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BLOG: The role of optometry in a community health center
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Last week, I had the opportunity to visit the East New York Diagnostic and Treatment Center, a Community Health Center in Brooklyn, N.Y. This center is part of the New York City Health and Hospital Corporation.
The mission of this organization is to join with other health care providers and communities to extend quality health care equally to all New Yorkers so as to promote health, welfare and safety to all citizens. My purpose there was to visit the optometry program housed there and lead a site visit for the optometry residency program, sponsored by SUNY College of Optometry.
The five boroughs of New York City are like no other place in the U.S. that I have ever visited. According to recent census reports, there are almost 8.5 million people living in a land area of 305 square miles. Not only does New York City have the most population density in America, it is also one of the most culturally diverse, with more than 800 different spoken languages.
As such, the mission of the Health and Hospital Corporation (HHC) to provide quality health care to all New Yorkers is particularly challenging. For me, as a person interested in health care reform and, in particular, the role of optometry, this was an enlightening and interesting day.
I had the unique opportunity to have lunch with the medical director of the health center. This physician is a seasoned medical director in the health center environment, having been recognized by the National Committee for Quality Assurance with both the Physician Practice Connections Recognition Program and the Patient-Centered Medical Home Recognition Program every year since 2011. I asked him two pointed questions that lead to a very rewarding conversation.
The first question that I posed was about his thoughts on the Affordable Care Act (ACA). He reported that this law has had a very positive influence on the health center. There are more people coming to the center for routine and preventive care rather than just for urgent medical problems. There is also a marked increase in this patient population of having billable health care. Because of the mission of HHC, all patients are seen, regardless of their ability to pay. With the new law requiring everyone to have access to affordable care, many more patients have some form of health insurance.
Overall, he believes that the ACA has not been just beneficial to the health center, but to the community at large. The center has been able to change their culture from primarily the treatment and triage of urgent and emergent medical problems to an overall wellness program with an increased focus on health education and disease prevention.
My second question was more specific and more directed to my personal interest. The question was related to the role of the optometry clinic at the health center. Optometry services have been available at this center for more than 20 years, and I was interested to see if there had been a change with our increased scope of licensure and with our promotion to being essential to the primary care team by the ACA.
He noted that he had not been the medical director at this clinic over that whole time period, but was a veteran of other health clinics and was well aware of the changes related to optometry. He reported that initially optometry was more of an adjunctive service, providing refractions and vision care as a convenience to patients otherwise at the center. As the program evolved, the physicians in the general medical clinic as well as the pediatric clinic began to respect the role of the optometrists to accurately detect systemic medical problems during the eye examination. This demonstrated competence in medical care led to an increased confidence in the optometry group to be able to follow diabetics and patients with other chronic medical problems and to manage related eye complications.
As a final step to collaborative care, the center instituted a “same day” policy that allowed for patients to flow back and forth between the optometry service and the medical clinics. The doctor went on to say that the optometry clinic is now part of the mainstream primary care team.
My visit to the health center was a very positive and enlightening experience. It validated my premise of this series of blogs that optometrists can indeed “step up” to a primary health care role and when they do so, the medical community accepts them with open arms.
My new friend seemed to think that the role of optometry in his clinic was rather unique, and I was pleased that he enjoyed some ownership in this strong optometry program. However, as a member of accreditation teams for almost 20 years and having seen many optometric residency programs in Veteran Administrations and hospitals all across the country, I find this program was more typical of optometry programs within a medical environment. That said, I was thrilled to see this model work so well in the unique health care challenge of New York City.
In the immortal words of Frank Sinatra, “If you can make it there, you can make it anywhere. It’s up to you…” And Ol’ Blue Eyes is correct – it is indeed up to you.