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Miles to go…
EDITOR’S PERSPECTIVE Paul B. Freeman, O.D.
Miles to go.
I
t is always a pleasure to see positive information about eye care in national and international newspapers, journals, and magazines. Recently, I was especially excited to see on the front page of the Personal Journal section of the Wall Street Journal, an article titled ‘‘High Technology for Low Vision.’’ As a private practitioner emphasizing this aspect of eye care, I always look for news articles, especially those that might serve as patient education materials to give not only to my patients but also to potential referral sources. Although the text of the article was good, generally accurate, and written in a positive light about the help available for the visually impaired individuals in our midst, two statements require clarification. The first statement suggested that a comprehensive vision rehabilitative assessment includes ‘‘a visit with an eye doctor, a technology specialist and an occupational therapist who can evaluate a person’s limits and goals.’’1 Although that model is more in line with a large group practice or institutional setting, many private practitioners (me included) have been able to help countless numbers of visually impaired patients with what is considered a comprehensive evaluation, which includes an eye health evaluation, refraction, and the determination and delivery of an appropriate rehabilitation treatment plan. In fact, the American Optometric Association’s (AOA’s) Clinical Practice Guideline ‘‘Care of the Patient with Visual Impairment (Low Vision Rehabilitation),’’ written by a multidisciplinary panel, states that ‘‘Examination of the visually impaired patient generally includes all areas of a comprehensive
adult or pediatric eye and vision examination, as the clinician deems necessary or appropriate, with additional evaluation to specifically assess the visual impairment and its impact on functioning. The examination is conducted to determine the physical causes of the impairment and to quantify the remaining visual abilities for the purpose of determining a rehabilitation plan.’’2 This examination is provided by the optometrist, typically in the practitioner’s office or in a clinic. Certainly, there are occasions when I and many of my colleagues will refer to occupational therapists, orientation and mobility instructors, teachers of the visually impaired, social workers, or psychologists to help those patients needing that type of assistance; the AOA Clinical Practice Guidelines support this treatment model as well: ‘‘The American Optometric Association supports an interdisciplinary approach to low vision rehabilitation. In addition to optometric vision rehabilitation, there may be other resources for evaluation, education, training, assistance, and support, or tools that may benefit the visually impaired patient.’’2 The second statement requiring clarification regards fees charged and reimbursement for the evaluation and subsequent devices prescribed. ‘‘Medicare and private insurance will pay for a doctor’s evaluation and occupational therapy. Devices generally aren’t covered, but low vision clinics may be able to get discounts for you or suggest lower priced alternatives.’’1 Medicare, and most private insurances, will pay for some (but not typically all) of the procedures and services included in a comprehensive rehabilitative evaluation, depending on the services
1529-1839/08/$ -see front matter Ó 2008 American Optometric Association. All rights reserved. doi:10.1016/j.optm.2008.09.010
Paul B. Freeman, O.D.
performed. Moreover, although thirdparty payors usually do not pay for devices, because they are not considered ‘‘durable medical equipment,’’ there are some state agencies that will help approved clients obtain prescribed devices by underwriting the device fees. Often, there are civic organizations that will provide assistance as well. What is most important in the rehabilitative treatment plan is to rely on the examining practitioner to prescribe the appropriate device(s). These points of clarification are important not only for potential patients to understand, but also for those doctors who refer patients for rehabilitative services. Most visually impaired patients enter the rehabilitative process by referral from an eye care provider, other physicians, or rehabilitation agencies. The referral of visually impaired patients is, I believe, a uniquely more delicate process than other ophthalmic referrals in that these referrals involve
626 patients and family members who are very frustrated by the fact that many were initially told ‘‘nothing more can be done,’’ only to then find out that there may be some potential help. Sometimes, the expectations of these patients, especially if they’ve been given minimal or inaccurate information about the examination or the finances involved, will serve to negatively impact the ultimate benefit a visually impaired person could have experienced. For example, if a patient has been told that what is needed to help with reading (by far the number 1 reason for patient referrals) is a ‘‘pair of magnifying readers,’’ there is little doubt that the patient will be frustrated by the thought of several visits and a rehabilitative process to regain the ability to read. If the patient understands that the referral is for an evaluation and development of a treatment
Editorial plan to improve impaired visual functioning, then expectations will be more in line with the ensuing process. Likewise, if a patient expects all services and treatment(s) to be covered by insurances or ‘‘discounted,’’ the result may be a disgruntled patient and family, despite a positive rehabilitative outcome. And, we all know that patients who return to a referring doctor and report having a bad experience (for whatever reason) typically will have the effect of limiting referrals by that doctor for other patients who could potentially be helped by the services. I applaud the Wall Street Journal for highlighting an area of eye care that will indeed grow over the coming years. Because rehabilitative services for the visually impaired are predominantly an optometric practice function, it is incumbent upon our profession to
help the public understand the nature of the evaluation of a person with a visual impairment, the rehabilitative process, the compensatory treatment options, and how third-party reimbursement fits in. Along with many of us who educate the public and health care providers in our communities, the AOA Low Vision Rehabilitation Section continues to work toward achieving those goals as well, but we still have ‘‘miles to go before we sleep.’’
References 1. Beck M. High technology for low vision. The Wall Street Journal September 9, 2008:D1-2. 2. Freeman KF, Cole RG, Faye EF, et al. Care of the patient with visual impairment (low vision rehabilitation). Optometry Clinical Practice Guidelines 2007.
Miles to go.
I
t is always a pleasure to see positive information about eye care in national and international newspapers, journals, and magazines. Recently, I was especially excited to see on the front page of the Personal Journal section of the Wall Street Journal, an article titled ‘‘High Technology for Low Vision.’’ As a private practitioner emphasizing this aspect of eye care, I always look for news articles, especially those that might serve as patient education materials to give not only to my patients but also to potential referral sources. Although the text of the article was good, generally accurate, and written in a positive light about the help available for the visually impaired individuals in our midst, two statements require clarification. The first statement suggested that a comprehensive vision rehabilitative assessment includes ‘‘a visit with an eye doctor, a technology specialist and an occupational therapist who can evaluate a person’s limits and goals.’’1 Although that model is more in line with a large group practice or institutional setting, many private practitioners (me included) have been able to help countless numbers of visually impaired patients with what is considered a comprehensive evaluation, which includes an eye health evaluation, refraction, and the determination and delivery of an appropriate rehabilitation treatment plan. In fact, the American Optometric Association’s (AOA’s) Clinical Practice Guideline ‘‘Care of the Patient with Visual Impairment (Low Vision Rehabilitation),’’ written by a multidisciplinary panel, states that ‘‘Examination of the visually impaired patient generally includes all areas of a comprehensive
adult or pediatric eye and vision examination, as the clinician deems necessary or appropriate, with additional evaluation to specifically assess the visual impairment and its impact on functioning. The examination is conducted to determine the physical causes of the impairment and to quantify the remaining visual abilities for the purpose of determining a rehabilitation plan.’’2 This examination is provided by the optometrist, typically in the practitioner’s office or in a clinic. Certainly, there are occasions when I and many of my colleagues will refer to occupational therapists, orientation and mobility instructors, teachers of the visually impaired, social workers, or psychologists to help those patients needing that type of assistance; the AOA Clinical Practice Guidelines support this treatment model as well: ‘‘The American Optometric Association supports an interdisciplinary approach to low vision rehabilitation. In addition to optometric vision rehabilitation, there may be other resources for evaluation, education, training, assistance, and support, or tools that may benefit the visually impaired patient.’’2 The second statement requiring clarification regards fees charged and reimbursement for the evaluation and subsequent devices prescribed. ‘‘Medicare and private insurance will pay for a doctor’s evaluation and occupational therapy. Devices generally aren’t covered, but low vision clinics may be able to get discounts for you or suggest lower priced alternatives.’’1 Medicare, and most private insurances, will pay for some (but not typically all) of the procedures and services included in a comprehensive rehabilitative evaluation, depending on the services
1529-1839/08/$ -see front matter Ó 2008 American Optometric Association. All rights reserved. doi:10.1016/j.optm.2008.09.010
Paul B. Freeman, O.D.
performed. Moreover, although thirdparty payors usually do not pay for devices, because they are not considered ‘‘durable medical equipment,’’ there are some state agencies that will help approved clients obtain prescribed devices by underwriting the device fees. Often, there are civic organizations that will provide assistance as well. What is most important in the rehabilitative treatment plan is to rely on the examining practitioner to prescribe the appropriate device(s). These points of clarification are important not only for potential patients to understand, but also for those doctors who refer patients for rehabilitative services. Most visually impaired patients enter the rehabilitative process by referral from an eye care provider, other physicians, or rehabilitation agencies. The referral of visually impaired patients is, I believe, a uniquely more delicate process than other ophthalmic referrals in that these referrals involve
626 patients and family members who are very frustrated by the fact that many were initially told ‘‘nothing more can be done,’’ only to then find out that there may be some potential help. Sometimes, the expectations of these patients, especially if they’ve been given minimal or inaccurate information about the examination or the finances involved, will serve to negatively impact the ultimate benefit a visually impaired person could have experienced. For example, if a patient has been told that what is needed to help with reading (by far the number 1 reason for patient referrals) is a ‘‘pair of magnifying readers,’’ there is little doubt that the patient will be frustrated by the thought of several visits and a rehabilitative process to regain the ability to read. If the patient understands that the referral is for an evaluation and development of a treatment
Editorial plan to improve impaired visual functioning, then expectations will be more in line with the ensuing process. Likewise, if a patient expects all services and treatment(s) to be covered by insurances or ‘‘discounted,’’ the result may be a disgruntled patient and family, despite a positive rehabilitative outcome. And, we all know that patients who return to a referring doctor and report having a bad experience (for whatever reason) typically will have the effect of limiting referrals by that doctor for other patients who could potentially be helped by the services. I applaud the Wall Street Journal for highlighting an area of eye care that will indeed grow over the coming years. Because rehabilitative services for the visually impaired are predominantly an optometric practice function, it is incumbent upon our profession to
help the public understand the nature of the evaluation of a person with a visual impairment, the rehabilitative process, the compensatory treatment options, and how third-party reimbursement fits in. Along with many of us who educate the public and health care providers in our communities, the AOA Low Vision Rehabilitation Section continues to work toward achieving those goals as well, but we still have ‘‘miles to go before we sleep.’’
References 1. Beck M. High technology for low vision. The Wall Street Journal September 9, 2008:D1-2. 2. Freeman KF, Cole RG, Faye EF, et al. Care of the patient with visual impairment (low vision rehabilitation). Optometry Clinical Practice Guidelines 2007.