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Clinicians, vendors outline shortcomings of contact lens prescription verification
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Eye care providers and industry representatives shared their experiences with the contact lens verification system, as outlined by the Contact Lens Rule, during an FTC-sponsored workshop on "The Contact Lens Rule and the evolving contact lens marketplace" last week.
Before hearing statements from presenters, attorney Elizabeth Delaney, of the Bureau of Consumer Protection, outlined the current guidelines as established by the Fairness to Contact Lens Consumer Act in 2004.
A contact lens vendor may only sell lenses in accordance with a prescription that is presented directly to the vendor or verified by direct communication, she said.
A prescription is considered verified if the prescriber confirms that it is accurate by responding to the seller, if the prescriber informs the seller that the prescription is inaccurate and provides the accurate information, or if the prescriber fails to communicate with the seller within 8 business hours after receiving the request – known as passive verification.
Cynthia Williams, general counsel at 1-800 CONTACTS, said the company has current prescriptions on file for 40% of their orders.
“We would like to process more orders with the actual prescription,” she said. “This means customers can get their lenses faster.”
For verification, 1-800 CONTACTS use a system called human-initiated voice response, she said. Each call is initiated by a live customer service agent who confirms the call is received by the right person and office. Next, a recorded voice is used to convey the script and patient information, “because it is more likely to be accurate and more reliable,” she said.
Call time is just about 2 minutes, she said, but can vary based on whether it is answered live or the information is left as a voicemail.
“It’s the gold standard for Contact Lens Rule compliance certification,” Williams said.
1-800 CONTACTS’ records show that prescribers are asked to verify about one order per week from the company, she said.
“Prescribers often hang up on our calls rather than taking advantage of the option to hold or having our system call back later,” Williams said. “While the call is coming from 1-800 CONTACTS, it’s the patient who is asking for 2 minutes to verify a prescription.”
If a prescriber says the customer is not their patient or the prescription is expired, the order is canceled, she said, and the error rate is relatively low. Of the 60% of orders going to verification, the majority are passively verified.
Jennifer Sommer, director of U.S. Ethics & Compliance at Walmart Inc., explained that if a patient requests contact lenses from Walmart and does not have a prescription on hand, he or she fills out a form containing all information necessary for verification.
Opticians will then contact the prescriber’s office to confirm the fax number and fax the form to the prescriber. If the prescriber does not respond to say it is invalid or incorrect, the opticians will dispense the lenses.
Sommer said Walmart completed an informal survey among 40 vision center managers in 15 states, where they found the verification process does not serve patients in the way they want. Most opticians will call the prescribing office while the patient is in the vision center.
“They find that is more effective to ensure a valid prescription and that they have all parameters needed,” Sommer said.
Shaun Schooley, vice president of LensFerry, discussed its contact lens reorder system, which allows a prescriber to offer their patients an email-, web- and mobile-friendly reorder capability through the prescriber’s EHR data.
LensFerry acts as an intermediary between the doctor and patient for the sale of contact lenses.
“It opens up a convenient, simple way for patients to be able to access products the way they like to purchase, through any channel,” Schooley said.
Providers set their own prices for the lenses and usually base them on sellers’ prices online, he added.
“Consumers are probably more empowered now than they’ve ever been. There’s a lot of transparency in price,” Schooley said.
David Cockrell, OD, FAAO , a private practitioner and past president of the American Optometric Association, said the verification process as it stands now is ineffective, does not work and is a one-way system.
“Every doctor gets contacted virtually every day by a seller with a prescription that is expired or incorrect. When we try to re-contact the entity that sent it, there is no way to do that. It’s a one-way issue,” Cockrell said.
He said that with a pharmacy, in terms of any question about a medical prescription, “I’m able to get ahold of them. I can’t get ahold of a contact lens reseller. No, I don’t think the system works.”
Some retailers, such as Hubble, say to get back to them within 48 hours, but the rule is 8 business hours, he said.
“It’s intentionally misleading to a provider and the staff. There’s a variety of problems,” Cockrell added.
Prescribers have no way of knowing whether or not the prescription was filled, he said.
Also, many robocalls that come through to his office are impossible to understand. Cockrell suggests written requests to correct this issue.
Clinician Thomas L. Steinemann, MD, agreed that robocalls are a big problem.
Steinemann receives five to 20 requests per week across the sites where he works in Ohio. He is professor of ophthalmology, MetroHealth Medical Center, Case Western Reserve University in Cleveland.
The verification framework is insufficient and is not properly enforced, he said.
Steinemann conducted his own informal survey and found that in the MetroHealth system there is an error rate of 50% to 60%, and at his private office sites there is a 25% error rate.
He sees four main sources of error with contact lens verifications:
expired prescriptions;
patients with no patient record;
inaccurate prescription, such as errors in transcription; and
people who are either not approved for a contact lens fitting, did not complete the fitting process or don’t have a prescription and are trying to get one.
Steinemann and Cockrell agree that the patient name, address and date of birth should be used on all verification requests to quickly and simply locate a patient record.
They both suggest that requests take longer than 2 minutes and prescribers should be allowed more time to reply.
“Technology has come a long way,” Schooley said. “In verification, errors can be introduced because of verbalization of complicated parameters and data points ... the FTC should take an open-minded attitude to digitize these things ... that would be a positive step forward.” – by Abigail Sutton
Disclosures: Cockrell is a diplomate of the American Board of Optometry. Delaney is employed by the Bureau of Consumer Protection. Schooley is employed by CooperVision. Sommer is employed by Walmart. Steinemann is a practitioner at MetroHealth Medical Center and professor at Case Western University. Williams is employed by 1-800 Contacts. No other financial disclosures were reported.