Immediate Past President

Just a quick note to thank everyone for allowing me to serve as the 87th President of the American Optometric Association this past year.

Today, I have handed over the reigns of the AOA to my good friend and colleague, Dr. Randy Brooks from New Jersey. Randy will do a tremendous job for all of us this next year.

I especially want to thank my optometric family from Illinois. Their support throughout the years has been unwavering and I couldn’t have done it without them.

Thanks again for a great year. Once I get back to Illinois I’ll catch up with this blog and continue it for another year while I serve on the AOA board to give everyone another vehicle to communicate with an AOA board member.

Pete

Obama says health care changes must come this year

Obama says health care changes must come this year

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Congratulations Class of 2009

Last weekend I had the honor of delivering the commencement address to the ICO Class of 2009. What an awesome experience and one that 25 years earlier at my graduation – was not a thought in my mind.

This years graduating class is the best educated in our profession and they can be proud of their education and training. Patients for years ahead will benefit from the care provided by these great doctors.

I delivered 5 points to them for consideration:
First and foremost, be an independent doctor of Optometry no matter what setting you choose to practice.
Second: Use the power of your exam room by becoming a doctor driven dispenser and educating your patients about a lifetime of healthy vision at EVERY opportunity. #3 Get involved in your local society
#4: join your state and national associations whatever mode of practice you choose. This is where the deep roots of optometry are planted.
And fifth and last…include your personal and extended family in all you do …and MAKE IT FUN.

Thank you ICO for allowing me the opportunity to deliver my message and best of luck to ALL 2009 graduates. The Future of Optometry is in Your Hands……GRAB HOLD!

National Licensure???

     One of the on-line newsletters today brought up the topic of National Licensure and while he made reference to the Joint Board Certification Project Teams model for maintenance of certification, I wanted to take a crack at explaining why true national licensure is unrealistic.
     I can only think of two national (issued by the federal government) licenses. A pilot’s license and a broadcasters license. I’m sure ther are more, but these two come to mind.
     There are NO national licenses for any healthcare profession. There are very similar scopes of practice for medicine and denstistry in most states, but not a national license.
     We have 50 different optometric practice acts and that is because our country operates on a states rights concept. Regulation occurs at the state level.
Scope of practice for optometry is a state issue that must be addressed by the state optometric associations, the state optometric boards and state legislatures – not a federal agency or even a national optometric organization. That said, the AOA continues to work with any state in their efforts to expand the scope of our profession to better serve the patients in their state.
     I am in St. Louis this weekend for the North Central States Optometric Council and had a member suggest that the current optometric board certification program and maintenance of certification proposal could help level the scope of practice across the country. His theory was that when the majority of doctors in a state had passed a board certification exam that included content beyond their scope, it would inspire them to encourage their state association to more aggressively pursue advanced scope of practice laws.
     Since this doctor had been through legislative batteles in his state and understands states right issues, I thought his was an intersting – and certainly more plausible concept than national licensure – way to go North Central optometry!
Until next time… Pete

Board Certification as of April 23, 2009

I want to thank everyone who has taken time to post comments and ask questions on this blog concerning board certification.
Hopefully all AOA members have received the letters by e-mail from Dr. David Cockrell last Wednesday and Yesterday. If you haven’t received them, you can follow the link below this post  for the latest updates.
Please keep your inbox, mailbox, eyes and ears open for more details about Value-based healthcare and how optometry is preparing for the future.
Until next time,
Pete

Optometric Bill of Rights

As I drafted the last President’s Column presenting a Declaration of Optometric Independence, I was about to share the message to nearly 300 industry executives at the Vision Monday Global Leadership Summit prior to Vision Expo East.
 
It seems fitting today as I depart Washington, D.C., after having met with several members of Congress and senators that I share my version of the Optometric Bill of Rights.    

The first five, in this issue, concern the rights of practitioners. With the national discussions of health care reform, it’s critical that optometry is clear with where we believe the profession must be, so we begin with the first five rights of optometrists.

First Amendment – Equitable Reimbursement – optometrists and ophthalmologists shall receive equal reimbursement for the same services regardless of the payer. There is currently discrimination in managed Medicare, some Medicaid and obviously in ERISA plans and even (possibly without common knowledge) traditional commercial insurers. Optometry, through the AOA and state associations, will need dues dollars and support in fighting for equal reimbursement for equal services.

Second Amendment – Truth and Transparency – optometrists shall be provided with easy-to-understand full disclosure statements by managed vision or health plans to more easily determine if joining a panel makes financial and  professional sense for his/her practice.  In particular, as in some managed vision plan carve outs of medical eye care – when there is disparity between reimbursement or scope of services provided between optometry and ophthalmology – the plan will clearly disclose the disparity and the optometrist can then determine if the lower reimbursement or limited scope of services provided is in the patients’, his/her practices’ or the professions’ best interest to join the panel.

Third Amendment – Optometric Co-Management and Intra-Professional Referrals – optometrists in all practice settings shall work closely with their optometric colleagues to ensure all patient needs are met by optometry whenever appropriate. This is a natural evolution for our profession and very successful in limited areas of the country for some specialties. There are thousands of patients who can benefit from vision therapy, low vision, sports vision and specialty contact lens referrals. In addition, based on experience, equipment limitations or practice settings, some optometrists choose to refer glaucoma and other medical eye conditions. In the future, those optometrists will first look to their optometric colleagues. The patients will be promptly returned to their family optometrist for care not based on the referral.

Fourth Amendment – Fair and Reasonable Reimbursement for Services Provided – The AOA will provide its members with tools and information to ensure that no optometrist shall ever have to make patient-care decisions based on the economics of reimbursement. Eye examination reimbursement will cover all costs of providing the services and a reasonable profit. The provision of professional services or materials will all cover the costs of providing the products or services and a reasonable profit.

Fifth Amendment – Lifetime of Learning and Professional Growth – all optometrists shall continue to commit to a lifetime of learning to ensure the best patient care possible. In addition, the optometric profession will never stop striving to provide necessary care to patients in need and will set no limits on the expansion of scope when it is in the patient’s best interest.
 

Because our patients are the focus of all we do, the next issue will conclude with my view of patient rights from a presbyopic perspective of optometric care.

Declaration of optometric independence

Webster’s defines independence as the quality or state of being independent, and offers several definitions of independent, some of which include: “1: not dependent: as a (1): not subject to control by others : self-governing (2): not affiliated with a larger controlling unit <an independent bookstore> b (1): not requiring or relying on something else : not contingent <an independent conclusion> … (1): not requiring or relying on others (as for care or livelihood) <independent of her parents> … d: showing a desire for freedom <an independent manner>”

The majority of AOA members define themselves, or their practice setting, as independent when they complete practice surveys; yet the independence of our profession is being threatened on many fronts. 
 
First, and most important, is professional judgment.   When speaking to students or groups of optometrists, I always remind them that regardless of where they choose to practice, or who writes their paycheck, they are the only person responsible for patient care decisions.   Non-licensed employers and employers of different professional designations can often influence employed optometrists in the way they practice, but the ultimate decision – the independent decision – on a patient’s care should always belong to the licensed OD. 
 
Some organizations and businesses don’t see it that way.  Recently, several state optometric associations found themselves in legislative battles with employers of AOA member optometrists over patient care issues. This places the employed OD in the awkward position of having to decide between his or her professional responsibility and the bottom-line desires of their employer. 
 
Second, we are seeing challenges to financial independence.  Even traditional solo/private practitioners are having their independence threatened by the growth in managed vision and health care.
 
As optometry has become a major provider of medical eye care and insurers are vertically integrating, there is downward pressure on reimbursement.  More and more health plans require us to accept a less than financially viable vision plan to have the “privilege” to provide medical care to larger and larger patient populations. And now, managed vision care companies are carving out medical eye care in arrangements that discriminate fees and/or administrative arrangements between optometrists and ophthalmologists.
 
Ask yourself the question, by your participation, are you supporting or fighting against provider discrimination?

So is this a doom and gloom column? Absolutely not, because we are optometry! Your AOA will continue to fight legislatively for your independence from others trying to dictate what services we can provide and those trying to devalue the quality services we provide.
 
With the blessing of our team, we will step up the fight.  We will expose vision and health plans that discriminate against our profession in reimbursements and administrative policies so you can make fully informed business decisions rather than feeling pressure to join out of fear of losing patient groups.
 
Tools being developed by the new Third Party Center at the AOA will prepare any doctor, in any setting, to analyze the finances of the practice.
 
We want to help you make informed business decisions on all discount vision or health plans. Armed with a clear financial understanding, maybe you’ll have the courage to declare independence from the handcuffs of accepting plans that reimburse less than the cost of doing business and definitely less than the value we provide to every patient.
 
Ultimately, when they see ODs asking hard questions, maybe plan administrators and employers will realize that they have to be more competitive and equitable with their fees if they want the best and the brightest optometrists to sign on.
 
So how do you declare independence when you are employed by an ophthalmologist or corporate entity? First, choose your employer wisely.  Discuss philosophy on the future of your profession PRIOR to accepting that first paycheck. 
 
And if you are considering joining a panel, ask yourself whether you are standing up for your profession or selling yourself short.   Always remember that it is your education, your license to practice and your profession that make up the three legs of your professional stool. Never allow an employer or plan manager to weaken any of those legs.

Please join me in rallying our colleagues in reconfirming the independence of optometry…for our patients, our practices and our profession!

Board Certification Is The Topic

Folks there are several comments from readers on the topic of board certification. I apologize for not responding earlier, but travels have gotten in the way. Please be sure to read everyone’s posts and my replies and feel free to respond with your own comments.

I also encourage everyone to visit www.aoa.org/jbcpt.xml frequently for the latest Q & A’s on the process and the latest information on the proposed model.

The executive committee of the AOA had a very excellent meeting with state leaders last week at SECO and a lot of good ideas were raised that I believe will further improve the model that is being presented.

My hope is that NO STATE ASSOCIATION will tie the hands of their leaders that attend the AOA House of Delegates this year. Those in attendance at the House of Delegates will need the lattitude to hear all the arguments for and against and make an informed decision for the future of our profession.

Until next time…
Pete

Three schools in three days

I was fortunate to be able to visit SUNY State College of Optometry, Pennsylvania College of Optometry at Salus University and New England College of Optometry Feb. 11-13.  The AOA sponsored faculty lunches, each attended by 25-30 faculty members and student events (each attended by between 125 and150 students from various classes).  The deans/presidents and administrators at all three schools and colleges welcomed the AOA, discussed their curricula and gave tours of their academic and clinical facilities. 
 The topic of greatest interest at all three schools was board certification.  I emphasized to faculty the “mentor” role they play and encouraged them to encourage their students to be active in organized optometry. 
With students, I emphasized the importance of getting involved, even if they weren’t sure what sort of practice they’d be involved in and that involvement in the profession was the surest way to keep it secure.

From left, Ray Pirozzolo, AOSA secretary; Denise Whittam, O.D., NYSOA president-elect; AOA President Pete Kehoe, O.D.; SUNY State College of Optometry fourth-year student Mansoor Syed; Diane Adamczyk, O.D., director of Residency Education; Leon Nehmad, O.D., associate clinical professor and SUNY’s AOA Faculty Relations Committee representative, and fourth-year student Ashley Fazzary.

At the NECO Student Bowl: Outgoing NECO AOSA Trustee Phillip Purcell; incoming NECO AOSA Trustee Jessica Crooker; incoming NECO AOSA Trustee-elect Joanna Galasso, Dr. Kehoe; Eric Hebert, O.D., of Rockland, Maine, NECO alumnus and AOA Student and New Graduate Committee member.

At left, students listen to my address at PCO. I raffled off several of his favorite “financial savvy” books to the students before joining them for an AOA-sponsored dinner in the PCO cafeteria.

Preventing history from repeating

For the past 10 years of my life I’ve felt incredibly fortunate to have been an AOA Board member, now serving as your president.
 
Throughout these 10 years one of my biggest privileges has been the process of learning about each aspect of our profession as a liaison to nearly every committee within the AOA.  An honor that accompanies that learning process is getting to participate in many discussions with ODs who have been leaders throughout our profession’s history.
 
With the current discussions about optometric board certification this spring, several voices from the past have called and written to remind me of historical conversations in our past as progress brought controversy and fear.

The leaders who were part of our optometric history at the front lines of change shared with me those historical conversations and outcomes in our profession’s history where a vocal minority or even our own house of delegates made decisions that slowed the progress of our profession.

Even during those historical setbacks, those who looked forward trusted their knowledgeable leaders at the national and state level, making the tough decisions to look beyond the short-term downside and refocus on the future for our patients and our profession.

An example of not seeing the future was in 1938 when the AOA House of Delegates passed a resolution: “…with emphasis on the fact that optometry has no desire to extend its practice to include any limited or other form of medical eye care.”

The stories told to me by those who were around in the early 1960s related that optometry did not initially want to participate in the Medicare system that launched in 1965. However, in 1967, realizing their error, the AOA House of Delegates went on record as wanting to be part of the Medicare system.  Unfortunately, because we were not part of the launch of that initial program, it took us 20 years to become full participants in the Medicare system.

Of course the transition into medical eye care with diagnostic and therapeutic pharmaceuticals flew in the face of the 1938 resolution and there were many within our profession vehemently opposed to our transition into medical eye care right up to the day of state legislature votes.

Fortunately, for the millions of patients, and our profession; state and AOA leaders did their homework and had a vision for the future in the 1960s, 1970s and beyond. They were bold and stood against the vocal opposition — and look where we are today as a profession: 37 years after Rhode Island’s first diagnostic law, optometry is in mainstream health care in America.

Today optometry sits at the table to help frame the NEW and changing American health care system.

Trying to ensure optometry’s full inclusion in the future has once again brought vocal opposition. Let’s not repeat history because a vocal few haven’t looked forward or fear the change that will be our catalyst into the future of total patient care.

Our leadership who sees the future does their best to position our profession for success by sharing the information and added wisdom with the majority.

The AOA Board and state leaders continue to do their homework to ensure that optometry will have full participation in the new quality-oriented, value-based healthcare that is being developed in America.

What a great time to be a member of your state association and the AOA in the age of information. Yet, I challenge everyone to do the necessary homework to provide informed feedback to your state leaders by reviewing the board certification materials that are posted on the AOA Web site: www.aoa.org/jbcpt.xml.

Let’s not get caught up in the negative hype that is being fueled on the Internet.

The misinformation and personal opinions being expressed aren’t substantiated by solid credible information.    I urge you to review the materials that have been developed by the Joint Board Certification Project Team.    Look at the facts both historical and current. You should find total confidence in the findings because of the amount of time and effort the team has invested in this project to ensure that optometry “gets it right” for our patients and our profession.
 
Value-based health care is the reality. The AOA Board and our state leaders realize that we may lose a few good members depending on the outcome of the vote on board certification, however, we should all be more concerned that as a profession we could be left out of the changing health care system or unable to participate at the full level with equal reimbursement as other board certified professionals.