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 and OcuHub.

BLOG: Attestation lessons

It is attestation time again. In the early months of each new year, health care providers that participate in government-sponsored health plans like Medicare must attest that they are effectively using their electronic health records.

The term for this is “meaningful use.” This brings to mind what it is, exactly, that we as optometrists do that is meaningful.

As the program has evolved though stage 1, stage 2 and now the Merit-Based Incentive Payment System (MIPS), we have learned about the expected quality measures. These include changes in vital signs, blood pressure screening, body mass index (BMI) measurements and smoking status. We have had to preform medicine reconciliation and provide patient education resources. Now with MIPS, we need to develop patient-specific education and attest that we are able to electronically transmit all this quality health data to other health care providers involved with our patient.

What we did not see was any measures related to ophthalmic lab choice, online refractions or online supply of optical goods. These issues, which seem to consume optometry discussions and are the targets of virtually all state association resources, are unrelated to the future of optometry as a primary health care profession.

As a profession, we are finally “at the table” of health care reform and transition. We have an opportunity to move into the mainstream of critical health services that can improve our nation’s health. Our unique access to patients to correct refractive error opens the door to identifying those patients with risk factors that can lead to a lifetime of chronic medical problems. The EHR revolution and the meaningful use process is leading us down a new road.

This new road, however, is difficult to navigate. The EHR transition alone has been difficult, and the meaningful use aspect is even more challenging. The MIPS attestation process is a constantly moving target. In five calls in 1 week to CMS we got five conflicting answers on how to even get to the attestation webpage. Our EHR company has not even finished the software to generate the required reports in spite of a 6-week deadline. We need our state association leaders to be on top of this process and provide us with guidance, seminars and programs to help us navigate this process.

We need to focus our attention on primary health care and the evolution of our practice patterns to address systemic medical problems that ultimately affect the eyes and vision. This obsession with trying to hold on to the traditional optical business is counterproductive. Online supply chains for optical goods are here to stay. Kiosk- and web-based refractions are only going to improve and become more widely accepted. Lab choice legislation is only going to fuel the managed care industry to move faster to alternative, more cost-effective suppliers of routine eye care services.

Landline phones are gone. Shopping malls are now like the ghost towns of the Old West. Gasoline-powered cars are on their way out. Human-driven vehicles are soon to follow.

Optometry is on the bubble. We can change and evolve and grow as optometric physicians and fill the huge void of primary health care services or we can go down fighting progress and technology while attempting to cling to our merchant roots.

The choice is yours, but you are not going to have long to make it.