Medicare payments increase by 75 percent in 10 years

Medicare payments increase by 75 percent in 10 years

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

Optometrists 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 optometrists approximately $1.163 billion in 2015. This is a slight increase over 2014's estimate of $1.116 billion.

Medicare payments to ODs have risen steadily over the past decade—by at least 75 percent—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 ODs and our patients are treated fairly is a basic AOA member benefit."

By comparison, Medicare payments to ophthalmologists have increased 24 percent 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, ODs in 2015 will experience decreases in some Medicare services and increases in others.

Changes for 2015 include:

  • 3.3 percent increase in the code for dark adaptation eye exam;

  • 1.3 percent increase in the code for the highest level office visit for an established patient;

  • 2.7 percent decrease in the code for removal of a foreign body from the eye; and

  • 8.0 percent decrease in the code for electroretinography.

CMS also had to reduce by 1 percent 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 percent 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 ODs this year. AOA is calling on members to attend its Congressional Advocacy Conference in April and fight for SGR reform.

March 19, 2015

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