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ODs nationwide continue to fight for legislative gains in their states
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Despite some setbacks, optometric legislation continues to make headway throughout the country. Expansion of privileges and the defeat of restrictive legislation will continue to strengthen the practice of optometry nationwide.
Formulary committee eliminated
Hawaii was one of the last states to have an active optometry formulary committee, according to Brian Kubo, OD, immediate past president of the Hawaii Optometry Association (HOA). However, this committee was recently eliminated through a two-part law that took effect on July 1.
“Our goal was to get rid of the formulary committee, because ophthalmology was using it as a way of controlling what we could prescribe, no matter what our laws said,” he told Primary Care Optometry News.
The formulary committee, which consisted of two optometrists, two ophthalmologists and two pharmacists, had been divided on the issue of topical steroids since the passing of Hawaii’s original therapeutic pharmaceutical agent legislation, Dr. Kubo said.
“The steroids issue was basically hung up in the formulary committee,” Dr. Kubo said. “The optometrists voted for it, the ophthalmologists voted against it and the two pharmacists were split. So we were stuck sitting on the steroids issue for the past few years, even though they are not technically disallowed in our law.”
The HOA became aware that, in order for progress to be made in Hawaii’s optometric legislature, the formulary committee would need to be dissolved. They opted to “piggyback” a bill for expanded topicals with the proposed elimination of the formulary committee.
“We were successful at getting rid of the formulary committee this session,” Dr. Kubo said. “And we were able to expand steroids, with restrictions.”
Hawaii’s expansion of topical steroid use basically mimics that of California, Dr. Kubo said. “Initially, we tried to get it without restrictions,” he said. “But we compromised, and also gave up limited orals and injectables.”
Prior to the signing of the July 1 bill, the only topical anti-inflammatories permitted to Hawaii optometrists were non-steroidal anti-inflammatories (NSAIDs), Dr. Kubo said. “It was pretty much just Acular (ketorolac tromethamine, Allergan) and Voltaren (diclofenac sodium, Novartis),” he said. “Now, we have all topical ocular steroids.”
The expanded scope of practice did not draw heavy opposition from ophthalmology, Dr. Kubo said. But the elimination of the formulary committee did raise objections, he said. “Some of the ophthalmologists viewed the formulary as a safeguard for the public,” he said. “So that was more difficult. But the expansion part was not difficult to get through this year.”
Missouri kills detrimental bill
House bill 2162, which was recently defeated in Missouri, is the latest version of a bill optometrists have been battling for the past few years, said Kyle Brost, OD, president of the Missouri Optometric Association (MOA).
“Ophthalmology wants to push forward a piece of comanagement legislation that is detrimental to the practice of optometry and that we believe is needless and unwanted,” Dr. Brost said. “This is the same old stuff we have been fighting the past few years.”
Bill 2162 is the house version of Senate bill 1097, which died in committee earlier in 2002, Dr. Brost said. The bill essentially would regulate the practice of surgical comanagement and would require additional protocols for communication between optometrists and ophthalmologists.
The MOA argued that optometrists have been providing high-quality, comanaged postoperative care in cooperation with ophthalmologists for more than 15 years. The association further maintained that optometrists are specifically trained to provide postoperative care and that their ability to do so is recognized by Medicare.
Dr. Brost said the MOA is pleased to have once again defeated this legislation. “I am pleased that the wise members of the Missouri senate realized that this is a piece of legislation that they should not be wasting their time with,” he said. “I am pleased that the more astute members of the house fought to keep this legislation from being passed.”
Minor setback in Florida
Optometric law in Florida experienced a minor hindrance recently with the passage of legislation that would eliminate the “double gatekeeper” system, according to Ronald Foreman, OD, legislative co-chairman for the Florida Optometric Association (FOA). “The issue isn’t dead,” Dr. Foreman said. “But sometimes in politics, you have to accept reality, go home and come back to fight another day.”
The double gatekeeper concept referred to a system in which two entities, specifically the HMO organization and the primary care physician, determined referral patterns in an HMO setting. “Ophthalmology and optometry were not part of that scheme,” Dr. Foreman said. “But the ophthalmologists’ contention was that primary care physicians were not allowed to send patients directly to an ophthalmologist under the double-gatekeeper system.”
The ophthalmologists further maintained that, under this system, patients were being sent to optometrists exclusively, Dr. Foreman said. “That’s false,” he said. “Some plans required optometrists to be gatekeepers, and some required ophthalmologists.”
As a result of the perceived imbalance of referrals, Florida ophthalmologists proposed eliminating “HMO organization” from the law, so that the referral power would be entrusted entirely to the primary care physician.
“It seemed likely that a medical doctor would most likely refer to another medical doctor, because the relationship between ODs and the militant faction in medicine in Florida is venomous,” Dr. Foreman said. “So, our contention to the legislature was that this is going to result in unnecessary referrals to ophthalmologists for cases that optometrists could handle. It would drive the cost of health care up.”
Dr. Foreman said although optometry had enough votes to kill the bill, its inclusion with other issues enabled it to pass. “They put every issue together in a special session. All of the issues were lumped together,” he said. “If we had killed it, we would have killed every one of the governor’s issues.”
Dr. Foreman admitted that he was disappointed in the legislative process that led to the bill’s passage. “We were disappointed in the way the process was handled, because, basically, it was the executive branch of government telling the legislative branch what they were going to do,” he said. “We couldn’t even have our issue debated or offer amendments. The system was just closed.”
However, Dr. Foreman maintained that the FOA has every intention of revisiting the issue in the next session. “We will try to remedy the situation next year, because the votes to kill the bill outnumbered the votes for its passage,” he said. “We have every confidence that we will be able to eliminate the bad language from the bill, because the consumer is the loser.”
For Your Information:
- Brian Kubo, OD, is the immediate past president of the Hawaii Optometric Association. He can be reached at 95-1028 Akaluli St., Mililani, HI 96789; (808) 395-6578; fax: (808) 394-3337.
- Kyle Brost, OD, is president of the Missouri Optometric Association. He can be reached at 37 Doctors Park, Cape Girardeau, MO 63703-4927; (573) 334-1034; fax: (573) 335-1934.
- Ronald Foreman, OD, is the legislative co-chairman of the Florida Optometric Association. He can be reached at 1387 South First Street, Lake City, FL 32055; (386) 752-1714; fax: (386) 755-1858.