff, investing in new technology and covering rent. As a result, Medicare reimbursement to doctors, including ophthalmologists, is 33% lower than in 2001 when adjusted for inflation. The ongoing systemic problems with the Medicare physician payment system threaten beneficiaries’ access to physicians.
Lawmakers can correct this problem by establishing annual inflationary updates for ophthalmologists and other physicians that keep up with the cost of practicing medicine. The budget reconciliation package that was signed into law includes a small 1-year payment bump for physicians. While the AAO and physician community greatly appreciate Congress taking action to provide a temporary boost to Medicare payments for 2026, this increase will not adequately address the years of Medicare cuts that have left physician practices and patient access to care at serious risk. Ultimately, the Medicare physician payment system needs long-term reform to better meet the needs of patients and physicians.
Healio: How can the ophthalmology community encourage policy changes?
Repka: The ophthalmology community must continue to engage with our political leaders about the value we provide to patients every day. This means sharing our perspectives on issues like scope of practice, prior authorization, step therapy and Medicare cuts. As president of the AAO, I am proud that so many ophthalmologists are getting involved in advocacy. More of my colleagues across the country are writing to their representatives in Congress and in their local statehouses, coming to Washington, D.C., to participate in the academy’s Hill fly-ins, and making their voices heard in their local newspapers.
Healio: Can you discuss how AAO plans to work with Washington to improve access to care?
Repka: We need to keep up the pressure on our leaders in Congress to protect our patients and profession from insurance company overreach that delays and denies medically necessary patient care. We got close last year with our prior authorization reform bill. We are hopeful that this year could be the year it happens.
Our bipartisan Improving Seniors’ Timely Access to Care Act has wide support in Congress. This bill would streamline Medicare Advantage plans’ prior authorization decisions, increase transparency and ensure patient access to care. The AAO was encouraged to see this critical legislation reintroduced in both chambers of Congress earlier this year. The ophthalmology community is holding meetings with leaders in Washington and educating the public about the need to implement necessary guardrails to improve Americans’ access to care.
For more information:
Michael X. Repka, MD, MBA, can be reached at politicalaffairs@aao.org.
Sources/Disclosures
Source:
Healio Interviews
References:
- Calendar year (CY) 2025 Medicare physician fee schedule final rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-medicare-physician-fee-schedule-final-rule. Published Nov. 1, 2024. Accessed Sept. 17, 2025
- Differences in education between optometrists and ophthalmologists. https://www.aao.org/about/policies/differences-education-optometrists-ophthalmologists. Accessed Sept. 17, 2025.
- Focus on the VA Federal Supremacy Project. https://www.aao.org/young-ophthalmologists/yo-info/article/focus-on-the-va-federal-supremacy-project. Published Feb. 16, 2023. Accessed Sept. 17, 2025.
- Gearing up for laser and minor surgery: Advice from experts. https://www.reviewofoptometry.com/article/gearing-up-for-laser-and-minor-surgery-advice-from-experts. Published Dec. 15, 2022. Accessed Sept. 17, 2025.
- H.R.1 – One Big Beautiful Bill Act. https://www.congress.gov/bill/119th-congress/house-bill/1/text. Published July 4, 2025. Accessed Sept. 17, 2025.
- Medicare physician payment continues to fall further behind practice cost inflation. https://www.ama-assn.org/system/files/2025-medicare-updates-inflation-chart.pdf. Updated January 2025. Accessed Sept. 17, 2025.
- National survey: Patient sentiment on scope of practice. https://www.ama-assn.org/system/files/patient-sentiment-scope-practice-survey.pdf#_blank. Accessed Sept. 17, 2025.
- NM governor nixes new license plates, state bread, lobbying disclosure. https://www.newmexicopbs.org/productions/newmexicoinfocus/nm-governor-nixes-new-license-plates-state-bread-lobbying-disclosure/. Published April 14, 2025. Accessed Sept. 17, 2025.
- Rutledge: When eye surgery by optometrists goes wrong — my story. https://nhjournal.com/rutledge-when-eye-surgery-by-optometrists-goes-wrong-my-story/. Published May 2, 2024. Accessed Sept. 17, 2025.
- Warner, Marshall introduce bill to improve seniors’ access to care. https://www.warner.senate.gov/public/index.cfm/pressreleases?ID=83596652-1362-4307-90CC-B9C1D180E86D. Published May 20, 2025. Accessed Sept. 17, 2025.
Disclosures:
Repka reports being president of the American Academy of Ophthalmology.
