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Primary care optometry: 'managing most conditions for most patients most of the time'
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CHICAGO – “We should all strive for the ability to independently take care of our patients without someone else telling us what we can and cannot do,” Peter Kehoe, OD, told attendees at the World Council of Optometry’s annual meeting here.
Dr. Kehoe is a North American representative on the World Council of Optometry Governing Board and a former American Optometric Association President.
“There’s a clear understanding of an obligation we have as optometrists in the developed world to understand the needs in the developing world and how we can contribute to make a difference in lives,” Dr. Kehoe said.
“The definition we should use for primary eye care is to be able to independently diagnose and treat and manage most of the conditions for most of our patients most of the time,” he said. “It’s also critical to use the phrase ‘from the cradle to the grave.’ It doesn’t mean leaving refractive services out.
“In 40 years in the United States, we shifted to a medical model,” Dr. Kehoe continued. “We’ve forgotten that the reason most patients come into our practices is to see better. Don’t give up the fact that we still, as optometrists, are the most qualified to provide vision care services to our patients: refractive care, binocular vision, low vision, contacts, vision therapy, comanagement.”
Dr. Kehoe provided a snapshot of the profession of optometry in four developed countries.
Australian optometrists now have the ability to prescribe, and by 2015 all new registrants in optometry schools must be therapeutically certified, Dr. Kehoe said.
“Medicare does not compensate optometrists who have become therapeutic,” he added. “They’re using the ability to prescribe as a practice builder. They’ve expanded their scope but are not being compensated.”
In the U.K., most of the medical care is being provided in hospital settings.
“The National Health Service endorsed the concept that having optometrists and other health care professions prescribe was a good idea as long as safety was paramount,” Dr. Kehoe said. “They thought it would speed access and care.”
Glaucoma treatment is only administered in the hospital setting, he added, so, “technically, optometrists are being paid to prescribe.
The majority of optometrists in Canada can prescribe, but they are not reimbursed for the treatment, according to Dr. Kehoe. They must bill the patient directly.
“They have the skills and ability, but is there access?” he asked.
“There may be some oversupply in urban areas, but an undersupply in rural,” he continued. “There’s a tremendous growth opportunity.”
In the U.S., it took 20 years for optometrists to get into the Medicare system. “We are treated equal to ophthalmologists regarding reimbursement,” Dr. Kehoe said. “The challenge is the limited definition in Medicaid.
“The biggest challenge is the ability to move from one state to the other,” he said. The concepts of endorsement and reciprocity have been adopted in different states.
“We have 50 different optometric laws,” Dr. Kehoe said. “There is no level licensure, no similar practice. We need to clean this up.”