States should widen their scope of practice (SOP) laws to permit greater access to non-medical clinicians, according to a joint report issued by the federal departments of Health and Human Services (HHS), Labor and Treasury. The report advocates for providers such as nurse practitioners, physicians assistants and, yes, even optometrists (among others), to be granted the ability to “utilize their full skill set.”

The report, Reforming America’s Healthcare System Through Choice and Competition, refers to state regulations on these non-MD providers as “harmful barriers.” It lays out three specific guidelines: (1) allow clinicians to practice at the “top of their license,” (2) allow non-physicians to be paid directly and (3) eliminate supervision requirements between physicians and “care extenders” (such as optometrists).

“The risk of anti-competitive harm may be even greater when the regulatory board that imposes SOP restrictions on one occupation is controlled by members of another,” the report reads.

The American Academy of Ophthalmology swiftly issued its interpretation of the report, saying it’s “generally supportive” of language asserting the importance of maintaining safety standards and adding commentary from the group’s president. “Too often there is a rush to extend surgical privileges to those who lack the years of medical education and clinical training necessary for understanding and safely performing critical procedures,” said Keith Carter, MD, president of the American Academy of Ophthalmology. “It is critical, certainly in eye care, that should our states opt to expand scope of practice, that they eschew any dangerous softening of surgical standards.”

The report also advocates for the expanded use of “telehealth” technologies. “A variety of regulatory barriers have kept telehealth from reaching its full potential to increase competition and access,” it reads, lamenting that “state laws and regulations typically require that providers be licensed in the state where the patient is located, thus restricting the provision of telehealth services across state lines.”  Specific to eye care, the report mentions that telehealth “is particularly effective when it replicates in-person care, speeds input from knowledgeable practitioners, provides information more frequently than would be possible with in-person visits, or involves conditions that can be evaluated from digital images.”

The report also refers to the Affordable Care Act as having “moved the [healthcare] system in the wrong direction, saying that the “focus on expanding health insurance coverage has had mixed and surprisingly small effects on health outcomes.” The report justifies this stance on the ACA with an Oregon-based study on Medicaid’s impact, which “found that low-income, uninsured individuals […] did not experience statistically significant improvement in any of the physical measures of health observed—cholesterol, blood pressure, and blood sugar–although there were some benefits for mental health.”

The American Optometric Association (AOA) applauds the reporting, according to a statement. "Our health care system and technologies are advancing at an incredible pace and the recommendations outlined within this report encourage our laws to do the same,” explains AOA President Samuel D. Pierce, OD.

Health and Human Services. Reforming America’s Healthcare System Through Choice and Competition. December 12, 2018. Accessed December 14, 2018.