March 21, 2018
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Experts debate prescription release form at FTC workshop

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Patients receiving copies of their contact lens prescriptions is a key component of the Contact Lens Rule, according to Elizabeth Delaney.

Delaney, an attorney at the Bureau of Consumer Protection, stated at the FTC’s “Contact Lens Rule and the evolving contact lens marketplace” workshop that the commission determined in the rulemaking review that automatic prescription release would improve compliance. To accomplish this, the FTC has proposed a requirement that prescribers obtain a signed acknowledgment from patients that they received their prescription.

The FTC believes this would serve several objectives, such as: reminding prescribers to release the prescription, informing patients of their rights, reducing misunderstandings and improving the commission’s ability to ensure the prescriptions have been released.

Linda Sherry, director of national priorities, Consumer Action, said they polled contact lens wearers and found that one-third were not getting a copy of their prescription, and many were unaware of their right to the prescription.

David A. Cockrell, OD, a private practitioner and past president of the American Optometric Association, said every patient gets a copy of his or her prescription at his offices, and they use the electronic medical record to confirm this.

“Every day we have a call from someone asking for a prescription,” Cockrell said. “It’s always someone we’ve given it to before who has misplaced or lost it. We look to see if the prescription is current and how many times we have given it to them. We want to track those numbers.”

He said the EMR helps his staff track those statistics.

Zachary McCarty, OD, chair of the AOA’s Quality Improvement and Registries Committee, said one-fourth of optometrists have an electronic health record and have attested to the Meaningful Use program.

“CMS has tried to put in place a program to push the adoption of EHRs,” he said. “Unfortunately, they made some errors and avoided looking at specialties and specifics in other nuances, like eye care. There are a lot of doctors that have walked away from EHR.”

McCarty’s referral-based practice has spent more than a year and a half working with their EHR vendor and with the vendors of their colleagues, “and we are nowhere near where we need to be to communicate electronically,” he said. “It is a very sorry state of interoperability affairs.”

Joseph B. Neville , executive director at the National Association of Optometrists and Opticians, and Cockrell, are both opposed to a signed acknowledgment form.

“My member response to the idea was ‘not another form, not another signature that the consumer needs to put on another piece of paper,’” Neville said.

Patients and doctors already have enough paperwork to deal with he said.

Cockrell said that in addition to creating a record-keeping burden for doctors, the form could spur patient distrust and doubt in their providers.

“Patients may think, ‘What happened to the doctor that this is now necessary?’” Cockrell said.

Sherry said the form is a simple statement and believes a reasonable consumer could understand its purpose. She disagrees that it will result in a lot of patient questions.

Optometrists are unique in that they can sell the products they prescribe, Sherry said.

“Maybe consumers don’t realize it, but it’s protecting them if they know they have a right to shop around,” she said.

“If there is a better record of prescription release, why isn’t it a win-win for both sides?” she continued.

Sherry said it would establish trust and confirm receipt of the prescription, even if it took a few more minutes.

Cockrell recommends appropriate signage at the front desk to alert a patient to their prescription rights, similar to the signage at government agencies regarding discrimination.

Sherry said that signs can be hidden, and many offices do not comply with the regulation.

“Providing that information electronically to patients, so they can do it independently, [such as in a patient health portal app] takes away a lot of the pain being discussed here,” Edward Chaum, MD, PhD, Plough Foundation professor at University of Tennessee Health Science Center, said.

Chaum said this issue is an example of the growing pains as medicine moves from the paper era to the EHR era.

“The reality is that the patient owns his or her health information,” Chaum said. “Doctors are the stewards of that information, and we are responsible for saving it ... the electronic format and the interaction of the patient with his or her information is where this discussion needs to go.”

“I hear from all of you the frustration of prescription verification,” Delaney said, “from consumers who lie about having been your patients or who stockpile lenses. I think if everyone works together to solve the problems, we can create greater competition in the marketplace and we can help all consumers in the end, if we get it right. I don’t see why the two sides are so different at this point.” – by Abigail Sutton

Disclosures: Chaum is employed by the University of Tennessee Health Science Center. Cockrell is a past AOA president. Delaney is employed by the Bureau of Consumer Protection. McCarty is chair of the AOA’s Quality Improvement and Registry Committee. Neville is executive director of the National Association of Optometrists and Opticians. Sherry is director of national priorities at Consumer Action.