News from the AOA's Blog

On Dec. 21, President Barack Obama signed into law a measure that prevents enactment of the scheduled 21.2 percent cut in Medicare physician reimbursement set to take effect Jan 1. 2010. The new law freezes Medicare physician rates for two months; however, the stop-gap measure will expire and impose massive Medicare payment cuts without AOA-backed corrective legislative action.

As the U.S. Senate continued work on health care reform legislation, President Obama signed into law the Fiscal Year 2010 Defense Department appropriations bill, which Congress gave prior approval to during a rare weekend session. The temporary fix expires on Mar. 1, 2010 and was attached to a spending bill that, in part, helps fund the wars in Iraq and Afghanistan.

Although the President did sign the bill into law, this approach does not end the uncertainty facing doctors, especially since it appears that Congressional leaders have decided to consider long-term Medicare physician payment reform separately from health care reform, notes the AOA Advocacy Group. Without permanent and lasting reform of the Medicare payment formula, ODs and other physicians face an overall cut of 40 percent by 2016.

Given the timing of the temporary fix, the Centers for Medicare & Medicaid Services (CMS) has instructed carriers to hold 2010 claims for the first 10 business days of January (January 1 through January 15) to ensure they are processed correctly. All claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures, CMS reports.

The AOA is already stepping-up efforts and working directly with leading members of Congress to prevent enactment of the 21.2 percent cut now scheduled to take effect on March 1, 2010. Work also continues to find an equitable and lasting replacement for the flawed Medicare Sustainable Growth Rate payment formula, which has mandated sizeable cuts in reimbursement levels over the last number of years.

At the same time, the AOA is also fighting a battle on another front to preserve a hard-won correction to the Medicare fee schedule and a better recognition of the value of eye care and practice expenses of ODs.

Early last month, CMS announced that the agency would move forward with plans to provide $288 million in additional payments to optometrists between 2010 and 2013.

As a result, the four-year Medicare payment boost to ODs will take effect as scheduled on Jan. 1, 2010 thanks to the updated practice expense survey data provided to CMS and AOA’s rapid response efforts. This result will mean a 5 percent boost in Medicare payments to ODs in 2010 as well as noticeable increases in future years.

It appears, for the time being, that the aggressive, multi-million dollar lobbying and media campaign launched by the medical specialty groups facing payment reductions has been effectively countered, and the improved Medicare payment structure remains in place, Advocacy Group staff noted.

Nevertheless, the opposing groups have made it clear that they intend to continue to try to invalidate or undermine the survey data as they seek relief in the new year, the staffer noted. Stay tuned for further updates as the AOA fights along side leading lawmakers to ensure fair treatment for ODs and patients.

Should the AOA prove successful in convincing Congress to prevent the 21 percent Medicare fee cut and persuade CMS to retain the repaired pay structure, Medicare participating optometrists will see the largest increase in fees of any Medicare specialty.