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Glaucoma screening benefit a plus for patients and providers
Physicians hope the new Medicare benefit, code V80, will encourage at-risk patients to seek treatment.
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Today in the United States glaucoma is the second leading cause of blindness, behind only age-related macular degeneration. An estimated 2.2 million Americans have glaucoma, yet only half of this number are aware that they suffer from the symptom-free disease.
“Glaucoma, and the risk of vision loss, remains unrecognized for millions of Americans,” said Paul A. Sieving, MD, PhD, director of the National Eye Institute. In an attempt to spread awareness and promote health maintenance nationwide, Medicare has expanded coverage, retroactive to Jan. 1, 2002, to include glaucoma screening under the code V80. The V80 benefit allows seniors and disabled citizens at risk for glaucoma coverage of $52 for a yearly dilated eye exam.
“The new coverage will help people keep their vision, especially those at high risk for the disease,” Dr. Sieving said. According to the NEI, the risk for glaucoma is higher in women, people suffering from diabetes, those with a family history of glaucoma and black people.
Secretary of Health and Human Services Tommy G. Thompson said the new coverage will “help keep people enrolled in Medicare healthy and improve their quality of life. An eye exam now can prevent serious problems later, even blindness.”
Many ophthalmologists have responded enthusiastically to the news that those at risk for glaucoma are now covered under Medicare. However, physicians now want to know: What will this new code mean to their practices and, more important, to the population at risk? It seems clear that getting the word out to potential patients who will benefit from this new coverage will be the work of ophthalmologists, associations and industry.
What Medicare V80 means to you
Ophthalmologists may choose to educate their patient population on the new coverage and the importance of taking advantage of this benefit.
According to glaucoma specialist Eve J. Higginbotham, MD, of the University of Maryland School of Medicine, not only does the new benefit provide the opportunity for long-term investment in a patient, but provides an excellent platform for alerting people who do not know they are at risk. “This new measure can have a significant impact on the general at-risk population to the extent of getting the word out and getting them in your office earlier, or getting them there at all,” Dr. Higginbotham said.
“We will have made a contribution to public health and we can feel good about that,” said Richard L. Lindstrom MD, of the Minnesota Eye Associates in Minneapolis. “Secondarily, we are probably going to find patients with glaucoma, cataract, diabetic retinopathy and all kinds of other pathologies. If they choose to be our patients, this would create an opportunity for us to get a return on the investment.”
“It’s a great opportunity for a solo or family-care practitioner, someone who is starting a practice, needs to grow one, or has idle time in the office when they might not be seeing patients,” said Leslie Giannakopoulos, COE, a practice administrator at DelRay Eye Associates PA in DelRay Beach, Fla.
However, in Ms. Giannakopoulos’s high-traffic clinic, which consists mainly of Medicare patients, the coverage offered by Medicare V80 may be insufficient to cover expenses, she said. The V80 code reimburses physicians for a dilated eye exam, in which the optic nerve is evaluated and intraocular pressure is measured. However, it does not pay for visual field screening and other procedures needed to fully clinically evaluate a patient for glaucoma.
“In my opinion, this reimbursement may be not enough to adequately cover the level of exam one feels is medically appropriate to give the best medical care,” Ms. Giannakopoulos said.
Nevertheless, the reality of actually getting a patient into your office is what is key, according to Drs. Lindstrom and Higginbotham. “While it is being positioned as a glaucoma screening opportunity, we think that when those patients come in we will find a lot of cataracts, untreated diabetes, diabetic retinopathy, hypertension and other ocular pathologies,” Dr. Lindstrom said.
“Those patients can be made aware of those issues, and then they can come back as they choose for a regular comprehensive eye exam and appropriate treatment,” Dr. Higginbotham added.
Opportunities for drug manufacturers, health care organizations
As a result of the Medicare mandate, ophthalmologists are hoping that drug companies and advocacy groups will spread the word. “It’s definitely a good thing for the manufacturers of glaucoma medications and other drugs,” Dr. Lindstrom noted. “From the company’s perspective, you’re looking at a lifetime of patient therapy.”
According to experts, there may be a large moneymaking opportunity for companies that produce drugs for glaucoma, cataract and age-related macular degeneration. Patients will now receive treatment. Many will be patients who had not been getting treatment in the past, or would have gone their entire lives without therapy for their condition.
“We say it’s a win for surgeons, and also a win for drug companies who will have a new public service agenda to put their ‘white hats’ on for,” Dr. Lindstrom added.
In fact, a number of organizations have begun to take a more aggressive approach to promoting free screenings in the light of the new code. Free education and screening initiatives have been undertaken by Prevent Blindness America, an organization that provides free eye exams to 1 million people on an annual basis, as well as the American Academy of Ophthalmology, which provides free health services through its National Eye Care Project.
Additionally, Allergan has now teamed up with Webb Patterson Communications, a public relations firm, to provide free glaucoma screening, education and treatment awareness in inner-city neighborhoods. This initiative stretches beyond the new Medicare coverage, attempting to reach patients who are at risk when they are younger.
“African Americans and Hispanics are six to eight times more likely to develop this disease than whites,” said Tom M. Jones, vice president of Webb Patterson Communications. African Americans and minorities age 45 and over, who might not otherwise have adequate access to health care, are eligible for the free program. They will also receive information about Lumigan (bimatoprost), Allergan’s recently introduced medication for glaucoma .
According to Dr. Higginbotham, the new code is an excellent opportunity for these high-risk patients. It is particularly important for any patients who cannot otherwise afford preventive health care, she said..
“This is the group I believe will benefit the most from the measure,” Dr. Higginbotham said.
What it means to your patients
Dr. Lindstrom agreed. “It poses a tremendous patient-centered opportunity, particularly for the inner-city patient who might not otherwise afford ophthalmic care.”
According to surgeons, more preventive measures should be taken in the coming years to ensure that minority and baby-boomer populations at risk are seen early before it is too late for treatment to help. Currently, there are a total of 3 million Americans nearly or completely blind. This figure is expected to double by 2030 if aggressive preventive measures are not taken, according to the NEI.
“Not only glaucoma but other conditions pose a public threat; detecting problems as soon as possible and alerting people early on will help slow down this steadily increasing problem,” Dr. Higginbotham said. For now, she added, health care providers will have to work together to reach the general public and educate them about this new benefit — before they are left in the dark.
For Your Information:
- Richard L. Lindstrom, MD, can be reached at Minnesota Eye Consultants, 710 E. 24th St., Suite 106, Minneapolis, MN 55404; (612) 813-3600; fax (612) 813-3660; e-mail: rllindstrom@mneye.com.
- Eve Higginbotham, MD, can be reached at the University of Maryland School of Medicine, Department of Ophthalmology, 419 W. Redwood, Suite 580, Baltimore, MD 21201; (410) 328-5929; fax: (410) 328-6346; e-mail: fcwejh6786@aol.com.
- Leslie Giannakopoulos, COE, practice administrator of DelRay Eye Associates PA , can be reached at 16201 S. Military Trail, DelRay Beach FL 33484; (561) 498-8100; fax: (561) 498-8188.
- Tom M. Jones, vice president of Webb Patterson Communications, can be reached at 112 W. Parrish Street, Durham, NC 27701; (919) 680-6111; fax: (919) 680-6141; e-mail: tjones@webbpatterson.com.
- Allergan can be reached at 2525 Dupont Drive, Irvine, CA 92612; (800) 433-8871; fax: (714) 246-5913; Web site: www.allergan.com.
- The National Eye Institute, a branch of the National Institutes of Health, can be reached at 2020 Vision Place, Bethesda, MD 20892; (301) 496-5248; Web site: www.nei.nih.gov.