ODs should be ‘team leaders’ in low vision

DENVER – The need for greater optometric involvement in, and improved reimbursement for, low vision services is crucial to providing the best care for patients, according to a presentation here at the American Academy of Optometry meeting by John Musick, OD, FAAO.

Dr. Musick's presentation was part of a Low Vision Section Symposium on the optometrist’s role in low vision.

"A recent National Board of Examiners in Optometry (NBEO) study found that most primary care optometrists are not providing low vision care," Dr. Musick said. "This is worrisome, because people are going to go somewhere for low vision services."

Others providing low vision services

Dr. Musick discussed some of the other types of practitioners who are currently providing low vision services. "Only a handful of optometrists are doing low vision, but a lot of other people are [providing these services]," he said. “In Kentucky, occupational therapists are providing low vision therapy, and they are being reimbursed for it. They can bill in 15-minute increments."

In addition, these occupational therapists in his state have become increasingly legislatively active regarding low vision privileges, Dr. Musick said.

"In Kentucky, occupational therapists tried to pass a law that was directly in contrast with the optometric law," he said. "They were not entirely successful. But they've been trying to encroach on Kentucky law."

Dr. Musick said he does not necessarily feel that occupational therapists should be altogether excluded from low vision, but he is concerned about their providing services for which they are not qualified.

"Personally, I'm OK with them doing activities for daily living and possibly training for some low vision classes," he said, "but I don't think they should do low vision exams, and I don't think they should prescribe low vision devices."

He also discussed some of the low vision services and products that are provided inexpensively by the Kentucky Office for the Blind. In addition, the Office for the Blind visits patients' homes, gives out magnifiers and sells low vision products at a very lost cost, he said. "They display, demonstrate and sell low vision non-optical as well as optical devices at just over wholesale prices," he said.

Reimbursement issues

Dr. Musick discussed some of the significant reimbursement obstacles he faces as a low vision optometric practitioner in Kentucky.

"Medicare does not specifically reimburse for low vision services by ODs or MDs, but it does reimburse for low vision services provided by occupational therapists," he said. Medicaid denies coverage across the board for low vision services, he said. "They deny coverage for low vision by optometrists, ophthalmologists and occupational therapists," he said.

He said for optometrists to take on the leadership role in low vision that should be theirs, such financial obstacles need to be removed. "It is not just the principle, it's the money," he said. "ODs should be the team leaders in low vision. We have the skills. But these reimbursement issues need to be resolved."