Dr. Starkey (second from right as you look at photo) with the other doctors in her practice. Dr. Starkey says the practice is taking a proactive approach to evaluating how best to offset the impact of Medicare cuts.
Planning for likely Medicare reimbursement cuts.
By Belinda R. Starkey, OD
April 2, 2025
Medicare reimbursements to ODs and other healthcare providers are likely to decrease this year.
Despite extensive efforts from AOA, ODs and students, as well as other coalition partners across the health care industry, Congress failed to include legislation in the March spending legislative package to stop the 2.8 percent cut impacting doctors of optometry and other Medicare providers.
While Congress did include AOA-backed language in the 2024 year-end spending package that would have stopped most of the cut, nearly all healthcare-related provisions were removed from the larger package before it was passed and signed into law.
Here is an update on what Belinda Starkey, OD, shared with ROB last year about how she and her practice partners are managing the potential negative impact of Medicare cuts.
Reevaluating Approach to Managing Low Reimbursements
My partners and I are analyzing how to best counter the lower valuation we receive from not only Medicare, but from vision benefit managers. We weren’t really sure how much the cuts from Medicare would affect our business, but dealing with insurance companies often feels like we are in a race to the bottom.
Stagnant or decreasing reimbursements create pressure on our clinic to increase patient volume daily to compensate for reduced revenue. This is a significant challenge and, if not managed properly, can lead to patient dissatisfaction.
Additionally, the costs associated with staff and clinic operations continue to rise. Health care practices across the country are facing these same challenges and we need to adopt innovative solutions to ensure growth and patient access to the care they need and services they seek.
This realization prompted a reevaluation of our approach, leading us to explore various avenues to counteract these financial pressures and maintain the profitability of our practice while maintaining our high standard of patient care and delivering the services our patients seek.
Specifically, we undertook a comprehensive evaluation and revision of our professional fee structure to ensure that our services are accurately priced based on their true value. Additionally, we incorporated procedures and technologies not covered by insurance plans into our practice. This expansion of treatment options and revenue streams has bolstered our financial stability.
Undertaking Comprehensive Evaluations of Vendor Partners
We also conducted a thorough evaluation of various vendors by meeting with their representatives. We visited doctors who were utilizing the technology to inquire about its reliability, customer service and the necessity and provision of consumables, among other aspects.
My partners and I then carefully weighed the pros and cons to select the most suitable technology for our patients and practice.
Assessment of Treatment Modalities & Implementing Staff Training
We proceeded with the purchase of the necessary equipment and allocated resources toward the comprehensive training of our staff members to ensure proficiency in the implementation of these new technologies.
Many companies offered on-site training and implementation services as we integrated new technologies. Certain companies provide certification training for staff members, tailored to the complexity of the technology. Additionally, we utilized various online educational opportunities.
Our office is genuinely efficient and successful because of our incredible staff. Their hard work and dedication are what keep us on track daily. It’s clear that continuous improvement and education play a significant role in maintaining this level of efficiency.
With this in mind, we strongly advocate for the pursuit of paraoptometric certification. This not only enhances our professional skill set, but also solidifies our commitment to excellence. This helps us seize the opportunity to grow individually and collectively, ensuring our office remains at the forefront of service and care.
Updating Fees
We conducted a thorough system-wide review to evaluate the fees associated with exams, contact lens fittings, ophthalmic lenses, frames and ancillary testing procedures. Our review encompassed all areas that had not been assessed recently to ensure comprehensive analysis.
We recognized that it had been several years since our last fee update. Due to the significant disruptions and necessary adjustments caused by the pandemic, we postponed our regular business reviews. Consequently, we recently revised most of our prices to account for various factors.
However, increasing prices where reimbursement is capped by insurance does not substantially benefit us and primarily affects the small percentage of private-pay patients we serve.
Adding New Services
We introduced intense pulsed light (IPL), low level light therapy (LLLT), radiofrequency (RF) for dry eye, radiofrequency microneedling for aesthetic purposes and Neurolens. All are considered out-of-pocket expenses.
We also now offer a range of products for purchase in-office, including clean makeup, cleansers, dermatology-grade skin care, nutraceuticals and pharmaceuticals.
The rapid adoption of dry eye treatments and Neurolens can be attributed to the pressing needs of our patients. Many endured these issues for a considerable time before seeking our expertise. Consequently, when we provide a novel solution that they haven’t yet explored, they are highly inclined to pursue it.
We also expanded our aesthetic service offerings to further enhance patient care. Notably, we now provide neurotoxin injections with Xeomin as an additional private-pay option for patients. We introduced this service through a discounted launch at an open house event before transitioning to standard pricing.
We added two associates to accommodate the increased patient volume that we are generating thanks to our enhanced service offerings.
Keeping Our Patients In the Loop
We inform our patients about the expansion of our treatment capabilities, ensuring comprehensive education across our entire staff—ranging from front desk personnel to medical staff and opticians—about the newly introduced procedures or technologies. This strategy ensures that every member of our team is equipped to address patient inquiries effectively, thereby cultivating patient interest in our new or expanded services.
Occasionally, a patient may express dissatisfaction regarding the cost of services not covered by their insurance. In anticipation of such scenarios, we proactively communicate with patients prior to their appointments about any expenses they may be required to cover out-of-pocket.
Continuing to Assess Need for New Investment & New Staff Training
We believe it is essential to periodically reassess our professional fees to avoid stagnation, so we plan to continue this practice. The services and technologies we introduced will be maintained as permanent offerings for our patients, ensuring they continually benefit from the latest advancements in care.
Advocacy Continues
The AOA says that it and other physician organizations will continue to increase the pressure for the inclusion of H.R. 879, the Medicare Patient Access and Practice Stabilization Act, in the upcoming budget reconciliation package expected sometime during summer 2025.
The AOA is asking ODs to continue outreach to their Members of Congress on this issue by visiting the AOA Action Center and completing this action alert urging Congress to include this fix in the upcoming reconciliation package. Also be on the lookout for additional action in the coming weeks on this critical issue.
Belinda R. Starkey, OD, is a partner with Parenti•Morris Eyecare, a two-location Vision Source practice in Rogers and Bentonville, Ark. To contact her: Drstarkey@parentimorris.com
