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Q: I heard about a new program for Medicare beneficiaries that includes a vision screening. What is it, and how does the vision screening fit into the program?
A: For beneficiaries who enrolled after January 1, Medicare Part B now covers a one-time preventative health physical, referred to as a Welcome to Medicare exam. One of the elements of the exam is a visual acuity screening.
For optometrists, this new program creates a tremendous opportunity to connect with primary-care doctors, says optometrist Christopher J. Quinn, of Omni Eye Services in Iselin, N.J. Welcome to Medicare is going to make sure that all new beneficiaries who take advantage of this program will have their vision screened, and its an opportunity for primary-care doctors to emphasize the importance of getting eye care.
The Welcome to Medicare exam includes:
Review of the patients medical history.
Review of risk factors for depression.
Review of functional ability and safety (i.e., hearing impairment, risk for falls, etc.).
Check of blood pressure, weight and height, as well as an electrocardiogram (EKG) test and a visual acuity screening.
Education, counseling and referral as appropriate for the above elements of the exam and to prevent disease, stay well and improve health.
A written plan (such as a checklist) of screenings and other preventative services that are recommended and covered.
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| The new Medicare physical gives optometrists a reason to contact local PCPs to educate them about your services. |
The new program was spurred by the Medicare Modernization Act as part of Medicares new emphasis on preventative care. According to the Centers for Medicare & Medicaid Services (CMS), Americans age 65 or older made up 13% of the population in 1999, yet consumed more than one-third of the nations spending for health care. The Welcome to Medicare exam aims to both lower health-care costs and to identify or prevent seniors health problems earlier.
Medicare has historically provided services only when a patient is sick, says optometrist Greg Kraupa, of Minneapolis and St. Paul, Minn. Now you have a new benefit for senior citizens on a more preventative basis to intervene earlier in problems that may be subclinical, before symptoms are present. He says this not from his position as a longstanding member of the AOAs Eye Care Benefits Committee, and not just as a private practitioner, but as a citizen and a taxpayer.
The visual acuity screening, for example, will prompt referrals for eye or vision problems that might have gone unchecked, says optometrist Don Williamson, of Cape Coral, Fla., and chairman of the AOAs Federal Relations Committee. More and more patients are going to be identified with potential visual problems that maybe havent yet been seen by an eye doctor, he says.
Specifically, the Welcome to Medicare exam calls for referral for obtaining appropriate screening and other preventative services. As part of those preventative services, Medicare Part B covers glaucoma screenings for those at risk.
Q: In my town, primary-care physicians seem to refer Medicare patients directly to ophthalmologists. How can optometrists get more involved in seeing this group of patients for their eye care needs?
A: Optometrists should already have established relationships with PCPs in their area, Dr. Williamson says. When a patient with diabetes or hypertension is in your office, for example, ask the patient if you can send a letter to her primary-care physician that explains her current visual status. When that patient reaches Medicare age, youve already established yourself with that doctor, Dr. Williamson says.
Optometrists need to continue to develop better working relationships on a first-name basis with primary-care physicians across the board, not only in the Medicare population but in all populations, Dr. Kraupa says. The Welcome to Medicare exam is just one more benefit that makes improving relationships with primary-care physicians a necessity, he says.
On the other hand, if the primary-care physician does not have a working relationship with optometrists, the PCP can easily steer patientseven those who have had a positive relationship with an O.D. up to that pointto an ophthalmology office, Dr. Kraupa says.
In a worst-case scenario, he adds, this new Medicare benefit could even be a threat to optometrists if they dont do their job at developing relationships with primary-care physicians.
How so? Ophthalmologists are probably by default going to get referrals if you dont do something to make yourself stand out, Dr. Quinn says.
The new program provides an opportunity to connect with PCPs, he adds, to inform them about what optometrists can do. To that end, Dr. Quinn says, identify your local physicians and take each one out for lunch to explain that youre interested in caring for patients, youre likely to be more available, you have more convenient office hours, and you will work in any urgent problem at any time.
Getting involved with the Medicare population is important, and will become even more critical in the coming years, Dr. Quinn says.
The baby boomers are leaving the presbyopia age and entering the disease age, he says. And, as optometrists become more involved with medical eye care, they should be actively pursuing this patient population. You can build a very successful practice by providing the medical eye care that these patients need.
