NANOSNET

Dear US NANOS members,

This is an unprecedented time for healthcare in the United States as many large policy changes are shaping the future of medicine and our profession as neuro-ophthalmologists.  With the support of the NANOS Executive Board, our advocacy committee wants you to help share your concerns where they count.  There are 2 items we are asking you to voice your concern to your congressional members ASAP. Please share personal stories on how it may impact your practice with your local and congressional leaders, how important these NEI funded programs are in the community to protect vision AND how the CMS proposals would harm your practice:

1. The NEI is at risk of a drastic funding cut (from $6.5 million to $4.5).
1. For AAO members, please use this link: to Act Now: Help Preserve an Independent National Eye Institute and Protect Vision Research.  
2.  CMS proposed 2026 Medicare Physician Fee Schedule (MPFS)-comments are due by 5 p.m. ET Friday, Sept. 12: 
1. for AAO members: ACT NOW: You Can Fight Unfair Policies in Proposed Physician Fee Schedule and submit this prewritten comment to Centers for Medicare & Medicaid Services (CMS).
3. For non-AAO members, you can still share your comments with your representatives using any method of your choice.  Here are a few resources to easily reach your congressional members:
1. To look up who your representatives are: http://www.house.gov/representatives/find-your-representative
2. To write to them: https://democracy.io/?utm_source=perplexity#!/
3. Or contact all members of Congress by other means:

• By phone: (202) 224-3121
• By email: Congress.gov
• By US mail: Representatives / Senators
• By fax: Representatives / Senators

The issues in more detail: 

1. NEI issue: NANOS supports the American Academy of Ophthalmology in sending a letter to the Senate Appropriations Committee regarding a proposed cut of $2 million from a $6.5 million budget for the Center for Disease Control and Prevention's Vision Health Initiative, which was part of the Passage of the "Labor, Health and Human Services, Education, and Related Agencies Appropriations Act" (see S. 2587).  If the funding is cut to $4.5 million, the work that they do in surveillance, research, education and advocacy for preventing vision disability would be in jeopardy.  

2. Here is CMS's 2026 Medicare Physician Fee Schedule proposal  https://public-inspection.federalregister.gov/2025-13271.pdf highlighting our concerns:

• Physician Fee Schedule Adjustments: CMS proposes a 2.5% reduction to work relative value units (RVUs) for non-time-based procedures, citing concerns about inflated payment rates from unreliable survey data. Evaluation and management services, care management, and telehealth are exempt from this adjustment.

• Practice Expense Overhaul: CMS rejects updated American Medical Association (AMA) survey data for practice expenses, instead proposing use of hospital cost data and indirect cost allocations to reflect the shift from private practice to hospital employment. **This is concerning that could drive down reimbursement for surgeons and services provided in a facility setting.  Practice expense RVU components are being reallocated from the facility setting to non-facility (office) service. The biggest impact will be to providers working mostly or exclusively in the facility settings (eg academic departments).

• Telehealth Policy Changes: The rule makes several pandemic-era telehealth flexibilities permanent, enables virtual direct supervision via audio-video technology for most services, but ends teaching physician virtual presence for resident supervision in metropolitan areas after December 31, 2025.  **Note that telehealth is also due to expire 9/30/25 unless congress acts to extend this measure.  Congress returned from recess 9/2/25 and if Congress does not act to extend this, neuro-ophthalmologists will experience the expiration of telemedicine.

1. 2026 Medicare Physician Fee Schedule Proposed Rule Summary
    
2. CMS Proposes Problematic -2.5% Efficiency Adjustment for 2026
    
3. CMS Proposes Misguided Practice Expense Reductions in Draft 2026 Physician Fee Schedule
    
4. CMS Cuts Rock Ophthalmology and Medicine (Experts InSight Podcast)