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Optometry Australia has recommended that the 10 contact lens items on the Optometry Medicare Benefits Schedule (OMBS) be amalgamated into three, without fee changes for any service, for more consistent and easier claiming.

This was one of four recommendations the organisation put forward in a proposal to be considered at the Optometric Benefits Consultative Committee meeting on 5 June.

The organisation also recommended altering the wording of explanatory notes for contact lens items to make clear that a service is rendered when a prescription is issued, regardless of whether lenses are purchased.

It was recommended to alter the wording of item 10905 to cover consultations provided on referral from medical doctors.

In a separate proposal, Optometry Australia recommended an increase to the domiciliary loading benefit.

National policy manager Skye Cappuccio said Optometry Australia was clear in its intentions for streamlining the OMBS.

‘These recommendations are needed to align the OMBS with modern clinical practice. We need to amend the OMBS in an effort to cut red tape, reduce unnecessary complexity, and support optometrists to consistently interpret the intent of each item,’ she said.

Prescribing

Merging 10 items into three for contact lens fittings would make it easier, clearer and more transparent for optometrists and their patients, Optometry Australia argues.

The current 10 items listed on the OMBS for contact lens fittings range from 10921 to 10930.

‘We are proposing to merge items of the same fee value without changing the fee charged, so there is negligible financial impact on patients, optometrists or the government,’ Ms Cappuccio said.

‘Many of the items have very few differences. For example, two items are identical except for a minor distinction between myopia (10921) and hyperopia (10922).

‘The wording is ambiguous for some contact lens fitting items, and some are rarely used throughout Australia. One item for example, 10926, was billed as few as 12 times nationally in 2013,’ she said.

Optometry Australia believes a clearer item structure will translate to a clearer message to patients. ‘The broader community will be better informed about which benefits they have access to and how often they are entitled to them,’ Ms Cappuccio said.

Merging items into three categories will facilitate greater transparency for administration purposes too, she said. ‘It will enable greater ease in determining patients’ eligibility for contact lens item benefits.’

In its proposal to the OBCC, Optometry Australia pointed to empirical evidence showing minimal use of items 10924, 10926, 10927 and 10929 for advanced contact lens fittings.

‘Amalgamating these four items into one would reduce unnecessary complexity and administration. Patients would be eligible based on a “clinical need” and entitled to the benefit only once in 36 months,’ Ms Cappuccio said.

Optometry Australia recommended retaining item 10930, for alteration to contact lens prescribing, in its current state.

Explanatory notes

Optometry Australia addressed confusing wording relating to contact lens billing.

The organisation highlighted to the OBCC the inherent confusion in the wording of the OMBS explanatory notes that states: ‘The date of service is deemed to be the date on which the contact lenses are delivered to the patient.’

‘The current wording frequently leads to confusion for optometrists about whether the patient is entitled to Medicare reimbursement for being assessed and fitted for contact lenses if the patient exercises their right to have the prescription filled elsewhere,’ Ms Cappuccio said.

‘A review to clarify the intent of contact lens item descriptors would assist in helping optometrists to understand their billing obligations and patient eligibility for Medicare rebates.

‘We believe that it is in the best interests of the patient that it is clear to optometrists that they can charge a Medicare fee for their services when a full assessment and contact lens fitting takes place and a prescription is issued, regardless of where the patient chooses to have the prescription filled,’ she said.

Tabel 1 Lobby OBCC

Proposal to amend item 10905 for fairer remuneration

A survey involving Optometry Australia members has helped shape a proposal for fairer remuneration for optometrists when a medical practitioner refers a patient who has had their vision assessed in the previous two years.

The current Optometry Medicare Benefits Schedule (OMBS) billing structure restricts what optometrists can bill patients under these circumstances.

Currently, when a medical practitioner refers a patient who has attended another optometrist in the past two years, the patient is not eligible for a rebate for a comprehensive examination unless they meet specific criteria stipulated in items 10900, 10912, 10913, 10914 or 10915.

Consequently, patients who don’t meet those specific criteria are billed item 10907, which currently provides the patient a rebate of only $30.25. This means optometrists must accept a significantly lower fee despite providing a comprehensive examination.

Optometry Australia (formerly OAA) surveyed optometrists to measure the rate of referrals from medical practitioners, and of those referrals, how many were ineligible to be billed an item 10907 comprehensive examination.

The survey respondents examined a combined total of 7,255 patients, of whom 12.5 per cent were referred from a medical practitioner either verbally or in writing. Of these patients, four per cent were ineligible to be billed an item 10907 comprehensive examination.

As a result of the survey and other empirical evidence, Optometry Australia has recommended that the Optometric Benefits Consultative Committee change the wording of a Referred Comprehensive Initial Consultation (item 10905).

Optometry Australia has proposed (in italics) item 10905 to state: ‘… where the patient has been referred by another optometrist or medical doctor, where the patient is not eligible for a 10900, 10912, 10913, 10914 or 10915 and who is not associated with the optometrist to whom the patient is referred.’

Clinical policy adviser Simon Hanna said this change in wording would ensure that optometrists could be fairly remunerated when examining a patient who presented on referral but who had had their vision assessed in the past two years.

He said that many patients who were referred required a comprehensive examination but the current billing structure restricted what optometrists can bill patients.

‘The billing structure for optometrists does not meet the financial or time commitments required to properly assess a patient who is referred by a medical practitioner for a comprehensive examination, when that patient has attended another optometrist in the past two years,’ he said.

‘Many patients who are referred by a medical practitioner are eligible only for a 10907 rebate yet require a comprehensive examination including dilated fundus, pupil assessment, colour vision assessment and visual field screening.’

Optometry Australia’s recommendation to the OBCC reiterated the value of positive collaboration between doctors and optometrists.

‘Including the term “medical doctors” in item 10905 will allow for optometrists to be appropriately remunerated for their time and resources, and will create a clear referral pathway between GPs and optometrists,’ Mr Hanna said.

‘This may also have positive flow-on effects, reducing referrals to ophthalmologists of patients who could be seen by optometrists.

‘Given the changes suggested in the Federal Budget, a portion of the patients who have been billed 10907 might now be eligible for a 10900 if they are over 65 years of age. In this case, there would be no additional cost to Medicare,’ Mr Hanna said.

 

Increased loading fee could lead to more domiciliary care

More optometrists might consider providing domiciliary services to aged-care facilities and patients in their own homes if the Medicare fee were fair, Optometry Australia argues.

The organisation is proposing a domiciliary loading benefit fee of $71.00 for Medicare item 10931 (currently $24.75), $35.50 for item 10932 (currently $12.35) and $23.70 for item 10933 (currently $8.20).

Medicare item 10931 is applicable when treating one patient at a single location on one occasion; item 10932, two patients at the same location on one occasion; and item 10933, three patients.

The argument follows that better remuneration would result in more optometrists working in domiciliary settings, which would widen access to this kind of care, ensuring the service is sustainable.

In a separate proposal submitted to the Optometric Benefits Consultative Committee, Optometry Australia has proposed an increase to the Optometry Medicare Benefits Schedule (OMBS) domiciliary loading benefit in a bid to counter the disincentives associated with providing domiciliary services.

The OMBS domiciliary benefit is an additional loading intended to account for travel and equipment transport that applies to optometrists visiting a patient’s home, residential aged-care facility or other institution.

Optometry Australia is adamant that the current benefit does not compensate for the time optometrists invest or the costs they incur in providing domiciliary services. The organisation has dedicated time and resources to conduct research with members about domiciliary services.

‘Domiciliary visits account for less than 0.5 per cent of total OMBS expenditure,’ national policy manager Skye Cappuccio said. ‘Our research shows that on average, the total cost incurred to an optometrist to provide a domiciliary service exceeds the MBS valuation,’ she said.

‘The inadequate domiciliary loading benefit is a clear disincentive for optometrists to provide this kind of care that—and I can’t stress this enough—is much-needed in residential aged-care facilities where there is a high prevalence of eye and vision problems.’

Optometry Australia has based its proposal to OBCC for a new domiciliary loading on quantitative and qualitative research it conducted with optometrists.

The organisation emphasised that it was seeking only an amendment to the domiciliary loading benefit fee for optometrists, not an amendment to the structure and application of it.

In presenting its case, the organisation outlined the benefits to community and government, and the difference that preventative investment in primary eye care can make.

Tabel 2 Lobby OBCC

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