Envisioning the interdependent profession of the future: ASCO president updates Ophthalmic Council™

May 1, 2013
ASCO President David Heath, O.D., addresses the AOA’s Ophthalmic Council.

ASCO President David Heath, O.D., addresses the AOA’s Ophthalmic Council.

The prospect of “health care drones” hovering over optometrists in the near future was raised as a metaphor for changes in health care at the March 14 meeting of the Ophthalmic Council™. In “Future Trends in Optometry,” David A. Heath, O.D., president of the State University of New York (SUNY) College of Optometry and the Association of Schools and Colleges of Optometry, assessed trends affecting both practice and education.

Optometry has already moved from a standalone profession to an integrated part of health care, he noted. But acceptance into the mainstream comes at a price, with ODs being scrutinized by third-party payers, both private insurers and government programs, to an extent not seen before.

As Dr. Heath described it, optometry and the rest of health care are moving from an internal accountability model (enforced by standards of professionalism) to an external accountability model, enforced by quality scorecards, efficiency measures, maintenance of certification, licensure, training and publicly available outcomes data.

The regulatory “ecosystem” he charted included 30 influences on the profession, ranging from traditional regulators such as state governments to emerging requirements tied to licenses.

Dr. Heath also detailed business pressures facing doctors, as hospital systems “gobble up” practices.

According to the Medical Society of the State of New York, five years ago half of the doctors in New York state were in private practice. Now, 70 percent are employed either by a hospital, health system or large group.

Optometric education is undergoing similar shifts, with increased customization of coursework and interdisciplinary studies becoming more widely available.

In fact, during the meeting, SUNY Optometry launched a partnership with Empire State College to offer an Advanced (Graduate) Certificate in Optometry Business Management, the first of its kind in optometry. (See article).

Shedding light on Sunshine Act

With ODs and educators anticipating increased oversight, characterized as hovering health care drones, industry representatives discussed the implications of the “Sunshine Act,” a federal law intended to shed light on relationships between health care providers and makers of medical devices and pharmaceuticals.

Rodney Peele, J.D., AOA assistant director for Regulatory Policy and Outreach, described how the law does not ban relationships or payments, but requires disclosure to the Centers for Medicare & Medicaid Services (CMS). Data collection begins Aug. 1, 2013, and public reporting is scheduled to begin March 31, 2014, on a CMS website called “OPENPAYMENTS: The National Physician Payment Transparency Program.”

The law only affects entities “operating in the United States to produce, prepare, propagate, compound, or convert a drug, device, biological, or medical supply covered by Medicare, Medicaid, or CHIP.” As Peele described it, any company making products that are prescribed and require FDA approval will need to report.

Physicians, including ODs, will not have to file reports, but they will need to review data on the site for information about them, correcting as needed.

Representatives of drug makers at the meeting said they are working hard to ensure they comply with the letter and spirit of the law, while at the same time striving to continue their support of the profession.

For them, sponsoring a meeting at an attractive destination such as a golf resort has the potential to create a troublesome “appearance,” and even low-value trinkets — traditional giveaways — are becoming less acceptable.

Just because a company doesn’t make drugs or medical devices doesn’t mean the law isn’t having an effect on its approach to sponsorship.

Most industry leaders expect media coverage of the reported relationships to be extensive, especially of the most egregious “outliers.”

Concerns about negative fall-out from stories about perceived payola could possibly lead to broad bans of sponsorships and giveaways.

By following the spirit of the law, officials in companies not directly named under the Sunshine Act hope to minimize the likelihood of such an outcome.

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