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PQRS incentives to optometrists top $3 million

May 23, 2012

The Medicare Physician Quality Reporting System (PQRS) issued more than $3 million in incentive payments to optometrists during 2010, according to latest in a series of reports on the program from the U.S. Centers for Medicare & Medicaid Services (CMS).

Nearly one in 10 (9.9 percent) optometrists who saw Medicare patients during 2010 earned a PQRS quality bonus, according to the CMS.

Those optometrists received an average (mean) payment of $1,107.59, according to the report.

In all, optometrists received a total of $3,387,013 in PQRS quality bonuses for 2010.

“The statistics confirm that a growing number of optometrists are taking part in the PQRS as means of both enhancing their practice income and demonstrating the quality of care they provide,” said AOA President Dori Carlson, O.D. “Understanding and participating in such quality reporting systems will be increasingly important as Medicare – and other health insurers – move to ‘value-based’ or ‘pay-for-performance’ reimbursement.”

Introduced in 2007 as the Medicare Physician Quality Reporting Initiative (PQRI), the PQRS is a voluntary program that provides health care practitioners bonuses, based on a percentage of their total Medicare approved charges for the year, when they report taking designated measures, determined by the CMS to enhance quality of care, for specified numbers or percentages of Medicare patients.

PQRS Measure 14 [Age-Related Macular Degeneration (AMD): Dilated Macular Examination] was the care measure most often reported by optometrists during 2010 (see below).

Optometry remains among the top health care professions in PQRS participation, the CMS noted (see table below).

Optometry ranked sixth among 42 health care professions in terms of the number of the practitioners participating in the program. It ranked 10th in the percentage of practitioners participating.

Ophthalmologists – who, thanks to their sizeable surgical reimbursements, stand to realize up to six times the bonuses earned by primary care practitioners under the program – ranked fifth.

Of the 31,028 optometrists who saw Medicare patients during 2010, some 6,949 – more than one in every five – participated in the PQRS program. About half (3,084) of those optometrists earned quality bonuses through the program.

Incentive payments issued to optometrists through the PQRS ranged from as little as $1.29 to as much as $22,413.63. The median payment was $599.54.

The PQRS quality bonus for 2010 was set at 2 percent of the qualifying practitioner’s total Medicare allowed charges for the year. The bonus was reduced to 1 percent for 2011 and has been set at 0.5 percent for 2012, 2013, and 2014.

However, health care practitioners can earn an extra 0.5 percent this year through the PQRS maintenance of certification (MOC) program. Optometrists holding American Board of Optometry (ABO) certification can qualify for the bonus.

The ABO is one of the few health care specialty certification boards recognized under the PQRS maintenance of certification program, the AOA Advocacy Group notes.

Practitioners can qualify for PQRS bonuses by reporting quality measures on Medicare claims or through designated registries.

The vast majority of participating optometrists reported PQRS measures on claims during 2010, according to the CMS report.

The AOA Practice Advancement Committee has prepared a guide to participation in the 2012 PQRS program. The guide appeared in the March AOA News. AOA members can also access the guide, as well as the AOA’s 2012 PQRS Eye Care Measures for Optometrists chart, on the AOA website (www.aoa.org/PQRS).

Top five PQRS measures submitted by optometrists

1 – Measure 14 – Age-Related Macular Degeneration (AMD): Dilated Macular Examination

2 – Measure 12 – Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation

3 – Measure 117 – Diabetes Mellitus (DM): Dilated Eye Exam in Diabetic Patient

4 – Measure 18 – Diabetic Retinopathy: Documentation of Presence or Absence of Macula Edema and Level of Severity of Retinopathy

5 – Measure 140 – AMD: Counseling on Antioxidant Supplement [e.g.: per Age-Related Eye Disease Study (AREDS) recommendations]

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