Money matters: Obama budget, office-based testing, more codes

San Diego-Spring is in the air and so is change, as ophthalmologists and the rest of the nation get a first look at some of the health-care payment reforms championed by President Barak Obama.

William L. Rich III, MD, FACS, medical director of health policy for the American Academy of Ophthalmology, said practitioners can follow the money to see the changes likely to impact them in the near future. The focus will be on the efficiency of services themselves and how effectively the services are provided.

The Obama budget bill includes:

• $20 billion for health information technology research.
• $1.1 billion for studies of comparative effectiveness of procedures.
• $330 billion to repeal the Medicare sustainable growth rate (SGR) formula.
• $634 billion for covering the uninsured.

“We never thought we would see the repeal of the SGR, but it’s gone from the budget bill,” Dr. Rich said. “The stick is that physician payment reforms will look at non-evidence-based testing and other modalities that don’t show clinical effectiveness. So we’ll be under the same pressures the pharmaceutical people are under.”

Dr. Rich said that practitioners should particularly brace for drastic cuts designed to slow the growth of office-based testing. Office-based diagnostic tests in all physicians’ offices are growing at a rate of 14% per year, and optic nerve imaging testing is the fastest growing of all in-office medical tests.

Glaucoma specialists may find themselves particularly targeted for cuts in a system designed to reward efficient provision of services, Dr. Rich added. The reason? Only one ICD-9 code covers the entire spectrum of glaucoma, giving practitioners no way to differentiate their claims data.

“All glaucoma [physicians] are inefficient, according to the government,” he said. “We all need to look at that and suggest new codes that represent progression of the disease and, therefore, explain the need for more resource use.”