"Please explain how VSP can justify reimbursing California optometrists 19.7% more than optometrists practicing in Texas, or in any other state, for performing the same eye examination (including dilation).
VSP is exhibiting geographical discrimination among providers practicing outside of California which is unacceptable.
Example:
VSP Allowed Amount (Brown County, TX) VSP Allowed Amount (Seaside, CA)
------------------------------------------------- = ------------------------------------
Medicare Allowed Amount (Brown County,TX) Medicare Allowed Amount (Seaside,CA)
(Brown County, TEXAS 43.9%) DOES NOT EQUAL (Seaside , CALIFORNIA 59.0%)
Note: Please refer to your Algebra I book under Ratios and Proportions.
If VSP’s methodology was fair as Medicare, the VSP-to-Medicare ratio of Texas optometrists would be equal to the VSP-to-Medicare ratio of California optometrists. Therefore, optometrists practicing in Brown County, Texas would be receiving $80.78 rather than $67.50 for performing an eye examination which includes dilation.
How Medicare Reimbursement is Calculated
Each CPT® code has a Relative Value Unit (RVU) assigned to it which, when
multiplied by the conversion factor (CF) and a geographical adjustment (GPCI), creates the
compensation level for a particular service. The Relative Value Unit (RVU) consists of Physician work RVU, Practice Expense RVU, and Malpractice RVUs.
Geographic Practice Cost Indices (GPCI) - Geographic Practice Cost Indices account for the
geographic differences in the cost of practice across the country. CMS calculates an individual GPCI for each of the RVU components -- physician work, practice expense and malpractice.
GPCIs are reviewed every three years.
How VSP Reimbursement is Calculated
Behind CALIFORNIA closed doors.
