The Centers for Medicare and Medicaid Services (CMS) will be implementing up-to-date practice expense rates in its Physician Fee Schedule (PFS) over the next four years. The 2010 Medicare PFS is projected to increase payments to practitioners by 5% to 8%.

House Passes Medicare Physician Payment Reform Act of 2009

Passed by the House on November 19, with a vote of 243 to 183, the Medicare Physician Payment Reform Act of 2009 (HR 3961) aims to stop the 21.1% scheduled cut in Medicare payments to providers and update the Physician Fee Schedule conversion factor to limit future cuts.

The act has moved to the Senate floor, where it must be taken up and voted on before January 1, 2010, when the cut is scheduled to be enacted.

Optometrists’ reimbursement should increase by an average of 5%, according to the American Optometric Association Advocacy Group.1

“For most specialties, CMS had been using practice cost data that was at least a decade old and does not accurately capture the relative costs faced by different physician practices today,” says David W. Parke II, M.D., CEO of the American Academy of Ophthalmology.

The expense data being used to update the PFS is derived from the Physician Practice Information Survey (PPIS) conducted by the American Medical Association and validated by a third-party firm. CMS will use these results to establish practice expense relative-value units (PE RVUs). Over a period of four years, CMS will transition from the current PE RVUs to the new PE RVUs based on the survey data.

CMS believes that the survey is the “most comprehensive source of PE survey information available to date ... The PPIS has gathered information from 3,656 respondents across 51 physician specialty and health care professional groups.”2

“The AOA worked extensively with the AMA to ensure optometry was included in the survey and worked extensively with CMS to make sure they would accept survey results,” said Jon Hymes, AOA Advocacy Group Director.1

The PFS update also includes changes to the E-Prescribing Incentive Program. CMS is broadening eligibility for the program by including additional professional services, such as nursing facilities and home care.  

1. Survey data to bring ODs 5% Medicare pay boost. AOA News. 2009 Nov;48(7):1,14.
2. Federal Register. 2009 Nov 25;74(226). Available at: (Accessed December 2009).