The critical difference: scope of optometry practice vs. entry level competency.

This paper proposes a survey-based approach on how optometry can define the critical difference in competency levels between entry level and experienced practitioners. The report describes the design and pilot testing of a survey instrument on clinical competencies. This work is still in an early stage, and these preliminary findings are meant to encourage other individuals to work on empirical models for defining entry level clinical competencies. The pilot study concludes that a full scale project to describe empirically the entry level competencies for optometrists is feasible and worthy of effort. The findings of a descriptive study can help gauge at an institutional or national level what is the extent and diversity of views about what constitutes entry level clinical competencies for optometry.

Specialty differentials, limited license practitioners, and Medicare's new fee schedule.

The use of specialty differentials in the newly adopted Medicare fee schedule has been debated over the past 2 years. Arguments supporting the elimination of specialty differentials for optometrists and ophthalmologists are presented. The first recommendations by the Physician Payment Review Commission eliminating specialty differentials represent a victory for optometry in its efforts to achieve parity in the reimbursement of Medicare-covered services. Relative value units and practice costs to be used by the new Medicare fee schedule must be determined for optometry. Estimates of the model fee schedules for eye care procedures have been released by the Department of Health and Human Services.

The Medicare Optometry Parity Amendment: predicted and actual payments to optometrists and ophthalmologists.

This paper compares various costs estimates for the expansion of optometric services under the Medicare program that were developed prior to the enactment the Medicare Parity Amendment of 1986. The new law, effective April 1, 1987 redefines the conditions of optometric participation and expanded coverage to include all Medicare covered services for which optometrists are authorized to perform under the state law. The paper describes the impact of the Medicare amendment with regard to payments to optometrists and ophthalmologists. Payments to optometrists increased from $12 million in 1986, a year before the Medicare Amendment to $81 million in 1988, the first full year after the law's implementation increasing their market share of Medicare payments from 2.6% to 11.1%. Ophthalmology incurred a significant decrease in market share from 97.9% to 88.9% during this period.

Predicted and observed effects of the Medicare Optometry Parity Amendment.

The Medicare Parity Amendment of 1987 redefined the conditions of optometric participation and expanded coverage to include all Medicare-covered services which optometrists are authorized to perform under state law. Prior to the law, a number of studies projected costs to Medicare as a result of a change in Medicare policy. This paper reviews these studies in relation to actual Medicare expenditures from 1986 to 1988. The paper describes the impact of the Medicare amendment on payments to optometrists and shows how payments increased from $12 million in 1986 to $81 million in 1988. Optometrists substantially increased their market share of Medicare payments from 2.6 percent in 1986 to 11.1 percent in 1988. Indications suggest that a shift of patient visits from ophthalmologists to optometrists has occurred.

Problem orientation in vision therapy.

Quantification and retrieval of data in vision therapy is a difficult task for both the private practitioner and optometric educator. The problem-oriented record provides an organizational approach that readily identifies patient's problems, therapeutic objectives, and the results of administered therapy. A minimum data base and the resultant problem list for vision therapy has been designed by us. By combining these two through a system of coding, a ready computer data retrieval system was devised. This system provides a method to clearly define terms, objectives, and results. Utilization of this record system by optometric schools and practitioners should reduce much of the confusion existing in the specialty field of vision therapy.

Implementation of the problem-oriented system in an optometric teaching clinic.

Problem-oriented records, performance audit, and a clinical index were implemented in the eye-care service of the Dorchester House Multi-Service Center, a neighborhood health center and teaching affiliate of the New England College of Optometry. We found that problem-oriented records facilitate communication and encourage logical thinking, that audit helps assure the quality of care and teaching, and that a clinical index provides a perspective on the overall performance of the eye-care service.

Identification of the patient at risk: an optometric role in the prevention of stroke.

Identification of patients at risk for stroke and institution of medical management to reduce risk are the essentials of preventing stroke. Optometrists can play a role in the prevention by identifying patients at risk and directing them to appropriate medical care. The paper reviews the pathogenesis and clinical presentation of thrombotic, embolic and hemorrhagic stroke. The profile of potential victims is outlined with emphasis upon risk factors which may present in optometric patients; hyperlipidemia, hypertension, smoking, unruptured aneurysm, retinal emboli, and transient ischemic attacks.