FACTS ABOUT OPTOMETRY AND OPTOMETRIC SERVICES IN HOSPITALS

Transcription

1 FACTS ABOUT OPTOMETRY AND OPTOMETRIC SERVICES IN HOSPITALS Tday s Dctrs f Optmetry Optmetrists educatin and scpe f respnsibility have changed dramatically ver the last 20 years. Dctrs f ptmetry are independent primary health care prviders wh are trained and state licensed t examine, diagnse, treat and manage diseases and disrders f the visual system, the eye and assciated structures as well as diagnse related systemic cnditins. While serving the primary eye care needs f the American public, tday s dctrs f ptmetry recgnize that respnsible, quality care must invlve the patient s ttal health. Dctrs f ptmetry wrk clsely with ther health prfessinals by cnsulting with family practitiners, pediatricians, neurlgists, phthalmlgists, dermatlgists, and thers when treatment is required utside the scpe f their practice. This cnsultatin prcess is tw-way, and as the health care delivery system cntinues t change, this interprfessinal cnsultatin and cncurrent care will becme mre imprtant. The prfessin f ptmetry is cnstantly evlving t meet the needs f patients, t prgress with technlgical advancements, and t match the great strides made in the educatin f ptmetrists. With this as a basis, ptmetrists have becme increasingly invlved in practicing in hspitals as the scpe f eye and visin care services ptmetrists can prvide becmes brader. These services include nt nly ptmetric specialty areas such as cntact lenses, lw visin, and visin rehabilitatin, but als pre and pstperative eye care, emergency eye care services, and the use f pharmaceuticals in the diagnsis f treatment f eye disease. Accessibility and Cst effectiveness Dctrs f ptmetry practice in mre than 7,000 cmmunities in the U.S. In mre than 4,300 cmmunities, ptmetrists are the nly primary eye care prviders. They prvide 70 percent f primary eye and visin care services in this cuntry and far utnumber any ther eye care practitiners. Dctrs f ptmetry are cncerned with prviding quality care in cst-effective ways, helping t make that care mre accessible. While the cst f ptmetric care has risen, the increases in recent years have been significantly lwer than increases recrded fr ther areas f health care and the verall cst f living.

2 Optmetric Educatin and Requirements fr the Practice f Optmetry The licensure t practice ptmetry is cntrlled by individual State Bards f Optmetry in every state and the District f Clumbia. While requirements vary, the fllwing are general factrs fr the educatin and licensure f ptmetrists: Cmpletin f preprfessinal undergraduate educatinal requirements at a cllege r university. The majrity f students have cmpleted fur r mre years f cllege educatin prir t admissin t an ptmetry schl. Satisfactry cmpletin f the fur year ptmetric prfessinal degree prgram at ne f the 19 schls r clleges f ptmetry accredited by the American Optmetric Assciatin s Cuncil n Optmetric Educatin, the accrediting bdy recgnized by the U.S. Department f educatin fr ptmetric educatinal prgrams. Althugh nt currently a requirement fr licensure, a grwing number f ptmetric graduates g n t specialized residency training prgrams prir t beginning practice. There are 39 residency prgrams acrss the cuntry specifically in hspital-based ptmetry. There are anther 48 residency prgrams (geriatrics, lw visin, cular disease, etc.) als based within hspitals. Optmetrists are required t pass a natinal bard examinatin administered by the Natinal Bard f Examiners in Optmetry and/r individual State Bards f Optmetry befre beginning practice. Cntinuing Educatin and Relicensure Tday s ptmetrists are cncerned abut delivering quality care based n current, upt-date infrmatin abut methds, materials, and technlgy in eye care. T ensure cntinued high quality ptmetric care, dctrs f ptmetry keep abreast f new examinatin, diagnstic and treatment develpments, and techniques resulting frm nging ptmetric and phthalmic research. All states require an average f mre than 15 hurs f cntinuing educatin each year fr license renewal. Few ther health care prviders are invlved in such cmprehensive cntinuing educatin effrts. In many states additinal hurs are required fr ptmetrists certified in the use f therapeutic pharmaceutical agents. In recent years the scpe f practice f ptmetry in the utilizatin f pharmaceutical agents has been expanded in every state. All 50 states and the District f Clumbia have legislatin authrizing dctrs f ptmetry wh have satisfactrily cmpeted specific educatin curses and examinatins t use pharmaceutical agents I the evaluatin and diagnsis f cnditins f the eye and visual system. In additin, as f August 1997, all 50 states have legislatin authrizing dctrs f ptmetry t use drugs t treat certain eye cnditins. Requirements fr certificatin and usage f pharmaceutical agents vary by state. 2

3 Histry f Optmetry in Hspitals Optmetry has lng histry f invlvement in the federal hspital system. Optmetrists have trained in and staffed hspitals in the Department f Veterans Affairs, Indian Health Service, and thse affiliated with all braches f the military. Althugh, ptmetry has been less active in the nngvernmental hspital system, there are ptmetrists in all 50 states wh have hspital privileges, the majrity f which are in nnfederal cmmunity hspitals. An increasing number f practicing ptmetrists have clinical privileges which allw them t perfrm eye care services in a hspital. The expanding scre f ptmetric practice, wide gegraphic distributin f ptmetrists, and frces f health care refrm have made the services f ptmetrists attractive t hspitals. Optmetric Clinical Privileges in Hspitals Many f the services that ptmetrists prvide in their ffices are ftentimes needed in the hspital. The scpe f services an individual ptmetrist might prvide in a hspital setting shuld be guided by the fllwing factrs: State statutry definitin f ptmetry Educatin, training and clinical cmpetence f the individual ptmetrist Credentialing prcedures f the hspitals Special needs f the hspital Areas where clinical privileges at a hspital will assist the ptmetrist in prviding enhanced patient care may include: 1. The use f hspital labratry and radilgic diagnstic facilities t enhance the ability t prvide brader diagnstic services. Fr example: Cultures fr differential diagnsis Fasting bld sugar fr suspected diabetes Orbital films, CT scans r MRI Thyrid prfile 2. The ability t serve as a cnsultant t ther members f the medical staff regarding care f their hspitalized patients. Fr example: Prvide emergency rm evaluatin f eye injuries. Prvide evaluatin f eye/visin effects f medical treatment (e.g., dilated retinal evaluatin f patients with diabetes). Prvide evaluatin f unexplained decreased visual acuity, increased intracular pressure, and headaches (e.g., angle clsure glaucma). 3. The ability t prvide eye and visin care services t the ptmetrists wn patients wh are hspitalized. Fr example: Prvide cntinued care fr patients under specific ptmetric treatment (e.g., glaucma, anterir uveitis). Evaluate new cular symptms (e.g., dry eye, flashes and flaters). 3

4 Optmetric Invlvement in Hspitals Just as the respnsibilities f physicians vary within the hspital, s des the rle f ptmetrists. The range f ptmetrists services may include, as needed, evaluatins f inpatients, assisting the emergency rm staff, prvisin f pre and pstperative care f cular surgery cases, and lw visin rehabilitative care amng many thers. The grwing rle f clinical prtcls such as HEDIS 3.0 guidelines fr the evaluatin f diabetic patients fr eye disease, may expand the need fr eye care prvisin within the hspital setting. Admissins and DRG s Hspital admissins fr eye-related prblems are quite rare, regardless f prvider type. Less than 0.4% f all hspital discharges have eye-related diagnstic related grups (DRGs). Given this, there are circumstances in which ptmetrists might need t admit patients. Mst ptmetrists wh currently have admitting privileges d s in cnjunctin with family physicians r internists. The DRG s under which ptmetrists might admit patients include eye-related DRGs Optmetrists invlved in lw visin rehabilitatin culd ptentially admit patients under DRG 462. The traditinal services f refractin, bincular visin evaluatin, and spectacle and cntact lens fitting are nt cvered under DRGs and admissin fr these prblems is nt apprpriate. Hwever, these services may need t be prvided during the curse f a patient s hspital stay fr a nn-related illness, r as an utpatient service. Peer Review Managed care entitles thrughut the cuntry have recgnized the value f ptmetrists as cst-effective prviders f visin and eye care services. As ptmetric invlvement with managed care has increased, s has ptmetric invlvement in the peer review prcess. Optmetrists have fr many years been subject t the same recrds/billing audit prcedures as ther health care prviders. The American Optmetric Assciatin, recgnizing the imprtance f clinical care standards, has prduced 13 clinical care guidelines which cver tpics such as: Care f Patients with cataracts, Glaucma, and diabetes Mellitus, amng thers. Cpies f these clinical care guidelines may be btained frm the American Optmetric Assciatin. Liability Even thugh ptmetrists respnsibilities have dramatically increased ver the last 20 years, the cst f malpractice insurance fr ptmetrists has remained extremely lw. Natinally, ptmetrists pay an average f apprximately $435 fr ne millin dllars f cverage. By cntrast, nnsurgical physicians pay apprximately $6,000 fr ne millin dllars f cverage and phthalmlgists pay apprximately $7,500 fr ne millin dllars f malpractice cverage. The malpractice insurance industry bviusly cnsiders ptmetrists an extremely gd risk. In recent review f mediclegal resurces, n cases were fund where litigatin against an ptmetrist has ever resulted in liability fr a hspital. 4

5 Summary Optmetrists have a lng histry f invlvement in the federal hspital system. Changes in the scpe f ptmetric practice alng with changes in the hspital industry have lead t increasing numbers f ptmetrists btaining hspital privileges in their lcal cmmunities. Optmetrists affrd the hspital the pprtunity t btain high quality accessible visin care t meet changing patient care needs. Optmetrists will cntinue t seek and prvide an expanded rle in patient care in hspital settings. The increased availability f ptmetric services will help t enhance the verall level f patient care and assist hspitals in carrying ut their cntinuing missin f prviding quality, cst-effective inpatient and utpatient services. Fr additinal infrmatin n ptmetric services in hspitals, please cntact: Clinical Care Center American Optmetric Assciatin 243 N. Lindbergh Blvd. St. Luis, MO /991/4100, ext r Rev. 7/96; 8/97 5