BLOG: Take a closer look at alternate eye care delivery

ByScott A. Edmonds, OD, FAAO

Eye care has traditionally been delivered in a doctor’s office. Although the setting has changed over the last century from only the classic “private office” setting to include shopping mall locations and retail store environments, the model was basically one of a patient going to the doctor’s practice location. Part of this relationship was due to the need for the heavy equipment related to the refracting lane. There have always been some unique versions of eye care as in a hospital, health care clinic or other interesting location, but, again, usually the patient came to see the eye doctor.

In today’s evolving health care reform market, there are changes afoot that traditional eye doctors need to at least understand if not to actually consider for participation. One of the key principles of health care reform is “primary care.” We have discussed the fact that eye doctors don’t quite understand primary care and how it relates to eye care in spite of optometrists being identified and in some cases paid to provide primary care services. The principle requires that the majority of the population see a primary health care provider and have a basic health care review that looks at family history and review of symptoms and collects basic vital signs. This is followed by health education and a long-term management plan for long term wellness.

The interesting feature here is that the principle does not require that the patient visit the doctor to achieve this. In fact, many more people can be seen and their health care data entered into the system if the doctor goes to the patient. This was the primary driver for the success of mall-based eye care – the doctor’s office moved to the location of the people. With today’s technology and Internet-based communication, the barrier of the clunky eye care equipment has disappeared. High-tech examination lane and testing equipment are quite portable and can be moved to where big blocks of patients can be examined and managed in their own locations.

One of the big lessons that I learned in this area happened when my older son graduated from optometry school and spent a year in rural Alaska flying from village to village to provide eye examinations and eye wear to native American children. His ability to reach out to provide these basic health services in a comfortable, convenient setting was remarkable and made me re-think the type of delivery systems that are required to truly have a primary care-based health system.

The Affordable Care Act may have operational and political issues, but a positive aspect for those of us in eye care is the recognition that all children require good vision for proper development and learning. As such, the law now requires a basic eye examination as an essential element of any health plan. The law, however, does not require that the patient must visit the eye doctor.

A number of new eye care delivery models are popping up around the country. These programs are delivering school-based comprehensive eye examinations and vision correction. And they are going directly into the school systems to deliver this care. A mobile vision and eye care unit comes into each school and sets up in the gym or other appropriate space. The children come through the unit during lunch or study hall or some other down time so as to not disrupt their daily routine. These programs require much advance work often provided by the school nurse or other school-based personnel in coordination with the mobile staff. Health benefits are verified, parental approval is obtained, schedules are coordinated and the programs are executed with quality and precision. This may not seem possible to some readers, but coming from a generation that grew up watching M*A*S*H, we learned that health care is not about a place but about caring and competent providers.

I bring this information to those of you who read these blogs to give you food for thought and to plant the seed of an opportunity for any optometrist that might be looking for a creative new opportunity to grow the medical aspect of a “traditional” practice. Many of these programs are looking for local medical directors to follow up on the pathology and abnormal findings. Being mobile, the day after the event is complete, the unit has moved on. These programs need community-based eye doctors to follow up and manage the problems that have been identified. These programs are willing to partner with local eye doctors to complete the cycle of quality care. It is not useful to identify problems if there is not a mechanism to resolve them.

These alternate eye care delivery models are growing rapidly. Some states even require them as part of a comprehensive eye care plan. Other alternate programs, such as pharmacy-based kiosks and community-based health fairs, often screen for chronic eye problems such as glaucoma, diabetic retinopathy and even uncorrected refractive error.

These alternate programs are not a threat to the traditional practice of optometry. For the enlightened and creative provider, they are a huge opportunity to expand your reach, spread your influence and build your practice. In addition, all this can be achieved while doing your part to improve our nation’s health by increasing the number of citizens that will receive primary care services.

Don’t wait for these groups to coming knocking on your door. Reach out to them and help them meet their objectives and reach their full potential by providing that community-based anchor for the continuity of eye care and communication with the family physician to close the loop with comprehensive health care for chronic medical problems.

Health care reform is providing so many opportunities for optometry that it is truly hard to keep up. Change is often seen as threatening or to some even catastrophic, but to those willing to evaluate, compromise and look at the long-term advantages, the opportunities are endless.