As health care reform evolves, problems, barriers and new challenges continue to arise. Although the Affordable Care Act was written and developed to improve access to wellness-based care, the implementation of the law has encountered a large number of obstacles to improving the health of the nation.
One of the critical problems with insuring a large number of new enrollees is having adequate access to health care providers to deliver the basic services required to assure better long-term outcomes. The added pressure on primary care physicians has resulted in patient backlogs and long wait times in crowded offices. The inefficient and inconvenient process has kept many citizens with no particular symptom or distress from seeking routine primary care or wellness services. These are the very services that are required to be able to provide the early detection and intervention that can improve the outcome of the chronic medical problems that plague our country.
With any challenge comes opportunity. For the profession of optometry, there is a real opportunity to provide the primary medical care for many American citizens who are not seeking health care. These people often have a lack of symptoms and a general perception of normal health. In spite of their overall perception of good health status, many people often have blurred vision, red or dry eyes, or functional vision problems that prompt them to seek optometric care.
The optometrist is in a perfect position to provide some of the missing primary health care and wellness services that can improve the outcome for problems like hypertension, diabetes, hyperlipidemia and obesity. To achieve this, however, optometrists must reconsider their role in the health system and adopt a more comprehensive approach to patient care. They must move away from the ophthalmology specialty practice model and adopt a more physician-like total health model.
Optometry must include the collection, analysis and transmission of several primary care data points in their routine encounter with each patient in addition to the traditional comprehensive eye examination. These data points include some traditional test points as well as some new data points that are unique to the human eye.
The traditional data points are: blood pressure, resting pulse rate, height, weight and body mass index. These points are easy to measure yet are not part of the traditional eye examination. The results of these tests are also not important to determine the ophthalmic correction and often not required for the immediate assessment of ocular health.
Unique eye-related indicators include the determination of diabetic retinopathy for patients who have been diagnosed with diabetes and glaucoma testing on at-risk patients. The eye is the one area of the human body where circulating blood can be directly viewed and photographed. Although these are not primary data points, they speak to the unique role of the optometrist in systemic health care.
The latest and perhaps most significant primary health care data point is the lifetime glucose profile. The data point is established by measuring the amount of glucose that spilled into the aqueous humor over a lifetime. Any glucose in the aqueous changes the proteins of the crystalline lens and increases autofluorescence. Although this fact has been well known for some time, the recent U.S. Food and Drug Administration approval of the ophthalmic instrument, ClearPath DS-120 by Freedom Meditec allows the optometrist to measure the lifetime glucose profile for each patient and follow it from year to year to monitor diabetic control.
To assume their role is primary health care, optometrists should collect the data points:
- blood pressure
- body mass index
- lifetime glucose profile
The optometrist should review these findings with each patient during the encounter summary (see The doctoring of the eye examination), include these issues in the treatment and management plan for the patient, and transmit the data points to the patient’s physician and/or health plan.
For optometrists who can collect these data points with an approved electronic health record and transmit the data points via a secure web portal, as part of the C-CDA (See Electronic Integration is here), there may be the opportunity for reimbursement from several managed care organizations for primary health care over and above the reimbursement for the eye examination.
Optometry’s primary health care data points are evolving to be the key components to the profession’s future in the American health care system.
Disclosure: Edmonds is a consultant for March Vision, Ocuhub and Freedom Meditec.