Optometry Coding & Billing Alert

Published on Mon Feb 13, 2006 PDF

Pay-for-performance program is looking a lot less likely

On Feb. 1, the U.S. House of Representatives finally passed a 2006 budget that replaced the scheduled 4.4 percent cut to your reimbursement with a pay freeze. Translation: You will continue to receive 2005 payment levels for another year, thanks to lobbying by professional organizations including the American Optometric Association.

The final 2006 budget doesn't include any mention of pay for performance (P4P). Legislators had wanted to include programs in which your reimbursement would be reduced by 1 percent, and that money would go into a pool.

In the first year, you-d get money from that pool for answering quality questions, but after that, you-d only receive the money if you followed quality guidelines.

Good news: Most observers had expected the budget to include P4P in exchange for scrapping the 4.4 percent cut. But Washington insiders say that legislators couldn't agree about how P4P would work and whether to add more money to pay for it. Those disagreements still haven't been resolved, and they may make it harder to pass P4P this year, as well.

Officials at the Centers for Medicare & Medicaid Services suggest that Congress is sure to pass P4P soon, according to Piper Nieters, an attorney with Powers Pyles Sutter & Verville. CMS claims that P4P is inevitable and only the details haven't been settled yet.

Bad sign: CMS launched its own voluntary program for physicians to report on quality indicators this year. Because you don't receive any extra money for participating in this program, many physicians have already decided not to take part, and many others are skeptical.

With cuts to some services and an overall freeze, physicians don't feel like doing extra work for Medicare without getting paid, Nieters says.

CMS claims that physicians should want to take part because it will give them a head start on preparing for P4P. But CMS wants you to use temporary -G- codes to report quality measures, and there's no way a final P4P program will use G codes, Nieters says.