Billing, Coding and MoreU.S. Senate Approves AOA-backed Medicare Fee Fix, DMEPOS Accreditation DelayWith nine senators deciding to reverse course after a week-long congressional recess, the U.S. Senate finally passed the AOA-backed Medicare Improvement for Patents and Providers Act (H.R. 6331) on July 9th. The bill, backed by AOA and a national coalition of provider and patient groups, would avert massive cuts in Medicare physician reimbursement over the next 18 months and provide positive payment updates through 2009 to be funded through reductions in subsidies to Medicare Advantage plans. The measure also contains a provision to block implementation of an unfair DMEPOS accreditation regulation that has been strongly opposed by the AOA. The Senate’s action is a key step toward ending months of uncertainty for ODs, MDs and other providers. As key votes in Congress approached, the AOA Washington office issued a series of legislative action alerts – including some directed at attendees at Optometry’s Meeting® in Seattle – urging optometrists to contact their senators in support of the legislation. Bolstered by AOA Federal Keypersons Leaders, volunteers and staff from state associations mobilized effectively and helped get optometry’s message to Capitol Hill. In remarks on the Senate floor on June 26, Senator Harry Reid (D-NV), the Majority Leader and key backer of H.R. 6331, specifically recognized AOA as a supporter of the bill. H.R. 6331 would eliminate the imminent 10.6 percent cut in Medicare payments to doctors and prevent the 5 percent pay cut scheduled to begin Jan. 1, 2009. The bill would also extend the 0.5% positive payment update in effect since January through December 31, 2008 and provide a positive update of 1.1% for 2009 while blocking implementation of a proposed DMEPOS accreditation regulation, which would be overly burdensome on optometry. The key Senate vote was 69 to 30 to end a Republican-led filibuster, with decisive votes cast by Senator Edward Kennedy (D-Mass.), returning to the Senate for the first time since he began treatment for a brain tumor, and a group of Republican senators identified by AOA and other groups as potential supporters of the bill. In the end, nine Republican senators – Mel Martinez of Florida; Saxby Chambliss and Johnny Isakson of Georgia; Arlen Specter of Pennsylvania; Lamar Alexander and Bob Corker of Tennessee; Kay Bailey Hutchison and John Cornyn of Texas; and John Warner of Virginia -- changed previous “NO” votes to “YES” votes after hearing from ODs and other providers from their home states during Congress’s week-long ‘Fourth of July’ recess. Last month, H.R. 6331 overwhelmingly cleared the U.S. House by a vote of 355 to 59. However, the White House and some Senate Republicans opposed the bill, in part because of its payment reductions to Medicare managed care plans. President Bush has vowed to veto H.R. 6331, though as of July 10, the White House had not made a formal announcement. The AOA Washington office notes that the Senate and House margins indicate that there is sufficient support for a veto to be overridden. Nevertheless, on behalf of ODs and their patients, the AOA has called on the President to sign the bill without any delay. The July 9 Senate victory was a remarkable turnaround from the devastating single vote defeat on June 26th. However, the week-long national lobbying by the AOA as well as other provider and patient groups was recognized to have made an important difference. “The Senate vote is a victory for our profession and our patients,” said Jerald Combs, O.D., chairman of the AOA Federal Legislative Action and Keyperson Committee. “The AOA Advocacy Group thanks our affiliate leaders, volunteers, members and staff as well as our Federal Keypersons who responded immediately to the Washington office’s call-to-arms on H.R. 6331. We had 10 days to gain votes, and we did it.” The AOA Federal Keyperson Program — optometry’s grassroots network of doctor advocates— was activated through urgent alerts from the Washington office. Keypersons, AOA volunteers and concerned ODs and students from across the country all got involved and called the Capitol Hill switchboard asking to be connected to the office of their senators. In addition, working with affiliate leaders in Florida, Georgia, Pennsylvania, Tennessee, Texas, Virginia and other states, the AOA worked to do its part to convert several June 26th “NO” votes into “YES” votes on July 9th. “Hopefully, with the additional time that passage of H.R. 6331 affords, Congress will begin to work on a long-term solution to the broken Medicare-SGR payment system without having to again resort to a temporary fix”, notes Michele Haranin, O.D., chair of the AOA Federal Relations Committee. AOA Fights Use of DEA Numbers to Identify E-Prescribers AOA learned that some of the 'free' programs for e-prescribing (Allscripts (eRx)) and other e-prescribing software manufacturers were requiring prescribers to provide a Drug Enforcement Administration (DEA) number in order to utilize the software, despite an April 2 directive from the Centers for Medicare and Medicaid Services (CMS) stating that the National Provider Identifier (NPI) be used to identify individual health care providers in e-prescribing transactions. After receiving complaints from optometrists, the AOA Washington Office, utilizing the Summary - Legend Drug Prescriptive Authority for Optometrists created and maintained by AOA State Government Relations Center - began a pro-active campaign to reach-out to e-prescribing software companies and discern why DEA numbers were the chosen provider identifier method despite the CMS directive that the NPI be used as the provider identifier. The AOA also informed the software companies that the AOA, CMS and the DEA were all in agreement that DEA numbers should only be required for prescriptions involving controlled substances. Within the last week, the AOA has learned that at least one e-prescribing software provider has reversed course and another has committed to a workable fix by the end of the summer. After working closely with the AOA, RCopia, the makers of the DrFirst e-prescribing software, agreed to change their policy and announced that they would no longer require DEA numbers for providers. Allscripts, the makers of eRx, has informed AOA that they will have a workable fix no later than August 31. The AOA will continue to reach-out to the providers of e-prescribing software technologies and those implementing their systems. With lawmakers moving in the direction of e-prescribing mandates, such as the provision included in the pending Medicare package (S. 3101) which aims to provide financial incentives to doctors who move to e-prescribing and penalize those who fail to do so by 2011, it is crucial that optometry be fully included in all e-prescribing initiatives today.
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R. Norman Bailey, OD, MPH, UHCO Professor, and Harris County Optometric Society member, has been selected as the recipient of the prestigious American Public Health Association Vision Care Section 2008 Distinguished Service Award (sponsored in part from a Vistakon grant) for his significant contributions and exceptional commitment to promoting and protecting the public and visual health of the nation and internationally. 
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