The Affordable Care Act and Our Professions - Players or Spectators?

Earlier this week while attending the American Academy of Optometry meeting I wrote a blog posing the question, "How does optometry want to fit into the new healthcare landscape?"  Much to my surprise, while many have had the opportunity to look at the entry, only one person responded - and that person did so in a personal email, not on the blog.  Now that the meeting is over and I’m headed home I'm wondering why the silence?  I think this is a discussion and debate that optometry and all the other health science professions need to have.  

As the effects of the Affordable Care Act take hold on the American healthcare system the number of payment and payer options for our professions will unquestionably change.  Today there are a myriad of payer and insurance companies.  According to the experts I've talked to this almost certainly will change.  In the (very near) future we will see a consolidation of insurance providers and payers much like we've seen in the American healthcare sector.  We've already seen this happen to our airline industry.  Remember when there was an Eastern, National, Pan Am, TWA, and Continental airline?  Well, now there are only a few major carriers.  We're going to see the same thing occur with health insurance carriers.  Optometry, Audiology, Occupational Therapy, Speech, Language Pathology and the other health sciences must be agile in adapting to this new environment, otherwise they risk being "boxed out" by major carriers or worse.  

In my humble opinion, one of the best ways to do this is to ensure we're all part of what will be an integrated system of healthcare providers who are aligned with Accountable Care Organizations, Patient Centric Medical Homes and Medical Neighborhoods and other entities that focus on the delivery of primary care, high quality and value.  As I mentioned in my prior blog I believe this will require all the schools and colleges to work together to develop and teach our students how to best work within this new landscape.  This includes business prowess but also must include in-depth discussions in policy and how to influence policies.  

For optometry, I also believe the profession will need to continue its evolution as a primary care profession to include the management or co-management of common metabolic disorders such as diabetes, hypertension and hyperlipidemia.  As our healthcare system focuses more on the public health, outcome data, access to care and cost, professions such as those were training need to become more involved in prevention and patient education.  Smoking cessation, nutritional counseling, and lifestyle advice need to become integral parts of what we teach and ultimately integrate into our everyday practices.  

There is a great deal to think about as we enter into this new chapter in healthcare delivery.  I want us to be part of the discussion on what this looks like and not the recipient of what others develop for us.  Complacency and sitting on the sidelines is not only an unacceptable course of action but can very well become a devastating behavior that leaves many health science professions subservient to others; something many have successfully worked very hard to avoid over the past 50 years.  

It's time to be bold, creative and responsible.  Educators, providers, researchers, industry and other important collaborators need to come together and have a very candid debate on how we all fit into this new healthcare landscape.   We can choose to be spectators or players - Players determine the outcome of the game - spectators only can brood about the outcome.  I want to play;  I hope you do as well!

How Does Optometry Want to Fit Into the New Healthcare Landscape?

I just finished participating in a meeting of the Association of Schools and Colleges of Optometry.  That group is composed of all the Deans and Presidents of the nations optometry schools with representation from our neighbors in Canada.  I had the distinct honor to lead a discussion on how optometry, as a profession, will prepare our new graduates to work in the new healthcare landscape that has been developed by the Affordable Care Act.  Along with that I also asked the group to explore how to build the foundation for the expansion of clinical privileges to include the diagnosis and treatment of such pervasive diseases as diabetes, hypertension, hyperlipidemia and other prevalent metabolic disorders that often beckon the doors of optometric practice.  The discussion on expanding the scope of practice was spirited, to say the least. There was consensus that we, as educators, need to do a much better job of preparing our graduates to succeed under the new healthcare landscape to include understanding the lexicon of Accountable Care Organizations, Medical Homes and other payor models.  I think we agreed to all work together to develop a consolidated curriculum that will address this in the near future.  I'm committed to having Salus take the lead on this.  

There was much more discussion and debate around the scope of practice expansion.  The Affordable Care Act will result in a significant shortage of primary care providers in the country through the foreseeable future. Someone is going to need to fill that void to see those diabetics, hypertensives and others needing care.  While physician assistants, nurses and possibly others will certainly help to fill that void, optometrists are extremely well positioned to provide the necessary care.   Many diabetics and hypertensive patients are often diagnosed or referred for definitive diagnosis following a routine eye exam.  With additional didactic and clinical training, optometrists can obtain the necessary skills to care for those patients.  While much work still needs to be done both academically and statutorily, I believe this is the direction that optometry needs to take.  A little over 30 years ago optometry obtained diagnostic and therapeutic privileges.  For the benefit of the public health, economics and the patients optometrists care for, it's now time for the profession to take the next evolutional step towards the diagnosis and management of the common diseases aforementioned.  Appropriately, there will be much debate over this, but in the end, the profession needs to decide what direction to take as we enter into this new landscape of healthcare delivery.

Reflecting on Veteran's Day and a Call to Service

As we approach Veteran's Day next week I can't help but to reflect on the sacrifices those in uniform and their families have made to ensure Americans continue to enjoy the freedoms and quality of life that help to define our lives here.   Those veterans who came before us, as well as those currently serving, have done so out of a sense of patriotism and having the call to serve. 

As we reflect upon all the great gifts we have in our country, I think it’s also very fitting to reflect on how we too, as healthcare professionals, can contribute and give back to society, both here and abroad.  I’m not suggesting or expecting anyone to all of a sudden to join the Armed Forces or volunteer for the Peace Corps (although I also wouldn’t discourage it) but I am proposing we take some time to explore how we can better leverage all of our skills towards the betterment of the public health of Americans as well as others.  The call to serve should be a natural desire for all of us in healthcare.  While many do volunteer to “do good things”, I don’t believe it’s the norm; and I certainly don’t believe there’s enough. 

I’d like Salus to set a new standard and redefine how we reach out to others, both here and abroad, to have an even greater impact than we do now on society.   As many of you know, we currently care for children in Philadelphia, Norristown and surrounding public schools, send teams to Haiti, rural, middle America as well as other locations, but we don’t have a centralized, fully aligned approach to this.  I would like to use this refection on Veteran’s Day and a call to service to challenge the Salus community to work together to see how we can COLLECTIVELY pool our expertise as a University community to positively affect the lives of others.

I don’t believe there’s a single formula for this, which is why I’m challenging you to come up with some ideas.  One idea I’ve discussed is to reorganize SOSH and have them align with others at the university to expand their scope of services and destinations.  Let’s talk about it, develop a plan and then, in the true spirit of caring, generosity, ingenuity, and selflessness, execute something that has the Salus signature on it in honor of all those who have paid the ultimate sacrifice which allowed us to exercise our freedom in being able to choose healthcare as a profession - and then give something back to society as a way of saying "thanks".