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A number of my colleagues have asked me why we should be interested in the health care reform debate.
Some optometrists have diligently followed the trend to institute electronic health records (EHR) and to keep up with the attestations of meaningful use. Of these, however, many have dropped out along the way, most at the stage 2 level, where secure communication with other providers created an insurmountable obstacle. We all learned that you can only control your end of a communication.
Other providers have been discouraged by the ineffective administration of the CPT II codes and the heavy-handed reductions of Medicare payments.
Yet a surprising number of optometrists have ignored the whole debate, stayed with paper charts and continued along the well-established path. Some of these providers have all of the high-tech clinical instruments, have maintained their continuing education and provide excellent optometric care.
A current review of the fiscal health of the practices at either end of the spectrum of compliance with health care reform will find little difference. How can this be?
Health care reform issues only affect government-sponsored health care programs. For the most part, this is Medicare and Medicaid. For optometry, this is only a small segment of the overall business of our practices.
Unlike many of our fellow health care providers, our income stream is very diversified. In addition to medical care, we provide nonmedical services such as refraction, contact lens fittings and vision therapy. We also have revenue from wearable hardware items that benefit from the fashion frame industry as well as the high-tech lens option world. With all these revenue options, why should we worry about health care reform at all?
Government-sponsored health care started in 1965 with the passage of Medicare and Medicaid under Title XVIII (Medicare) and Title XIX (Medicaid) of the Social Security Act. These were initially rather simplistic single payor payment programs. Since that time, the government has been increasingly involved in the “nuts and bolts” of health care and has moved into dictating the delivery system and has made attempts to dictate quality of care.
Although optometry is currently not severely impacted finically by government-sponsored programs, these programs tend to set the standard for all health care. For example, the Resource-Based Relative Value Scale, which sets the relative value for all services we provide, became the payment system for Medicare with the passage of the Omnibus Budget Reconciliation Act of 1989. Since then, it has become the standard for all health care services.
The government programs have long been the testing grounds for health care delivery programs. Managed Medicaid, Medicare Advantage and the Accountable Care Organizations are all examples of models of health care delivery systems that have been tested and adjusted with government programs. The Evaluation and Management coding system was adopted in the Health Insurance Reform Act of 1995 and has since become the universal standard for payment of medical services.
Although the short-term effects of health care reform have not had a profound impact on the business of optometry, the trend related to the government’s role in health care since the 1960s is quite clear. The adoption of a single payor system or other reforms that affect the delivery of commercial health insurance or vision insurance could limit our access to patients or change the payment system virtually overnight.
In this critical government transition period, we must closely follow the debate and evaluate the impact on our profession. For the medical aspect of our practice, we are already deeply invested in the process. To maintain our role, we must learn the required clinical care that matches the coding. We must meet the quality initiatives and learn to communicate and collaborate with other providers.
At this point, it is hard to predict or recommend a strategy. For now my advice is simple: Just “buckle up,” as the road ahead may be a bit bumpy!