Is PQRI really the future of Optometric Billing?

As I was scanning the web, like I always do, looking for information on optometric billing, I came across a letter from the Massachussettes Society of Optometrists to its constituent members ( You can view the letter for yourself by clicking here).

This letter was written in 2007 and outlined the basics of the PQRI program for Optometrists, such as yourselves, in order to make it easier to understand the program and also the procedures one should take when submitting claims containing PQRI codes to Medicare. The funny thing about this letter is that the person writing it and the group he or she represents believe that PQRI coding will be the future of billing; and I quote "This process is voluntary through the end of the year. However, in the future, such reporting is expected to be required by all insurers as they each implement pay-for-performance programs. Please become familiar with these billing-and-coding methods now!"

Now, it is not that I don't believe in paying someone based on their performance but can it be speculated that paying a physician, a specialist at that, based on their performance is a slippery slope in terms of the quality of medical care that one receives?

Here is an example of my thought process. As an optometric billier myself, I know that many high volume optometrists are forced to code their claims after the exam and other procedures have been performed, rather during the time that services are being rendered, because it is necessary in order to save time. On average, this process can add 1-2 hours to a normal work day. Now factor in PQRI reporting and you are adding another 30 minutes or so to that entire process.

The added work of PQRI coding forces a physician to have to do one of two things. Either decrease the amount of patients that he sees in a day or decrease the amount of time he spends with each patient. Most physicians are forced to do the latter because adding 5 or so more patients to the work day only incrementally increases the amount of added work at the end of the day but it substantially increases the over all gross profit for the work day. In other words, added requirements raise the cost of healthcare because they inversely affect the quality of healthcare rather increase the quality of healthcare as programs such as PQRI have been intended to do.

I want to be very clear that I AM NOT SAYING THAT OPTOMETRISTS ARE BECOMING GREEDY. In fact, that is not even close to the truth. I am saying, however, that if PQRI reporting is to be the future of optometric billing one should make sure that their patient's quality of care does not suffer as a result. There are many ways to do this and one of the most fantastic is to consider outsourcing your optometric billing functions. Why? Because outsourcing is a low cost alternative to hiring an in house person or persons to perform the same functions. Also, it allows those that are members of your group or practice to focus solely on maintaining a high standard of care and it alleviates the overall workload on what I am sure is an already, much too busy staff. Remember, "Anything that you spend money on to save time saves people, and people time is the most expensive part of any practice".

As for PQRI, if you are an optometrist and you are not participating as of yet, this is the last year you can do so and receive incentive payments in return. For more information, visit the cms website at: http://www.cms.hhs.gov/pqri/ and http://www.massoptom.org/images/customer-files/PQRI_Overview.pdf. I am sure your local Optometric Society will have information as well. You can also contact RLR Consulting by clicking here. Any one of these sources can help to steer you in the right direction.

By the way, do you really think PQRI should be the future of Optometric Billing? Post your comments and let the world know what you think!
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Andrew Roy owns and operates RLR Consulting which specializes in Optometric Billing. For more information, please visit their website at: optometricbilling.rlrbillingsolutions.com