Doctors of optometry can play a role in erasing health disparities

When doctors of optometry feel called to care for underserved communities in a multidisciplinary workplace, Gary Chu, O.D., has just the prescription for them: their local community health centers (CHCs).

Through community health centers, doctors can play a part in increasing access to affordable, cost-effective and high-quality care in medically underserved communities. The role of CHCs is being recognized Aug. 7-13 with the observance of National Health Center Week.

"Health centers are a way to be involved and to really show people the value of eye care," says Dr. Chu, senior director of public health and community collaborations at New England Eye and associate professor at the New England College of Optometry (NECO). He also is a member of AOA's Multidisciplinary Practice Committee.

Dr. Chu recalls a patient at a Boston community health center. While she was undergoing an examination for her pregnancy, the woman complained of "graying vision" to her primary care physician.

She was then escorted to the center's on-site eye clinic, where she was diagnosed with branch retinal vein occlusion, a blockage of the veins in the retina that can result in vision loss.

There is value in health care providers collaborating under one roof. They saved her vision.

"I've heard time and time again from health care executives, 'Why didn't we think to open an eye center earlier?'" says Dr. Chu.

"They see the tremendous asset that optometrists are to their primary health care team," he adds. "Optometrists have been involved with health centers for a long time, but we need to make a bigger dent."

By the numbers

According to the Health Resources and Services Administration (HRSA), which oversees the nation's CHCs:

• 1,375 federally qualified CHCs were operating in the U.S. in 2014.
• About 24.3 million patients are served by the centers.
• 1 in 14 people are receiving care at an HRSA-funded clinic.

The work can be very fulfilling, Dr. Chu says. The population served by CHCs is diverse—including immigrants, ethnic minorities, veterans, homeless individuals and low-income populations—and the breadth of clinical diagnoses wide. Beyond health services, many centers take a holistic approach to care by offering such services as child care, case management, home delivery of meals, housing and nutrition education.

No patient is ever turned away at a CHC. His or her care is covered by health insurance (Medicaid and commercial health plans, based on a sliding fee scale) or is no cost. Reducing health-care disparities—by providing access to care—is a primary objective of CHCs.

"Health centers have become the safety net for health care in this country," says Dr. Chu, noting how the Accountable Care Act has reinvigorated the relevance of health centers since their founding in 1965. "The population they serve isn't always an easy one. But they never turn anyone away. Individuals receive the care they need."

The challenge is filling the positions. According to HRSA data, physicians provided the full-time equivalency (FTE) of 10,733.7 doctors in 2013. Compare that to an FTE of 3,379.4 for dentists and 359.7 for vision care providers.

An HRSA fact sheet for the same year listed the professional services provided at community health care centers. General primary medical care was provided at 100% of the centers nationwide. Only 19% provided vision services.

The centers are primarily funded by a variety of sources including HRSA grants, public and private insurance and patient fees. They are governed by a board that includes community residents.

Says Dr. Chu: "It's not that health centers don't want eye care services. They do. It comes down to money—how they can figure out ways to start the eye clinic.

"They are really looking for primary-care optometrists," he says.

A heart for health care disparities

Unfortunately, Dr. Chu says, HRSA does not consider vision care a primary health care service. That's something he would like to see changed. "It would take an act of Congress to change it," he says. Still, the AOA's Multidisciplinary Practice Committee is working toward developing programs and policies that support the addition of primary eye care as part of the HRSA definition of primary health care services. This includes supporting the National Health Service Corps bill (H.R. 1312/S. 898), which aims to restore doctors' of optometry eligibility for federal scholarships and loan repayment programs that incentivize their service in CHCs.

Dr. Chu suggests interested doctors put in a call to their local community health centers. At NECO, for instance, Dr. Chu manages relationships between NECO and community health centers in the Boston area. Clinical faculty provide optometric care and educate NECO students. NECO has 14 such partnerships, and counting.

"If an optometrist has a desire to get involved, he or she should start conversations with his or her local health center," he says. "It's a rewarding profession. It's a rewarding place to work. You do have to have a heart to make a difference in health-care disparities that occur in our society."

Read more about community health centers in the April 2014 edition of AOA Focus, on page 36.