Article Date: 5/1/2011

Practice pulse TIPS, TRENDS & NEWS YOU CAN USE

SURVEY REVEALS PATIENTS ARE HAPPY WITH OPTOMETRIC PRACTICES

Optometry Makes Top 10 List for Patient Satisfaction

■ A survey of more than 3.1 million patients in 2010 reveals that optometric practices rank #5 for patient satisfaction with a rating of 91.81 out of a 100-point scale. The rankings were based on the evaluation of 99 different medical practice specialties.

“It's clear that medical practices are working hard to improve the patient experience,” says Patty Riskind, senior vice president of medical services at Press Ganey Associates, Inc., the company that conducted the survey. “With the recent launch of the Physician Compare website (www.medicare.gov/find-a-doctor/provider-search.aspx) and the likelihood that patient satisfaction will become part of public reporting and future pay-for-performance programs, we've been pleased to see that our medical practice clients who have started measuring the patient experience are already making significant improvements.”

The top 10 consists of Medical Oncology (92.76), Gynecological Oncology (92.39), Interventional Cardiology (92.01), Cardiovascular Disease (91.99), Optometry (91.81), Hematology (91.77), Geriatric Internal Medicine (91.37), Gynecology (91.32) Nephrology (91.29) and Family Medicine (90.76).

“It is great to see optometry in the top 10 list of medical specialties for patient satisfaction,” says Neil Gailmard, O.D., who practices in Munster, Ind. and writes OM's Practice Management Tip of the Week. “In order to make the list again next year, I recommend that optometrists (1) tell patients in advance about fees, payments and insurance, (2) have a great record for punctuality for appointments and (3) offer convenient office hours, including evenings and Saturdays.”

Press Ganey (www.pressganey.com) is a South Bend, Ind. company that specializes in healthcare performance improvement. It works with U.S. healthcare organizations to improve clinical and business results.

DRUG COMPANY MAINTAINS ITS FDA-APPROVED DRUG IS BETTER THAN ITS OFF-LABEL DRUG

Study Concludes Avastin is as Effective as Lucentis in Treating AMD

■ On the heels of the first-year results of the Comparison of AMD Treatments Trial (CATT), which revealed Bevacizumab (Avastin, Genentech), a cancer drug used off-label to treat AMD, appears just as effective as ranibizumab (Lucentis, Genentech) an FDA-approved AMD drug, Genentech maintains that Lucentis is better than Avastin for the treatment of AMD.

“Avastin and Lucentis are different medicines. We specifically designed Lucentis to be cleared more quickly from the bloodstream to minimize side effects,” says a statement from Genentech. “The data reported by [the study] state that ‘the rate of serious adverse events, primarily hospitalizations, was higher among bevacizumab-treated patients than among ranibizumab-treated patients.’ These findings from CATT add to an emerging body of evidence from much larger analyses that suggest the risk of systemic adverse events may be higher when injecting Avastin into a person's eye compared to Lucentis.”

Genentech adds that the CATT trial also showed Lucentis was statistically superior to Avastin in removing the fluid from the eye that can cause vision loss.

Meanwhile, Philip J. Rosenfeld, M.D., Ph.D., professor of ophthalmology and retina specialist at Bascom Palmer Eye Institute, whose research on the two drugs played a catalytic role in CATT, has said that it's “reassuring to learn that both drugs are equally effective, and Avastin can serve as a low-cost alternative to Lucentis.”

The CATT study is a two-year, federally funded multicenter, single-blind, noninferiority trial, in which 1,208 neovascular AMD patients received bevacizumab or ranibizumab injections on a monthly schedule or on an as-needed basis with monthly follow-up.

CALIFORNIA CO-LOCATION PRACTICES BILL IS APPROVED IN COMMITTEE

Healthcare Plan Ownership Bill Clears First Hurdle

■ California Assembly Bill (AB) 778 (Atkins D-San Diego), which would allow an optical company, an optical goods manufacturer or distributor, a registered dispensing optician or a non-optometric corporation to own a healthcare service plan that provides visioncare services, has passed in Committee, enabling it to continue to move up the legislative ladder. AB 778 would also enable the aforementioned parties to share profits with the healthcare service plan, contract for specified business services with the healthcare service plan and jointly advertise visioncare services with the healthcare service plan, while also prohibiting behavior designed to influence or interfere with the medical decisions of an O.D.

According to the California Optometric Association (COA), the sponsor of the legislation is Luxottica, which has been involved in litigation with the State of California over the business model utilized in its subsidiaries: LensCrafters and Pearl Vision. The COA, which opposes the bill in its current form, says the litigation generally revolves around Luxottica and LensCrafters' relationship with optometrists employed by the vision plan EyeMed. (Luxottica also owns EyeMed.)

In 2002, California's Attorney General filed a suit against Pearl Vision alleging the unlicensed practice of optometry, use of deceptive marketing and unfair business practices (see: http://ag.ca.gov/news alerts/print_release.php?id=666.)

“The Attorney General contends, and COA agrees, that the business model utilized violates California statutes that prohibit economic relationships between optometrists and opticians,” the COA released in a statement to OM. “They (Luxottica/LensCrafters) seek to avoid adverse court decisions by utilizing legislation to create an exemption to the statutes in question.”

Although current California law prohibits O.D.s from engaging in business relationships with optical manufacturers or retailers and constitutes such a relationship as a misdemeanor, the current law also permits a healthcare service plan to both hire and contract with licensed professionals and to engage in a business relationship with any entity.

“The ambiguity in the current law has led to years of litigation, and it's really limited and halted the growth of eyecare access in the state,” says Eliot Grossman, O.D., president of EyeExam of California, Inc., a Luxottica-owned licensed vision care service plan that employs optometrists to deliver eyecare. “So, the ambiguity is hurting patient choice and the economy.”

Dr. Grossman noted that Pearle Vision “decided to leave the state completely because of the instability and on-going litigation.”

Dr. Grossman is also a member of The Californians For Healthy Vision coalition, a group comprised of healthcare organizations, such as Aetna, trade groups, such as the National Association of Optometrists and Opticians and the California Retailers Association, and Luxottica-owned optical retailers, such as LensCrafters, who support AB 778.

EHR COURSE INTRODUCED

JCAHPO Offers Staff Training in Electronic Records

■ How do you provide your staff with training on electronic health records (EHR) systems before the system is running live in your practice? The Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO) has developed an answer: the course “Electronic Health Records (EHR) Training.”

Supported in part by an educational grant from Compulink Business Systems, this course, a comprehensive simulation with interactive video screens, addresses four learning objectives:

► the key differences between EHRs and manual paper records;
► the challenges and benefits of using an EHR system;
► the information needed to complete an EHR;
► navigation through a typical EHR system.

The course allows test takers to proceed at their own pace while receiving practice in entering data through an EHR system developed specifically for an ophthalmic practice. The cost of the course is $15 ($10 for JCAHPO members). For more information or to order the course, visit www.actioned.org, or call (800) 284-3937.

Management MEMO

Staff Referrals: An untapped source of new patients

Bob Levoy, O.D., Roslyn, N.Y.

■ In addition to their family members, your staff members likely have a wide circle of friends, new people they meet socially and perhaps a presence on Facebook, Twitter and other social media—all of which offer opportunities to recommend, when appropriate, your practice.

Question: How many new patients have your staff members been directly responsible for bringing into your practice in the last six months? A few? A lot? None? Not sure?

If employees aren't recommending your practice, it may be because they haven't thought about their role in out-of-office public relations or aren't sure what to say. These are easily rectified.

Action steps:

At your next staff meeting, discuss the unique opportunity everyone has to bring new patients into the practice starting with family members and friends. Other potential patients include new people they meet socially, who (learning what they do) have questions or concerns about their eye health, contact lenses, a child's vision, computer-related vision problems, etc.

Role play what to say and how to best say it when dealing with these issues—and recommending your office in a manner that's low-key and professional.

To facilitate referrals in such situations, print business cards for each member of your staff. Include all the usual information (practice name, address phone number and website), and add the staff member's name and title. (Ask if staff members prefer the use of only their first names).

These cards will also be useful if patients need to reach staff members about their bill, insurance, appointment, contact lenses or numerous other matters. This “personalizes” such contacts and further bonds patients to your practice.

Reality check:

Cards of course, are only tools. For your staff to be effective referral sources for your practice, they have to truly like their jobs and be proud of the practice. Also, they must be kept up-to-date on the scope of services and materials in your practice and experience first-hand, your optometric skills, thoroughness and caring ways. Then, they can be genuinely enthusiastic of the practice and you.

West Virginia and Ontario Make Strides

Updates in Scope of Practice Legislation

House Bill 2639, a West Virginia bill, which contains legislative rules that authorize the Board of Optometry to add new oral medications as they become relevant in the treatment of disease of the eye and its appendages, and also outlines the certification process allowing O.D.s to provide non-global injections in the treatment of the eye and its appendages, as authorized by the Board of Optometry, has been signed into law by Governor Early Ray Tomblin.
“This is another significant step for West Virginia optometrists, in that it allows them to practice to their fullest extent,” says Chad D. Robinson, executive director of the West Virginia Optometric Association. “This bill was the first implementation of the scope of practice bill enacted in 2010.”
The bill of which Mr. Robinson speaks places the formulary for oral prescription drugs solely under the jurisdiction of the state's Board of Optometry and enables the Board to go through the state's legislative rule-making process for injections—excluding globe injections—for therapeutic use and additional surgical procedures, provided what the Board proposes is taught at 50% of all accredited optometry schools.
“We are privileged to practice in a state where the members of legislature respond to improve access to medical care by recognizing advancements in science and technology,” Matthew Berardi, O.D. and president of the West Virginia Board of Optometry, released in a statement.
In related news, Ontario O.D.s who have demonstrated their compliance with the College of Optometrists of Ontario's Therapeutic Pharmaceutical Agents Policy (e.g. appropriate educational background, proof of competence and currency of knowledge) can now prescribe drugs. Specifically, these O.D.s can prescribe drugs for bacterial and viral eye infections, contact-lens-caused red eye, eyelid infection and inflammation, eye inflammation, ocular pain, ocular allergy, superficial foreign bodies and glaucoma.
“Most of our members have been educated and trained to prescribe medications for years,” says Ontario Association of Optometrists' president John Mastronardi, O.D. “We are pleased that the Ontario government has made changes that will broaden access to medically necessary services across the province.”
Before this regulation, Ontario O.D.s were required to refer patients to an ophthalmologist or other medical doctor, when diagnosing an eye condition that required medication.
Manitoba is now the only Province in Canada that does not allow optometrists to prescribe drugs, according to The Canadian Association for Optometrists.

Corrections: In our “Annual Contact Lens Update” article (April 2011 issue), we inadvertently removed Susan Kovacich's credentials. Dr. Kovacich is an associate clinical professor in the Cornea and Contact Lens Clinic at the Indiana University School of Optometry.
In the Contact Lens Management article “Fitting Post-Corneal Transplant,” (April 2011 issue), the caption should have read: “Soft toric lens on an eye with a PKP. The white arrows indicate the lens toric markings.”

RESEARCH Notes
• The prevalence of open-angle glaucoma (OAG) for Asian Americans is 6.5%—similar to that of Latinos (6.4%) and higher than that of non-Hispanic whites (5.6%). In addition, Asian American's prevalence rates for narrow-angle glaucoma (NAG) are substantially higher among Asian Americans (3% and .73%, respectively) when compared with other races.
Also, after adjustment for potential cofounding factors, Asian Americans had a 51% increased hazard of OAG, a 123% increased hazard of NAG and a 159% increased hazard of normal tension glaucoma (NTG) relative to non-Hispanic whites. Finally, Vietnamese Americans, Pakistani Amer icans and Chinese Americans have substantially higher hazards of NAG, whereas Japanese Americans had a considerably higher hazard of NTG, compared with non-Asian Americans, says February's Ophthalmology.
• Wearing goggles while wearing contact lenses and swimming appears to limit bacterial colonization regardless of the lens type (silicone hydrogel or hydrogel) worn, says April's Optometry & Vision Science.
Vitamin D (serum 25-hydroxyvitamin D) may be associated with decreased odds of early AMD in women younger than age 75, says April's Archives of Ophthalmology.
Abdominal obesity appears to be a risk for AMD for men, says March's American Journal of Epidemiology. Specifically, each increase of 0.1 in waist/hip ratio (1 standard deviation) was associated with a 13% increase in the odds of developing early AMD and a 75% increase in the odds of developing late AMD.

O.D. NOTEBOOK
■ Eschenbach has announced it will offer one-hour low vision education webinars on a variety of topics to assist practitioners in maximizing their low vision patient outcomes.�For more information, click on the Webinars link at our website at www.eschenbach.com.
■ According to OCuSOFT, its prescription-only Ocudox Convenience Kit for lid disease is now available at most retail pharmacies including, but not limited to: Walgreens, CVS, Wal-Mart, Rite Aid and Duane Reade.
■ VSP Vision Care and Vistakon announced an exclusive satisfaction guarantee on Acuvue brand contact lenses for VSP members. If members are not completely satisfied with the lenses, up to $60 of their benefit will be reinstated for use toward glasses or a replacement of their current contact lenses. For complete details, visit www.specialoffers.vsp.com/acuvue.
■ Transitions Optical announced the availability of the 2011 Multicultural Resources Catalogue, which offers resources to help eyecare professionals better serve their culturally diverse pateints. A hard copy of the catalogue is available free of charge at CService@Transitions.com or (800) 848-1506. A pdf version of the catalogue may be download at the Multicultural Tools section of Transitions.com/PRO.
■ The AMD Alliance International has released a white paper on treating wet AMD as a chronic disease that focuses on the various elements of ongoing care that AMD patients require. For information, visit www.amdalliance.org.
■ The Vision Performance Institute at Pacific University College of Optometry, in collaboration with the American Optometric Association and 3D@Home Consortium, will hold the conference Vision and 3D on June 1 through June 3. For more information, contact marcieb@pacificu.edu or phone (503) 352-3194.
■ Mountain Computer Systems' EyeBase Smartware, an electronic health records software system, has received ONC-ATCB 2011/2012 modular certification for modules 170.302 (A-J, M, O-V) and 170.304 (A, C-F, H, J). For an explanation of these module criteria numbers, visit http://healthcare.nist.gov/use_testing/finalized_requirements.html.
■ Davis Vision announced that Seiko has been selected as a primary supplier for its new Ultra free-form progressive lens product offerings.
■ The 2011 allergy season is expected to be 27 days longer in northernmost parts of North America, To help allergy sufferers better cope, the Asthma and Allergy Foundation of America offers a free educational brochure titled “Eye Health and Allergies.” The brochure includes strategies for contact lens wearers and is available at www.aafa.org/eyeallergies. or www.acuvue.com/seasons. The Acuvue site also includes a certificate for a free trial pair of 1•Day Acuvue Moist brand contact lenses.
■ The Illinois College of Optometry Board of Trustees has approved a $3.5 million renovation of the school's Lecture Center. The project is expected to be completed in August. For more information, visit www.ico.edu.


Optometric Management, Issue: May 2011