Optometrists, more than virtually any other type of health care professional, will benefit from newly announced technical changes in the Medicare fee-setting process that promises to boost their reimbursements 5 percent in 2010 - and more in the years to come, according to the AOA Advocacy Group.

The U.S. Centers for Medicare & Medicaid Services (CMS) confirmed Oct. 30 that, beginning next year, results from the American Medical Association (AMA)-led Physician Practice Information Survey will be included in the data used to set the Medicare Physician Reimbursement Fee Schedule.

"Optometrists are benefitting because the AOA worked extensively with the AMA to ensure optometry was included in the survey and worked extensively with the CMS to make sure they would accept survey results," said AOA Advocacy Group Director Jon Hymes.

"This is great news," AOA President Randolph Brooks, O.D., said.

Representing a joint effort of more than 70 health care profession organizations, the survey was conducted in 2007-08 to provide up-to-date information on health care practice expenses and related factors for the CMS and other health care policymakers, according to Hymes.

Prior to the survey, comprehensive practice data for many health care professions had not been compiled in a decade or more, according to the AOA.

In the case of some professions, it had never been compiled at all.

Survey data was shared with the CMS on March 31 of this year.

On Oct. 30, in announcing its 2010 Medicare fee schedule, the CMS announced that it was "adopting several refinements to Medicare payments to physicians which will improve payment rates for primary care services relative to other services."

As a result of those refinements, reimbursements to optometrists will be increased an average of 5 percent in 2010, according to the CMS.

That means if Medicare reimbursements overall were to increase an average of 1 percent next year, as they would under some pending congressional legislation (see related article), optometrists would see reimbursements increase a total of 6 percent.

The average 5 percent increase anticipated for optometrists is the biggest for any of the 54 specialties tracked by Medicare, Hymes reported.

The Medicare fee schedule is based on the Harvard-developed Resource-Based Relative Value Scale (RBRVS), which assigns theoretical values to health care procedures.

Expressed in relative value units (RVUs), the values are based on the work, malpractice risk, and expense involved in each procedure.

Medicare fees are determined by multiplying the total RVUs for a reimbursable procedure by a conversion factor (expressed in dollars).

The total RVUs for a procedure represent the total of separate work, malpractice and practice expense RVU assigned to the procedure.

Medicare fees are also adjusted slightly based on location.

Beginning with the 2010 Medicare fee schedule, the RVUs will be based at least in part on the results of the survey.

Survey data will be gradually introduced over four years, with 25 percent of the practice expense RVUs based on survey results in 2010; 50 percent in 2011; 75 percent in 2012; and 100 percent in 2013.

The transition will increase the RVUs for procedures performed in optometric practices by an average of 5 percent in 2010 - and increase them an average of 12 percent by 2013.

Percentage increases for individual eye care procedures will vary.

Work and malpractice RVUs associated with optometric procedures will both increase 1 percent in 2010.

Practice expense RVUs for optometrists will increase 3 percent in 2010 - and will have risen 10 percent by 2013.

Those increased RVUs will essentially mean additional Medicare revenues for optometrists, above and beyond what practitioners would have received had the RVUs not been adjusted.

Specifically, they will mean approximately an additional $25 million for optometrists in 2010; $42 million in 2011; $68 million in 2012; and $85 in 2013.

"That is approximately $220 million over the next four years," Hymes said. "The survey will continue to make payments $85 million higher than they would have been each year after that, until new data is collected." The exact increase in reimbursements an optometric practice may realize will depend on the mix of services provided in that practice, the AOA Advocacy Group notes.

Dmrkynetec, a survey firm with extensive experience in the area of physician practice finance, was retained by the AMA to administer the survey.

AOA Advocacy Group staff worked extensively with the AMA to develop survey content and ensure that an adequate number of optometric practices were included.

More than 100 optometrists took part in the survey, according to the AOA Advocacy Group.

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