Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

BLOG: Applying risk management to clinical practice

Risk assessment and risk management are common tools in modern society. Although the concept can be traced back to the ancient Greeks from around 400 BC, the science of risk management is a product of the late 20th century, according to Aven.

Risk assessment has been extensively used in health care and became a part of the standard of care for diabetes in 2002 (American Diabetes Association).

The nature of diabetes and the moving target of the test results, as well as a management plan that is based on lifestyle changes, make it a disease often treated by managing risk factors. Other disease management programs have also adapted risk-based tools as a foundation for care.

Artificial intelligence (AI) programs that are poised to make a significant impact on health care often use risk assessment as the platform for medical decision-making (Dankwa-Mullan et al.). Unlike most humans, AI can constantly update the underlying database and precisely assess risk well past the decimal point.

Optometry has been slow to adopt a risk management approach to clinical care. We have had a small taste in the field of myopic progression and counseling young teens and their parents on the contact lens strategies for myopia control. We assess the risk based on the refractive error of the parents, lifestyle factors of excessive reading, screen time and little time in the outdoors and clinical finding of early myopic tendencies. We intervene with contact lenses, bifocal glasses, vison therapy or cycloplegic medicines. These are good examples, but just the tip of the iceberg.

We should use risk assessment tools for many ocular diseases. Those with genetic tendencies and prevention strategies, such as age-related macular degeneration, are particularly well suited for a management plan to reduce risk. Others, as in glaucoma, are best treated on the basis of multiple risk factors rather than the traditional control of IOP.

When considering the medical necessity of special testing and procedures, a risk assessment tool can help document the medical necessity for third-party payors. As a seasoned medical chart reviewer, I can tell you this is exactly where I look when attempting to justify payment for medical services.

The comprehensive eye examination is, in essence, a risk assessment and management exercise. Starting with the “reason for visit” and proceeding with the family history, social habits, review of systems and medical reconciliation, this critical aspect of care is the gathering of a collection of risk factors. The battery of vision function tests with refraction, vital signs and the physical examination of the structures of the eye may pinpoint a diagnosis but more often provides a list of risk factors that point to a disease or disorder.