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BLOG: Collaborative care payment models for optometry
As one of the leading advocates for optometry providing primary health care in addition to traditional eye care, I am often asked how we will be paid for the additional services and administrative support that are required.
Primary health care, in addition to medical eye care, are going to be paid as part of several new programs that are part of health care reform. These programs include pay-for-performance, bundled disease state management, capitated risk arrangements and collaborative care. All of these payment models will require optometrists to provide and bill for medical services in a different way.
These changes will occur over a relatively long time frame and may roll out differently in each state and region of the country. This series of blogs has provided a number of suggestions on the things that optometrists should be doing today to prepare for these changes. Several of these editions should be reviewed to better understand this blog on collaborative care.
“The new team for optometry in health care reform,” “New delivery models for primary care optometry” and “Primary health care data points” will give you a good start.
One of the principles required for several of these payment models is collaborative Care. This is care that is provided between two or more unrelated providers and will require the sharing of electronic health data across a secure HIPAA-compliant platform and the active use of this data to improve the quality of care, lower cost and improve health outcomes.
One example of this would be an optometrist and a glaucoma specialist that share the care of a patient with glaucoma by maintaining a joint log of serial intraocular pressure readings with data tabulation and interpretation. This could also include communicating field tests and tomography reports on a shared web portal. Effective collaboration of care will increase per encounter reimbursement in a shared risk pool or may qualify for a different compensation as a diagnosis-driven bundle payment.
Collaboration between optometrists and ophthalmologists is an obvious example of this concept and should have every optometrist thinking about their referral patterns and working with ophthalmologists to develop the compliant electronic connections that are required for these new opportunities.
A newer and more provocative model will be the collaboration between the optometrist and the primary care physician (PCP) to increase access and promote earlier intervention in the management of chronic disease. This health care team can open all of the payment vehicles noted above as well as provide a classic model for a pay-for-performance program. Optometrists who are providing primary health care services as discussed in “Keeping an eye on your health,” can upload vital signs and other health data to the patient’s PCP. This procedure is as simple as a few keystrokes to send the data from an optometric EHR directly to the EHR of the patient’s physician. The data will flow through the ophthalmic portal of an ophthalmic health system such as OcuHub, through a health information exchange, through a physician or hospital health system and into the EHR of the patient’s PCP. Although this is not a functional option today, there are examples of this connectivity.
Optometry’s role in identifying and fostering early intervention for chronic medical problems such as diabetes and hypertension can save significant health care dollars, reduce pain and suffering, and improve the quality of life. Each documented episode of this type of care can trigger a payment that is based on that actual cost saving.
Patients with diabetes, for example, who wait until symptoms develop before seeking medical care have had the disease for an average of 7 years before the symptoms emerge. The symptoms are often a sign of end organ damage that cannot be reversed. A simple optometric test of the lifetime glucose profile, with results uploaded to the PCP, can initiate treatment options at a time well before any organ damage has occurred.
In addition to reducing pain and suffering and improving quality of life, the significant savings of the medical cost will be the source of the funding of the pay-for-performance reimbursement to the optometrist.
These concepts and ideas are still in development in several areas of health care. Some of them have been less than successful and have not achieved the desired outcomes. Like the early managed care models, lack of success leads to changes that ultimately have improved the models.
Prior to optometry having a reasonable number of EHR users and recent electronic connectivity, we have been largely ineligible to participate in any of these new payment model opportunities. With today’s connectivity and the increase in ophthalmic health systems, we are now able to consider these options.
Some of these models may totally transform the delivery and payment models for optometric care. To participate, however, optometrists must start making the fundamental changes in their practice habits now.
We need to institute EHRs in all of our practices, we must become part of an ophthalmic health system and we must adopt a more comprehensive health care approach to the traditional eye exam. A great way to start is by attending meetings like the Vision Expo East later this month. Take a look at the EHR options for optometrists and options for connectivity among unrelated EHRs. Take a look at new instruments for primary health care to collect vital signs and the lifetime glucose profile and attend some of the systemic medical lectures at the show. Hope to see you there!