Medicare files

What new Medicare data means for ODs

Optometrists who serve Medicare patients take note: Patients now have access to a large data set that might include what Medicare services and procedures you got paid for in 2012—and the amounts.

"America's doctors of optometry have been caring for the aging eyes of our seniors for nearly three decades as physicians under Medicare."

The Centers for Medicare and Medicaid Services (CMS) released this data set on April 9 to increase transparency and inform the public about which services doctors provided under Medicare. The data had been withheld for decades due to a court order, but the order was lifted in 2013.

The information covers more than 880,000 health care professionals who received $77 billion in payments for Medicare Part B services in 2012. An AOA analysis shows that the data includes services provided by 25,509 ODs, who collectively received $680 million for the care they provided.

Consumers who access this data can make comparisons by Medicare physician specialty, types of medical services and procedures, submitted charges, and total reimbursement, according to a CMS press release.

The AOA encourages members to look up their numbers in the data so they can find out what the public sees. Be prepared to discuss those numbers with patients. CMS indicates that the information comes from claims data.  If you feel your number is incorrect, contact your Medicare contractor and notify the AOA of the problem via Kara Webb at  

In the meantime, know the limitations of this data.  

1. It's not complete

The information does not include all expenditures. CMS excluded some data, specifically services provided to fewer than 11 patients in 2012. This means ODs were probably paid more than $680 million; other data show that they were paid around $1 billion in 2012 overall.

In general, OD Medicare payments have been on the rise, mainly because the amount of services and the payments per service are increasing. ODs have been caring for "the aging eyes of our seniors for nearly three decades as physicians under Medicare," says AOA President Mitchell T. Munson, O.D. In 2014, AOA expects Medicare will pay ODs more than $1.1 billion.

2. Doctors don't set payment rates

The amount ODs get paid is not the amount they charge, but the amount they've agreed to accept from an insurance company—which is usually lower than the charges.  

Patients may view the new data and think doctors are charging too much. In fact, federal regulators under Medicare's fee schedule formula are responsible for setting the payments.

3. There are inconsistencies across regions

Some geographic considerations apply. The information only reflects a partial set of physician practice data, which can limit doctor-to-doctor comparisons. Payment amounts can vary by site of service or geographic location—as can standards of care, coverage, and coding and billing rules.

Health status determines the type and level of services provided and billed; yet the data provide no information on how healthy or sick the patients were.

4. It doesn't reflect quality

Patients should know that the new data doesn't reflect quality of services or procedures.

Dr. Munson observes that ODs have been taking steps to align their practices and patient care protocols with health care reform initiatives, which place an emphasis on quality.

As CMS statistics show, the profession has embraced the Affordable Care Act with its "robust implementation of electronic health records, e-prescribing, and participation" in the Physician Quality Reporting System, he says. 

April 17, 2014

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