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BLOG: Tear osmolarity is a medically necessary test. Period.
For reasons that are unclear at best, the Medicare carrier in Florida is apparently questioning the medical necessity of tear osmolarity testing in the treatment of dry eye. A declaration that this test is not medically necessary would then lead to a denial of insurance payment for the test by Medicare in Florida. It is difficult to express how disappointing it is to hear this, especially because it seems to stem from the same outdated, ill-informed Preferred Practice Pattern from the American Academy of Ophthalmology that caused a similar issue to come up in Pennsylvania earlier this year.
Let me be clear: Tear osmolarity testing is medically necessary. Period. Full stop.
Elevated tear osmolarity is a defining component of dry eye, per the definitive DEWS report whose guidelines we all follow. In all but the most superficial dry eye care (pun intended, I think), it is not only the standard of care, it is a mandatory component of best practices. It is simply not possible to provide the best possible care to our dry eye patients without the use of tear osmolarity, and the sad fact is that those same patients will simply not agree to pay for it out of pocket. Certainly not for both eyes, and we now know that measuring the presence or absence of symmetry between the eyes is integral to understanding the disease state.
At SkyVision, tear osmolarity is utilized in the diagnosis of every dry eye patient. The result informs our choice of both prescription and over-the-counter medications. During follow-up exams, we use tear osmolarity to evaluate both the accuracy of our original diagnosis as well as the efficacy of our chosen treatment. We had an account hiccup (to be covered in an upcoming post) and were without chips to do the test for approximately 5 days, affecting roughly five dozen patients. It’s hard to explain just how difficult we all found it to treat these dry eye patients without this standard. Seriously, it was like driving with one eye or boxing with one arm.
It’s time for this madness to stop. Tear osmolarity testing is medically necessary and in a dry eye clinic is part of the standard of care. Perhaps it’s time for an email campaign directed toward CMS and AAO.
Disclosure: White reports he is a consultant for Bausch + Lomb, Allergan, Shire and Eyemaginations and on the speakers board for Bausch + Lomb and Allergan.