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: Where is the resistance to health care reform?

Although most people believe that our health care system is in need of reform, there exists a subtle resistance to many of the required elements of reform execution.

Yet the numbers don't lie. In a 2013 report in the National Academies Press titled “U.S. Health in International Perspective” that looked at 17 developed nations, the U.S. ranked dead last. We also know, according to OECD Health Statistics 2012 that the cost of health care in the U.S. is 2.5 times higher than most developed nations in the world. Health care reform will improve quality and lower cost. so why is there such resistance?

Optometrists do not want to health care reform (say, what?). That’s right, in promoting reform issue to optometrists over the last 5 years I have found a striking resistance to many of the issues of reform. In spite of being on the front lines of health care for patients between the ages of 13 and 30 years, the target population for the prevention of chronic medical problems, optometrists don’t want to take blood pressure, screen for diabetes, measure body mass index, talk about obesity or get involved with medical care. Most want to do primary eye care, code for refractions and glasses. Perhaps this is a little harsh, but wait, I’m not done.

Physicians do not want health care reform. Physicians may have more education on the overall system heath and complex disease states, but starting with their busy clinical training and in the actual practice of medicine it is all about managing acute distress and symptoms and then moving on to the next patient. Physicians are too busy to be able to spend the time on the overall health and wellness of each patient.

Our current procedure-driven, fee-for-service payment system provides no reward for solving the long-term health problems of patients. The incentive is to see patients more often and do tests and procedures on them. If a doctor actually “cures” a patient by resolving the underlying health problem, the patient stops coming in and the payment stops.

The health insurance industry does not want health care reform. This is a multi-billion dollar industry that enjoys huge profits from the high cost of health care in America. As the fee-for-service system keeps increasing cost, the result is higher and higher premiums, and the industry lives on a percentage of the premium payment. Life is good for this business with the current health delivery model.

The pharmaceutical industry does not want health care reform. The current symptom-based health care culture puts little value on drugs that cure disease but great value on drugs that resolve a symptom. Oddly, it does not seem to matter if the symptom being treated is mild and that the side effects of the drug may cause a host of long-term medical problems. If immediate relief is obtained, the drug will sell.

These companies spend millions on television-based direct-to-consumer advertising to tout the immediate relief of an acute symptom. Even though the commercials are required to list the often lengthy list of horrible side effects, the air time is worth the cost. The fact that these outright comical commercials are effective brings me to my next point.

American patients do not want health care reform (say it isn’t so!). If there is one health care statistic where America leads the world, it is obesity. According to the Centers for Disease Control and Prevention, 35% of American adults are obese. This is up 13% since 2010. Obesity is a leading risk factor for chronic medical problems such as hypertension and diabetes. Unlike many risk factors for disease, this is a modifiable risk factor, and yet the health care establishment has done little to affect the progression of this problem.

One of the key issues here is not so much related to the doctor, but rather the patient not wanting this type of health care. The American patient does not want to hear about diet and exercise strategies to resolve the obesity; rather they want a pill for the symptoms of the chronic medical problems caused by the obesity.

And so we continue with a health care crisis in America. We, as a nation, clearly need an overall shift in our thoughts about health and wellness and the health care system that will support us. But where do we start?

For me, optometry is a great place to start. We see patients starting at a young impressionable age. We are a non-threatening health care provider. Improving vision with the magic of refraction is a very positive experience for the patient and instant confidence in our problem-solving abilities. We are in the perfect position to offer advice, counseling and health education to this population.

The first step on the path to a paradigm shift of your practice to primary health care and the road to health care reform is the electronic health record. These programs are built to show you reform topics such as Review of Systems and medicine reconciliation and will guide you toward a more comprehensive examination. Learning to provide health and wellness education as part of the eye exam as well as taking continuing education courses in the management of hypertension and diabetes are great second steps.

Optometry, a licensed medical profession in all 50 states and classified as an essential primary care provider by the Affordable Care Act, has a unique opportunity to be part of the solution to the American health care crisis.

Reference s :

Centers for Disease Control and Prevention. Adult Obesity Facts. http://www.cdc.gov/obesity/data/adult.html. Updated September 21, 2015. Accessed February 4, 2016.

Organization for Economic Cooperation and Development. OECD Health Statistics 2012. http://www.oecd.org/els/health-systems/health-data.htm. Accessed February 4, 2016.

Woolf SH, et al. U.S. Health in International Perspective. 2013. http://www.nap.edu/catalog/13497/us-health-in-international-perspective-shorter-lives-poorer-health. Accessed February 4, 2016.