Appreciating optometry’s value to patients with diabetes and their primary care physicians
Two events converged to create an opportunity for doctors of optometry to underscore their value to patients with diabetes and the care they provide—the Centers for Medicare & Medicaid Services (CMS) tying provider reimbursements to patient outcomes and Medicine lowering the range of what was once considered a normal A1C reading, says Kenneth Lawson, O.D., a Florida practitioner of 30 years who is a medical director for vision services for a major health insurer.
“The same thing happened with hypertension,” Dr. Lawson observes. “You’ve just created a whole new group of folks who have elevated risk for hypertension and diabetes. The diabetes population really blew up when the ‘desired’ A1C value was lowered from 7.0 to 5.7 for type 2 diabetes.
“When all this occurred, it placed an increased burden on primary care physicians,” he adds.
Nevertheless, it’s a burden that presents an opportunity for doctors of optometry who look to level up their roles in the eyes of other providers and payers. Dr. Lawson discusses the role of optometrists in diabetes care and the one thing they could do better.
How can doctors of optometry ensure their value is well-demonstrated to those who evaluate the health system?
One way is to carefully document our care in the management of diabetes among patients. Toward the end of each year, when CMS and payers come to the primary care physician and look to see, based on Healthcare Effectiveness Data and Information Set (HEDIS), what percentage of their patients are receiving in-person, comprehensive, dilated eye examinations. They must prove they gathered data on over 50% of those patients for Medicaid and 89-92% (a 5-star rating) for Medicare. If they get to the end of the year and they don't hit their mark, they can face a financial penalty depending on the egregiousness of being out of compliance. The onus is then on the primary care physician to quickly collect the information and the doctor of optometry can be a huge well source for this data.
What is one thing the doctor of optometry could be doing better when it comes to the care of patients with diabetes?
Once a patient visits a doctor of optometry, optometrists perform comprehensive, dilated eye examinations that yield a variety of encounter data—from rapid refraction shifts to disease information from the front and the back of the eye that might indicate whether an undiagnosed patient could have hypertension or diabetes. It is just as imperative that we also report back to the primary care physician if a patient currently treated for diabetes has any presence of it in the eye. I transmit a simple report electronically and hand the patient a note to personally deliver to their primary care doctor to try to ensure the message is delivered. This encounter data is pure gold in that it helps the primary care physician take better care of their patients and meet their HEDIS metrics. Put simply, a note should say that you have thoroughly examined the patient, what you saw and that you’re taking the appropriate steps to manage it.
Why is communication back to the primary care doctor so critical?
The reason is simple: the earlier the intervention in diabetes, the better the chance of preventing blindness. That is one of the main driving forces behind HEDIS. By sharing our medical record data, we can prevent disease progression and generate better outcomes for our patients. We also build strong relationships with our community primary care physicians and prove our value as a player in the medical health care arena. Put simply, better eyes equal better lives and enhanced patient quality of life. Who wouldn’t want that for their patients?
Diabetes resources for optometrists
In collaboration with the American Diabetes Association® (ADA), the AOA and other eye health care organizations developed the "Eye Care Interprofessional Communication Protocol," a digital resource outlining how eye care professionals and other health care professionals can efficiently and routinely exchange information to increase patient co-management. The communication protocol is available online for download and review after completing a form with the ADA. Read more about the Eye Care Interprofessional Communication Protocol.
Go to the AOA’s EyeLearn Professional Development Hub and find the course #AskAOA: Coding for Major Eye Diseases: Diabetic Eye Disease.
Infographic with key stats and information on diabetes and the importance of regular comprehensive exams by doctors of optometry.
Doctors of optometry should consider the benefits of adding office-based laser procedures, such as YAG capsulotomy (after cataract surgery) or selective laser trabeculoplasty (SLT, for glaucoma), to their practice.
Doctors of optometry are performing office-based laser procedures in 11 states, as AOA affiliates have seen historic scope expansion wins in the past four years and momentum continues to build. Doctors of optometry are pursuing legislation in other states that would allow them to serve their patients at the highest level of their education and training. Some of these optometrists, who have performed hundreds of laser procedures, share key considerations in providing this care to patients.
Currently, licensed doctors of optometry in 10 states perform YAG laser capsulotomy and a new study provides further evidence to support its use in optometric practice.