Help Fee-For-Service Medicare Beneficiaries Access Eye Exams

Medicare has covered an annual diabetic eye exam by an optometrist or ophthalmologist since 2002. Unfortunately, most people with diabetes do not get that exam because it requires them to make and attend an extra doctor visit. Now, there’s a way to get that annual exam in the primary care setting that’s proven to help people get their eye exam - except it’s not available to everyone.

No Access in Primary Care Settings

Fee-For-Service Medicare beneficiaries cannot get an exam in the primary care setting because of a Medicare policy (one that’s not mandated by law) that says only an optometrist or ophthalmologist may conduct a diabetic eye exam. This rule is outdated in this era of telemedicine. Diabetic retinal exams can be safely and effectively performed in primary care settings by utilizing digital retinal imaging with remote eye specialist interpretation. In this exam, primary care providers use a special camera to acquire high resolution retinal images, which are then sent electronically and evaluated remotely by board-certified, state-licensed ophthalmologists. Then, if there’s indication of a problem, the beneficiary can follow up with an in-person visit with an ophthalmologist.

Eye Exams for Beneficiaries Who Live in Rural Areas or Cannot Access a Second Appointment

Now, imagine you live three hours from the nearest doctor. Chances are you’d at least make the trip go once a year to your primary care provider to make sure everything is ok, right? But how likely is it that you’d go back a week later to follow up? Not too likely. When a beneficiary gets their eye exam provided in primary care, they don’t need to go back unless there’s a problem indicated. The numbers speak for themselves: evaluating retinal health in primary care settings during regular office visits achieves up to 90% diabetic retinal exam compliance in a single year.

By The Numbers

Here are some more numbers: Diabetic retinopathy is the leading cause of vision loss and blindness among adults 20 to 75 years of age, and will soon be an even bigger problem within the Medicare population. According to the CDC, 25.2% of Medicare-aged adults had diabetes in 2015. The CDC predicts that these numbers will double or even triple by 2050. Additionally, more than 80% of people living with diabetes will eventually develop diabetic retinopathy. That creates a massive group of Medicare beneficiaries who are affected by diabetic retinopathy that will only increase in number as years go on. And, unfortunately, 24,000 Americans go blind from retinopathy each year, 75% of whom are Medicare-age. Luckily, with early detection, 95% of vision loss cases can be prevented.

Eye Exams for Some, but Not All

Fee-For-Services Medicare beneficiaries are missing out on this service, but other government programs have had great success implementing this digital retinal imaging with remote eye specialist interpretation. The U.S. Veterans Administration and the Indian Health Service have both used this model of care to significantly increase the percentage of diabetic patients who receive retinal exams each year. Additionally, 82% of patients in Medicare Advantage plans are currently covered for annual diabetic retinal exams in primary care settings. Fee-For-Service Medicare beneficiaries also deserve access to this convenient and effective vision-saving technology.

Take Action! Ask Your Rep to Support H.R. 6639!

H.R. 6639 would clarify that ALL Medicare beneficiaries with diabetes have access to annual diabetic retinal exams in primary care settings using digital retinal imaging with remote eye specialist interpretation. Ready to speak up for Fee-For-Service Medicare beneficiaries? Take action today!

Click here to send a letter to your representative asking them to support H.R. 6639 and give Medicare beneficiaries the care they deserve!