Medicare payments increase by 75% in 10 years

March 19, 2015
Doctors of optometry will get paid $1.163 billion by Medicare in 2015

The increase “demonstrates how successful we’ve been in educating policymakers and eliminating barriers.”

Doctors of optometry who participate in Medicare will get paid slightly more for some services in 2015 and experience some decreases for others. The good news is that Medicare payments continue to rise on a cumulative basis, thanks to AOA's ongoing advocacy efforts.

AOA, in reviewing data from the Centers for Medicare and Medicaid Services, reports that Medicare will pay doctors of optometry approximately $1.163 billion in 2015. This is a slight increase over 2014's estimate of $1.116 billion.

Medicare payments to doctors of optometry have risen steadily over the past decade—by at least 75%—despite fluctuations in reimbursement for individual services.

The increase "demonstrates how successful we've been in educating policymakers and eliminating barriers," says AOA President David A. Cockrell, O.D. "Fighting to safeguard our physician status in Medicare and ensuring that doctors of optometry and our patients are treated fairly is a basic AOA member benefit."

By comparison, Medicare payments to ophthalmologists have increased 24% over the same time period.

"The fact that optometrists bill many more evaluation/management service codes and eye examination codes and many fewer eye surgical codes is the primary reason for the large increase in payments to our profession in comparison to ophthalmology," says Charles Fitzpatrick, O.D. The New Jersey-based optometrist is AOA's optometry delegate to the American Medical Association's Specialty Societies Relative Value Scale Update Committee.

2015 yields some increases, decreases

As is the case with any given year, doctors of optometry in 2015 will experience decreases in some Medicare services and increases in others.

Changes for 2015 include:

  • 3.3% increase in the code for dark adaptation eye exam.
  • 1.3% increase in the code for the highest level office visit for an established patient.
  • 2.7% decrease in the code for removal of a foreign body from the eye.
  • 8.0% decrease in the code for electroretinography.

CMS also had to reduce by 1% the malpractice relative value units (RVUs) used for optometry. This was to correct a mistake the agency made in calculating these RVUs over the past five years.

AOA doesn't expect a huge impact from this change. "The malpractice component accounts for only about 4% of the total relative value for each service, so the impact on many services that optometrists provide is relatively low," according to AOA's analysis.

Any reduction to Medicare's sustainable growth rate (SGR) formula is another factor that could affect payments to doctors of optometry this year. AOA is calling on members to attend its Congressional Advocacy Conference in April and fight for SGR reform.

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