Predicted and observed effects of the Medicare Optometry Parity Amendment

The Medicare Parity Amendment of 1987 redefined the conditions of optometric participation and expanded coverage to include all Medicare-covered services which optometrists are authorized to perform under state law. Prior to the law, a number of studies projected costs to Medicare as a result of a change in Medicare policy. This paper reviews these studies in relation to actual Medicare expenditures from 1986 to 1988. The paper describes the impact of the Medicare amendment on payments to optometrists and shows how payments increased from $12 million in 1986 to $81 million in 1988. Optometrists substantially increased their market share of Medicare payments from 2.6 percent in 1986 to 11.1 percent in 1988. Indications suggest that a shift of patient visits from ophthalmologists to optometrists has occurred.

A comparison of charges by optometrists and ophthalmologists under the Medicare program

Medicare data obtained from the Health Care Financing Administration was analyzed in relation to average allowed charges by optometrists and ophthalmologists. Optometric charges are considerably lower than ophthalmological charges for all services compared. The policy of different reimbursement levels is currently a major issue being considered by the Physician Payment Review Commission. Optometry must demonstrate that the procedure codes for which they submit Medicare claims are comparable and identical in service content to those provided by ophthalmologists.

Comparison of examination fees and availability of routine vision care by optometrists and ophthalmologists

A national telephone survey of eye care practitioners shows that the average fee for routine eye examinations was less among optometrists than ophthalmologists. The average wait for the earliest appointment was 5 days for optometrists and 20 days for ophthalmologists. Weekend and evening appointments were also more obtainable among optometrists. The study did not determine what tests were included in the routine examination of each practitioner. Optometrists are licensed to use diagnostic drugs in all 50 States and prescribe therapeutic drugs for the treatment of ocular diseases in 25 States. Legislation that would update State laws permitting doctors of optometry to prescribe and use pharmaceutical agents for the treatment of eye diseases has been introduced in many of the remaining States. Supporters of bills permitting therapeutic pharmaceutical optometry contend that these changes would ensure the availability of quality eye care at significant savings, since optometric fees are generally lower than ophthalmological fees. In addition, it has been argued that optometrists are equitably distributed geographically and are more likely to have weekend and evening office hours, thus enabling increased patient access to eye care. When considering cost-effectiveness and accessibility, this study may provide information to those States considering changes in the scope of optometric licensure.

A survey of optometric practice in New York State: trends and policy considerations

A mail survey of actively practicing optometrists in New York state revealed information about present and future manpower supply, modes of practice, procedures and instrumentation used, services rendered, third party reimbursement and involvement in continuing education. The survey illustrates the need to increase the gathering of such data in order to analyze practice patterns and more accurately initiate short- and long-term planning within the profession.

Comprehensive vision care under third party programs: increased services and increased scrutiny

Physician reimbursement under Medicare has been rising by about 15 percent each year. Part of this increase is due to an increase in unnecessary tests and procedures. To control provider billing, Congress passed legislation that will establish a Medicare fees schedule and expenditure targets. Increased surveillance and monitoring of Medicare claims are taking place. Diagnostic procedures are being questioned and denied when deemed inappropriate in relation to a diagnosis. Managed care techniques also are being implemented by private insurance carriers to prevent overutilization. Clinic practice guidelines are being developed by the health professions. Optometry, as well as all other health professions, will be subject to increased utilization and quality review.

Vision care benefits and optometric services in HMOs

General eye care, although not a required basic health service of federally qualified health maintenance organizations (HMOs), is being offered in virtually all HMOs. Reasons for including vision care benefits and optometric services are presented. Data from the Group Health Association of America and the Department of Health and Human Services demonstrates that HMOs are in fact providing vision care benefits and optometric services. The growth of the independent practice association (IPA) model is significant for optometry as it threatens to limit the scope of optometric practice. New professional problems arise as participating optometrists are constrained from performing the full range of optometric services. In recent years optometry has expanded its scope of licensure and practice to incorporate both diagnostic and therapeutic drugs in its management of visual problems. Managed care and alternate delivery systems, however, may restrict the advances that optometry has made in the legislative arena.

Vision care and health insurance coverage

This paper presents an overview of third party coverage for optometric services. A questionnaire survey of insurance companies was conducted to determine the extent of major medical coverage for specific optometric services. The influence of freedom of choice laws, expanded scope, pharmaceutical agent legislation and the Medicare program is discussed. The proper use of accepted diagnostic and procedural codes is underscored.

Vision care in the Medicare program: renewed political and professional debate

An examination of proposed changes in the Medicare regulations indicates that there is a wide divergence of views and many unrealistic arguments advanced by both optometry and ophthalmology. Current financial considerations make it unlikely that any changes will be made if they raise costs.

Vision care policy, ophthalmological practices and the Medicare program

Medicare specifically excludes routine eye examinations and refractive services. In optometric circles, it is widely believed that ophthalmologists are currently receiving payment for routine eye care and refractive services. A survey of ophthalmologists and optometrists in New York State is presented with respect to their fees and participation in the Medicare program. The use of procedures and diagnosis codes and its impact on billing practices by ophthalmologists is reviewed. Data from a Medicare intermediary and from a provider of health care services raise serious issues regarding Medicare's policy of excluding routine eye care. A review of existing rules and regulations and its implementation appears in order.

Vision screening requirements under 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) Programs

A 1979 survey of vision screening requirements in 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) programs revealed that 17 percent of the programs had no requirements, and 17 percent required only distance visual acuity testing. An additional 25 percent required distance vision and ocular muscle-fusion tests only, and the remaining programs required various combinations of three or more tests. Fewer than two-thirds of the programs with requirements had referral criteria for the tests. The ages at which initial testing was required also varied among the programs. The differences in requirements were not related to the demographic, socioeconomic, and other variables analyzed in this study. Programs with specific referral criteria, however, had a higher percentage of referrals for vision screening than those without such criteria. Because of the variability in vision screening standards and referral criteria observed among the programs, the authors conclude that national standards are needed.

Vision care for the nation's elderly: a plea for policy direction

Eye care services are largely provided by two professional groups--optometrists and ophthalmologists. Professional rivalry between the two exists mainly because both are in direct competition for patients with routine diagnostic and treatment needs. With the advent of Medicare and Medicaid, a substantial amount of health care services rendered to the elderly has been financed by the federal government. The use by the elderly of eye care services and the cost of such services are influenced by Medicare reimbursement policies. Medicare specifically excludes routine eye care and refractive services, but includes diagnosis and treatment of ocular disease. This article examines the impact of eye care benefit exclusions and restrictions and their effect upon the use of ophthalmological and optometric services by the elderly.

Optometric and ophthalmological eye care under the Medicare program

A questionnaire survey was administered to more than 600 elderly persons within several senior citizens centers in New York City. Data was collected on the elderly's use of eye care services, particularly the site where eye care was obtained, the type of provider chosen and the source of payment, i.e. Medicare, Medicaid or self pay. The second stage of the survey was to screen all participants for the absence or presence of visual problems. Significant differences were found when comparing the use of optometrists and ophthalmologists with the method by which the respondent paid for their last eye examination. Among those who were seen by an ophthalmologist and reported that Medicare paid for their examination half either passed or failed the vision screening test due only to poor visual acuities. Statistical evidence seems to indicate that Medicare payments to ophthalmologists may not be solely for actual or suspected disease conditions. Implications for the Medicare program seem evident.

Knowledge and use of eye care services by college and health professional students: implications for the profession

A questionnaire survey of 1277 students in colleges of liberal arts, medicine, pharmacy, nursing, dentistry, and podiatry was undertaken in an effort to determine their knowledge and use of vision care services. Students were asked to define the differences among optometrists, ophthalmologists, and opticians. Utilization, type of practitioner used, and site of examination are reported. About 56% had had an examination within the past year. Optometrists provided at least 40% of the examinations, but the confusion in the minds of the students is revealed by the fact that some said they were examined by opticians, some by the Department of Motor Vehicles, and some by a person they were not able to identify. Clearly, optometry and the related disciplines have a responsibility to clarify the public confusion.

The supply of optometric manpower

Approaches to determining health manpower requirements are reviewed. The paper identifies a source of error in determining the present supply of optometric manpower which will ultimately influence any policy or program intended to either correct or adjust future health manpower supplies. The study also demonstrates a need to refine the data on health manpower supplies with particular reference to the characteristics and practices of the optometrist.

A national optometric-student attitudinal survey

This paper contains the results of a survey of 1549 optometry students who responded to a questionnaire that was sent to all optometry schools and colleges in the United States. The results reflect student attitudes and opinions about such issues as commercial optometry, malpractice suits, price advertising of glasses and professional services, and the cost of professional education. In addition, the survey results disclose the reasons students enter the profession, their anticipated modes of practice and their expected incomes. We believe that the issues encompassed in this survey will affect the future practice of optometry.