Jessica Heinke, OD, is looking at OCT findings, which allow her to see the various layers of the retina. Drs. Grue, Snyder and Lipson note how important co-management and the use of clinical registries are to practicing “full-scope” medical eyecare.
Practicing full-scope optometry in the age of healthcare reform.
By James E. Grue, OD,
Ronald P. Snyder, OD, FAAO,
and Michael J. Lipson, OD, FAAO, FSLS
August 21, 2024
Optometric providers often use different terms to describe how they practice. Some might say they practice “general optometry,” others might say they practice “medical optometry,” while others may say they practice “full-scope optometry.”
We typically think of full-scope optometry as a comprehensive approach to eyecare that encompasses routine vision exams as well as the diagnosis and management of ocular disease.
How Healthcare Reform Changes the Definition of “Full-Scope Optometry”
Healthcare reform has ushered in an innovative approach to delivering care that now requires us to Triple Aim that description. The Triple Aim of healthcare reform incorporates the following three components, which are often aided by technology:
- Clinical outcomes are measured and tracked, and the analytics are used to support clinical decision-making.
- Patients are engaged in a way that empowers them to take an active role in managing their health by creating a care plan that works for each individual, empowering them to make better day-to-day decisions on how to manage their condition.
- Care is coordinated with the rest of the patient care team thus ensuring that patients receive seamless and integrated care across different providers and settings.
If you are not already utilizing technologies that make it easier to do these things, you might say to yourself, “Oh no, more work to do!”
The reality is that the exact the opposite is true. Providers who utilize the technologies available through their Electronic Health Records (EHRs), which support the triad of healthcare reform, are seeing more patients with less effort, are more profitable and enjoy their practice more than those who have not learned how to use those tools.
Let us look at how incorporating those tools could affect how you practice.
Using a Clinical Registry
The first step is to sign up to a clinical outcomes registry to measure and track your clinical outcomes. This is crucial because without measuring outcomes, providers cannot identify where improvements are possible and needed. It is common for providers to be surprised when they first see clinical analytics for their practice, which almost always uncover immediate opportunities for improvement.
When you sign up for a registry, the data used in the analytics is automatically shared with the registry from your EHR. This means no extra effort is required by you or your staff.
Registries typically go back and look at 1-2 years of data, providing you with an immediate track record of analytics to evaluate. This historical data gives a comprehensive view of your practice’s performance and helps pinpoint areas for improvement.
Empowering the Patient
Many providers believe they empower their patients by simply telling them what they think the patient needs to know. However, once you have access to clinical analytics, it becomes clear that this approach does not significantly improve clinical outcomes and can sometimes even decrease them. The link in the previous section showed what diabetes analytics look like.
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Once you have access to your analytics, you quickly find out that proper patient engagement, which empowers the patient, leads to improvement.
For example, the key to understanding patient empowerment is to recognize that the only person who knows why HbA1c levels have changed is the patient.
This is the point where exams diverge significantly in offices that utilize clinical analytics from those that do not. Offices that do not guide decision-making with analytics are following the pre-healthcare reform approach to care and feel that their role in diabetes management is to simply screen for retinopathy.
In contrast, those offices that utilize clinical outcome analytics are much more likely to feel their role is not only to screen for diabetic retinopathy, but also to actively work with the rest of the patient care team to empower the patient to reduce their risk of developing retinopathy.
Analytical studies have shown that when the HbA1c is lowered from an average of 9 to 7 over a 10-year time period, the incidence of retinopathy is reduced by over 50 percent. You can read a summary of this study in the AOA Guide to Diabetes Management. This guide provides detailed insights into how data-driven approaches can significantly improve diabetes management.
You may be asking, “How can I as an optometrist help the patient reduce their HbA1c?” If you are examining a patient whose HbA1c has increased since their last exam, the answer lies in asking one simple question.
To learn more: 844.393.3282. (toll free) or ContactUs@HealthCareRegistries.com
After informing the patient that their HbA1c levels have increased, which increases their risk of developing retinopathy, ask: “What is going on in your life that is making it difficult to better control your diabetes? What challenges are you facing on a daily basis?”
One provider who started asking that question told us he could not believe how much he did not know about his patients’ past before he took this approach. Only the patient knows what their challenges are, and they will tell you.
Once you know the patients’ challenges, you will know exactly what is needed to improve their outcomes. You can then focus your plan of care on helping the patient overcome those challenges. Patient responses may range from confusion about exactly what to do, to frustrations and misunderstandings. These challenges may include food and housing insecurities, cultural challenges and incorrect perceived assumptions.
These factors drive the day-to-day decisions that patients make in managing their diabetes. Until you uncover those issues, you will not significantly improve the patients’ outcomes.
Fortunately, there are tools available to help identify and address these challenges. When the patient’s challenges fall into the category of “social drivers of health,” there is a free app called Neighborly. This app allows you to enter any zip code in the country and provides a comprehensive list of every social service organization in that region. Optometrists who have taken this approach have successfully assisted their patients in securing housing, and have helped many who face food insecurities.
There is an interesting story we heard about a patient who said that she knows what she should be eating, but simply cannot afford healthy food. When asked whether she was taking advantage of the local food bank, she responded that she did not want to eat expired food or things that restaurants and stores would otherwise throw away.
What she did not realize is that today many food banks are federally subsidized and the same food delivery trucks that bring fresh vegetables to your local grocery store also deliver the same exact food to food banks. In fact, the local food bank in this patient’s area had a requirement that one-third of the food a person receives has to be in the form of fresh fruits and vegetables.
Coordinating Care
The third component you need to add is coordinating the care of the patient with the rest of the patient care team. One effective way to accomplish this is by using Direct Secure Messaging (DSM), which is built into every certified EHR. Because of the way healthcare reform is being rolled out in the country, DSM works very well in some areas of medicine, but eyecare providers that have tried using it to coordinate care, in general, have met with considerable frustration. That will change with the new information blocking rules that are set to take effect in 2026.
Information blocking rules explicitly state that using fax machines does not meet federal guideline requirements. The fax should no longer be used in medicine due to its inefficiency and security vulnerabilities. Providers should instead adopt more secure and efficient methods of communication like DSM.
A recently release alternative is the “Universal Co-management App,” which is a highly effective solution to enhance collaboration among eyecare providers to coordinate care with the rest of the care team. This can be useful, whether referring a patient with dry eyes to a dry eye clinic, to a cataract surgeon, to a glaucoma specialist or to a primary care physician for diabetes management.
Summary
Healthcare reform has given us powerful tools to deliver full-scope optometric care to achieve better patient outcomes, and is more professionally and financially rewarding. This has opened new opportunities to expand the scope of care that we deliver and our importance as an integral member of the patients’ care team.
By embracing a collaborative approach and leveraging the capabilities of the new co-management app and DMS, you can enhance your impact on patient care while also experiencing greater professional fulfillment and financial rewards.
James E. Grue, OD, is a health-care reform speaker and consultant. To contact him: JimGrue@HealthCareRegistries.com
Ronald P. Snyder, OD, FAAO, is the president and CEO of HealthCare Registries, LLC. To contact him: RonSnyder@HealthCareRegistries.com
Michael J. Lipson, OD, FAAO, is the chairman of the OrthoK Advisory Panel of HealthCare Registries, LLC.
