Problem of Basing Fees on the Medicare Schedule
fees with the "original discount healthcare plan"
is no way to run an optometric practice.
WALTER D. WEST, O.D., F.A.A.O., Chief Optometric Editor
we approach the end of 2005, many optometrists across the country can't wait to
get the new Medicare fee schedule so that they can raise their fees (egad!). If
this sound's familiar to you, please read on.
The long road
Optometry has invested countless hours visiting
with legislators and attending certification courses to qualify for the ability
to provide medical care in every state. In addition, we've invested thousands of
dollars in the pursuit of the expansion of optometry's scope of practice in all
50 states. Since April 1, 1987 optometry has enjoyed parity with medical doctors
within the Medicare system. This ability to participate in Medicare has perhaps
been one of the most important opportunities in optometry's entire history.
Yet, many optometrists don't appreciate
the advantages that participating in Medicare provides. Nor do they recognize that
Medicare fees are based on what the "original discount healthcare plan" is willing
to pay. For example, for the year of 2004, while optometrists were focused on getting
their fees up to the level designated by a conversion factor of 37.8975, the mean
conversion factor utilized by medical practitioners was approaching 68.0000.
What does this mean? It means that
optometrists who set their fees based on the Medicare fee schedule are placing a
value on their services that is 56% of what the vast majority of physicians believe
their time and expertise are worth.
It seems to me that for all the aggravation,
time and effort we put forth so that we could provide medical eye care and gain
parity under Medicare, we're selling ourselves short. Surely we didn't invest sizable
amounts of money and years of hard work just to demonstrate that we value our services
at almost half the amount as those of a medical practitioner.
A larger issue
So far I've limited my comments to Medicare but
there is a farther-reaching effect, which is potentially a larger issue relative
to optometric earnings. Setting fees only at the Medicare reimbursement level means
the optometrists who do so are leaving significant amounts of money on the table
every time they file a claim with many health insurance carriers that cover patients
who are not on Medicare.
Here's your wake-up call
This is not an attempt to encourage you to charge
any specific fees. But rather, it is a wake-up call to all those optometrists who
see Medicare fees as premium reimbursement instead of the discount reimbursement
that they are.
By the way, those of you who set your
fees based on the Medicare fee schedule, get ready to reduce your fees by about
4% beginning in 2006. That is, unless you and the other Part-B providers can get
together and convince your legislators in Congress to reconsider the 2006 budget
Happy New Year! OM
Optometric Management, Issue: December 2005