Prescription writing privilege: Use it or lose it?

Issue: February 1997

ByJoseph Hoffman

Operation Optometry Prescribe What's all this about denying payment to practitioners who diagnose conditions without treating them? Why did the Health Care Financing Administration (HCFA) feel it necessary to restate a Medicare rule on the matter late last year, as reported on page 4 of this issue ("HCFA regulation addresses medical necessity of diagnostic testing")? It might just be the first stab at cutting out non-MD practitioners from reimbursement for services they are qualified and authorized to provide.

No need to panic

Let's first be clear that, as explained in the article by correspondent Bob Kronemyer, the rule published in the Federal Register is not a new policy. Furthermore, diagnosis without treatment happens all the time — it's called referral. The HCFA policy does allow payment for diagnostic testing by a referring practitioner as well as for additional testing required by the practitioner receiving the referral.

The publication of this policy, however, is an amplification that might discourage a non-MD from participating in the diagnosis and care of conditions for which there are treatments beyond his or her scope of practice. That is, maybe someone would like you to think you must refer that patient immediately rather than doing the initial evaluation. This could be the thin part of a wedge that someone out there hopes to slip between ODs and their primary eye care duties.

Optometrists achieved parity in Medicare and in managed care plans because they promised economical delivery of high-quality services to a wide geographic distribution of patients. Third-party payers will consider this promise unfulfilled if someone manages to show optometry acting more as unappointed gatekeeper than primary care giver.

When large numbers of a health care profession routinely relinquish their role in patient care following diagnosis, that profession starts to be seen as redundant by third-party payers. And if members of those professions find their reimbursement claims denied be cause referrals are followed by retesting, what incentive do they have to continue acting as primary care practitioners? Both edges of the sword could carve away the substance of primary care optometry practice.

Parry the attack

This attack can be parried if ODs use their hard-won therapeutic privileges to the fullest. If you diagnose conditions that your state authorizes ODs to treat, you had better be up to date on your therapeutic pharmaceutical agent (TPA) certification so that you can treat them. If proper treatment includes prescription pharmaceuticals, you had better write prescriptions (no samples!) and do your best to see that patients fill them.

So once again Primary Care Optometry News offers Operation Optometry Prescribe at your service. Directly opposite this page Dr. Bobby Christensen recaps the basics of prescription writing for those of you who haven't been exercising those skills. Our TPA Notebook this month presents a quick look at ophthalmic fluoroquinolones, the newest weapon in the antibiotic armamentarium. We hope this information helps new optometrists, optometrists in states with new TPA laws and optometrists who have been reluctant to use their TPA privileges to deliver the level of care that the profession may now deliver — and will be fully empowered to deliver as long as optometry exists.

For Your Information:
Joseph Hoffman is Editor in Chief of Primary Care Optometry News and can be reached by telephone at (800)257-8290, by fax at (609) 853-5991, by e-mail at jhoffman@slackinc.com and by mail at 6900 Grove Road, Thorofare, NJ 08086-9447.