As we close out the year, its always a good time to reflect on the past year. And, 2008 certainly has been a tumultuous year for us.
We have seen changes in our financial systems that have not been experienced for generations, and we are faced with daunting changes in the health-care delivery system. It could be enough to make anyone worried, maybe even fearful.
Maybe I can spread a little early holiday cheer: Optometry is doing well. We averted a significant Medicare payment reduction, and we achieved our exemption from the DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) accreditation requirements. Also, as recent studies have shown, O.D.s provide nearly 75% of initial visits to the U.S. population and, on a continuing basis, nearly 68% of those individuals continue their care with an optometrist.1
Consumers are returning more frequently for annual eye exams, revenues for most O.Ds are holding steady, and a greater percentage of revenues are coming from providing medical eye care.
How do weas both a profession and as individual practitionerscapitalize on this momentum going into 2009? By practicing smarter, which means understanding how to avoid problem areas by knowing whats on the health-care radar. One of my primary radars, one where I can identify red flags, is a government resource that is free to all of us. The 2009 Work Plan from the Office of Inspector General (OIG) is a tremendous resource and can be accessed at: www.oig.hhs.gov/publications/docs/workplan/2009/WorkPlanFY2009.pdf.
The OIGs Work Plan should be a must-read on every O.D.s list. I know its something that probably only has appeal to someone like me; however, it does provide insight into what the OIG is placing on its priority list of issues for the upcoming year. Anyone with a stake in health care should take it seriously, because the OIG is the enforcing body for CMS fraud and abuse in health-care policy.
A quick scan of the table of contents takes us directly to the Physicians and Other Health Professionals section. Areas of focus for the OIG in 2009 that concern optometry are fairly minimal: Place of Service Errors; Evaluation and Management Services During Global Surgery Periods; Medicare Payment for Unlisted Procedure Codes; and Medicare Billings With Modifier GY.
So, why is the Work Plan a must-read if issues facing optometry this year are minimal? The obvious reason is that we wont know what issues optometry might face unless we read the Work Plan. But it can also shed light on continuing efforts of previous issues and how the OIG has dealt with them.
The not-so-obvious reason is that, in past years, many of the issues identified had a direct and significant impact on optometry.
Some areas of continual focus are efforts to combat waste, fraud and abuse in the Medicare and Medicaid programs. The Deficit Reduction Act of 2005 grants the OIG $25 million per year for this effort. The recently published successes of the Recovery Audit Contractors program demonstrate that the OIG is serious about pursuing fraudulent and abusive practices. While optometry may not be in the center of the OIG bulls-eye, dont assume that were out of its sights for fraudulent or abusive practices that may trigger an audit.
The OIGs Work Plan can provide us with insight regarding its thought processes and initiatives in the upcoming year. Boring or not, it should be on your reading list. Remember that fear is often a byproduct of lack of information. Armed with information contained within the OIGs Work Plan, perhaps practicing in fear of doing something wrong can be replaced with the confidence of doing things right.
Happy Holidays! I look forward to our paths crossing in 2009.
1. American Optometric Association. Caring for the Eyes of America 2008, A Profile of the Optometric Profession.