AOA prioritizing vets’ standard of care

Veterans deserve timely, quality eye and vision services without sacrificing the standard of care long-established by Department of Veterans Affairs (VA) doctors of optometry, AOA asserts amid new care model proposals.

AOA is continuing its lead role as an advocate for veterans' eye care in legislative and regulatory efforts.

The VA recently published a proposed rule to loosen state licensure barriers for VA health care providers to furnish telehealth services irrespective of patient or provider location, soliciting comments in an abbreviated, four-week window. Following that comment period on Nov. 2, the House Veterans Affairs Committee passed legislation that supported VA providers' ability to offer telehealth services across state lines.

While AOA supports the appropriate use of eye and vision telehealth services to supplement access to high-value, high-quality care, the AOA expresses concern that for many patients in-person care is their preferred choice-of-care setting, providing peace of mind about the quality of care; access to additional services, coordination of care and appropriate referrals as needed; satisfaction with the comprehensiveness and effectiveness of the care; and, a much-needed opportunity to connect with others who may have shared experiences. At any point in the diagnosis and care continuum, a patient should have the right to choose in-person care.

That was among the concerns that AOA President Christopher J. Quinn, O.D., recently expressed on Capitol Hill as AOA met with the VA and other top policy officials, including a lengthy discussion with Sen. John Boozman, O.D., (R-Ark.), who has spoken out on behalf of veterans' care.

"High-quality care to VAs has always been important to me, which was only reinforced during my internship at Fort Howard VA Medical Center," says Dr. Quinn. "The AOA cannot and will not stand for a lesser standard of care for the more than 1.5 million veterans a year who trust their eye health and vision care to doctors of optometry."

Last year alone, the VA Optometry Service provided primary eye care services for nearly 1.8 million veteran visits, while almost three-quarters of the total unique veterans receiving eye care services annually were cared for solely by VA doctors of optometry. Considering eye care clinics staffed by VA doctors of optometry and residents are among the busiest primary care settings in the veterans' health care system, AOA urges the VA not to overlook the quality care already in place.

In comments to the VA, AOA noted that eye and vision telehealth services—when used appropriately—can improve patient coordination and provider communication, but stressed several important criteria must be met for such services:

• The standard of care must remain the same regardless of whether eye and vision services are provided via telehealth or in-person care;
• Eye and vision telehealth services cannot, based on current technologies, replace an in-person, comprehensive eye examination, and must operate in compliance with existing rules and regulations;
• Eye and vision telehealth services may be appropriate for collecting basic or repetitive data, confirmation of expected therapeutic results or homeostasis, and notifications of changes in chronic conditions;
• Eye and vision telehealth services aren't appropriate for establishing a doctor-patient relationship or initial diagnosis, replacing face-to-face interactions or categories of care;
• Screenings using telehealth services should not be used to diagnose eye health conditions, or used as a replacement for a comprehensive, dilated eye exam.

In addition to these points, AOA stressed that telehealth services should be intended to support, not replace, in-person care.

"Veterans should be made fully aware of their rights, the process that will be used for the care provided, how best to maximize the approach, and any limitations that may exist," AOA's comments read.

Read how AOA, the Georgia Optometric Association and the Armed Forces Optometric Society took action against a program subverting the VA's one standard of care principle.

Advocating for optometry's definition

Beyond telehealth, AOA continues to provide input on another VA Optometry Service concern—the VHA Eye Care Handbook. This VA administrative document lists the standards and policies necessary for the provision of eye care in the VA health system, including clinical guidance, direction for provider collaboration and explanation of eye care disciplines.

Given that interdisciplinary care teams are a stated emphasis of the VHA Eye Care Handbook, ensuring VA Optometry's explicit definition and role remain consistent with the high-quality care furnished by doctors of optometry nationwide is essential. Currently, the handbook defines optometry as "independent primary health care providers who examine, diagnose, treat and manage disease and disorders of the visual system, the eye and associated structures, as well as diagnose related systemic conditions."