Our profession sees around 85% of all comprehensive eye exams.1 We are the ideal providers of primary eye care, from the treatment of refractive error to the diagnosis and management of hundreds of ocular conditions.
Today’s ODs live in an exciting time of growth in the field. In 10 states and counting, the optometric scope of practice now includes noninvasive surgical procedures and lasers, such as YAG capsulotomy and SLT. Being known as the “go-to” doctor for all eyecare needs—from emergencies to red eyes, glaucoma to dry eye and cataract and refractive surgery care to glasses and contact lens prescriptions—is an enviable position. Plus, it makes a 30- to 40-year career far more interesting and enjoyable.
Here’s the catch, though: patients don’t know all that optometrists do—and how would they if we’re not educating them? It’s estimated that more than 80% of pediatric conjunctivitis goes to a pediatrician, Urgent Care doctor or other primary care provider rather than to an eyecare provider.2 Many patients are also unaware that we perform diabetic eye exams or that systemic illness ranging from hypertension and autoimmune disease to brain tumors and even pending aneurysms can be diagnosed with an annual eye exam. We perform the majority of these exams, giving us a fantastic opportunity to educate patients and their families.
Payment in comanagement arrangements must be reasonable and abide by rulings from the Centers for Medicare and Medicaid Services (CMS), meaning they make up about 20% of the comprehensive fee. Fortunately, many surgical practices apply this to premium intraocular lenses (IOLs) as well, but not all. If optometrists provide four perioperative exams per cataract surgery plus the other aspects of care for premium IOL patients—education, follow-up, adjustments—it becomes necessary to work with the surgeon to ensure that compensation meets CMS guidelines and isn’t equal to that of a standard monofocal IOL surgery. Find a talented surgeon who understands the expertise, time and care optometrists provide.
Working with Outside Providers
I have a large dry eye practice, with over 800 diagnosed Sjögren’s syndrome patients. It would’ve been impossible to see and manage this many cases without rheumatologists having the largest growth in referring physicians this past year. When managing Sjögren’s, these physicians know what to ask patients but, frankly, they don’t have the capacity, equipment, desire or ability to manage this level of dry eye disease. These referrals help patients receive necessary care from the most suitable doctor (you), as well as help you gain the trust of patients and outside providers.
Many similar opportunities exist in optometry, such as working with endocrinology to provide diabetic eye exams, retinal surgeons for low vision care or corneal specialists for scleral lens referrals.
If we do all of these effectively—comanage with ophthalmologists, educate patients on optometry’s role in primary eye care and work with providers outside our field—there is a huge potential reward: turning the tables on insurance companies. These entities wouldn’t exist if patients didn’t sign up, and patients won’t sign up if no providers are willing to accept absurd compensation amounts. As consolidation continues in eye care via private equity or simply via the understanding that ODs perform nearly nine of 10 exams, this will put providers in a position of leverage. It’s a matter of time and organization before we optometrists can dictate fair terms.
Strength in Numbers
Individual state scope laws abiding, there are numerous ways to embrace the power of this 85% statistic and take steps to help primary eye care improve. Pathways to success include working with subspecialties, such as retinal specialists and cataract surgeons, and caring for systemic disease patients referred for ocular exams. This will allow the healthcare system to be most efficient and enable every physician, from surgeons to optometrists, to do what they do best.
Dr. Karpecki is medical director for Keplr Vision and the Dry Eye Institutes of Kentucky and Indiana. He is the Chief Clinical Editor for Review of Optometry and chair of the New Technologies & Treatments conferences. A fixture in optometric clinical education, he consults for a wide array of ophthalmic clients, including ones discussed in this article. Dr. Karpecki's full list of disclosures can be found here.
1. Wilson FA, Stimpson JP, Wang Y. Inconsistencies exist in national estimates of eye care services utilization in the United States. J Ophthalmol. 2015;435606.
2. Shekhawat NS, Shtein RM, Blachley TS, Stein JD. Antibiotic prescription fills for acute conjunctivitis among enrollees in a large United States managed care network. American Academy of Ophthalmol. 2017;124(8):1099-107.