News from the AOA's Blog

Optometrists across America earned a total of $4 million in bonuses through Medicare incentive programs during 2009, according to a report issued last month by the U.S. Centers for Medicare & Medicaid Services (CMS).

Optometry ranked among the top 10 physician specialties for participation in both the Medicare Physician Quality Reporting System (PQRS) and Medicare e-Prescribing (e-Rx) Incentive Program, according to the report.

“Clearly, optometrists are embracing Medicare incentive programs as a means of increasing practice revenues and objectively demonstrating the delivery of high-quality, state-of-the-art care,” said AOA President Joe Ellis, O.D.

“In addition, by implementing e-prescribing and PQRS quality measure reporting now, optometrists are taking the steps necessary to protect themselves from Medicare payment penalties that will be imposed in the not-too-distant future,” Dr. Ellis said (see “Bonuses, penalties becoming important factors in Medicare payment,” AOA News, April 2011).

For optometrists not yet involved in Medicare incentive programs, the report offers evidence that participation is practical, as well as financially advantageous, for virtually any eye care practice, Dr. Ellis said.

“Hopefully, optometrists will now quickly embrace the new Medicare Electronic Health Records (EHR) Incentive Program as well,” Dr. Ellis added.

Overall, optometrists ranked ninth among physician specialties in PQRS participation and sixth in e-Rx incentive program participation.

Bonuses paid to optometrists under each program averaged well over $1,000.

More optometrists participated in the PQRS than the e-Rx program during 2009; probably because the PQRS [formerly, the Physician Quality Reporting Initiative (PQRI)] is older and more established, according to the AOA Washington office. The PQRS began in 2007, while 2009 was the first year for the e-prescribing program.

However, a higher percentage of those participating in the e-Rx program earned bonuses.

Optometrists participating in the PQRS program during 2009 received an average (mean) payment of $1,168 – with some receiving bonuses of as much as $21,276. The median payment to an optometrist was $653.

The PQRS bonus is 2 percent of Medicare allowed charges.

One ophthalmologist received $70,000 under the PQRS program, according to the CMS report.

Optometrists received a total of $2,172,814 in PQRS incentives for 2009. Those optometrists collectively billed Medicare for $108,640,733.

Nearly one in every five optometrists who see Medicare patients (19.78 percent) participated in the PQRS program, according to the report. That was slightly below the participation rate (20.91 percent) for all eligible professionals.

Moreover, the participation rate for ophthalmology was twice as high (38.8 percent).

Some 1,859 optometrists earned PQRS bonuses, according to the report. Again, that was less than the total for ophthalmology (3,695). However, it was “way more” than the next highest-ranked non-MD physician specialty: podiatry (369), Dr. Ellis noted.

In all, 5,923 optometrists submitted at least one PQRS quality data code in 2009. There were 7,387 ophthalmologists reporting at least one code.

According to the CMS, the number of optometrists eligible for the PQRS grew from 22,441 in 2007 to 29,440 in 2008, and 29,940 in 2009.

The increase in the total number of eligible optometrists from 2007 to 2008 probably reflects the expansion of the PQRS reporting period from six months to a full year, according to the AOA Advocacy Group. The expanded reporting period allowed more practitioners who infrequently bill Medicare to become eligible for the program.

In some prior PQRS reports, the CMS mistakenly listed optometrists as “nonphysicians.” At the AOA’s insistence, the agency this year classified optometry as a “physician specialty,” the AOA Advocacy Group notes.