house calls
This
Doctor Makes House Calls
The
OSU College of Optometry Home Care Program brings vision care to patients who would
otherwise go without.
ROBERT D.
NEWCOMB, O.D.
Every
football Saturday, thousands of fans in Buckeye vans converge on the Ohio State
University campus to cheer their team on to victory. But there is only one "BuckEYE"
van that stays on campus throughout the year. OSU College of Optometry faculty and
students use this vehicle to provide optometric care to central Ohio patients who
cannot come to campus clinics.
An unusual mode of practice
Every Wednesday afternoon, a fourth-year optometry student and
I load portable optometric equipment and supplies into the BuckEYE van and provide
primary eye and vision care to homebound patients. These patients have multiple
chronic diseases and are not able to travel easily. For that reason, many have neglected
their eye care for years. Yet the majority of their day is spent either reading
or watching TV — two visual tasks that require the best possible corrected
visual acuity. Although they could receive a more thorough eye examination at the
OSU teaching clinics, performing some standard vision and eye health testing for
these patients, in most cases, results in improved visual acuity, prevention of
vision loss and a concurrent increase in quality of life.
Most O.D.s can provide in-home eye and vision care with a minimum
of additional equipment and expense. We take four boxes of equipment with us to
every exam: a trial lens case with a trial frame, a hand-held slit lamp, 120 sample
frames and a large box with acuity charts, a portable lensmeter, a hand-held applanation
tonometer and more (see table on page 90). Depending upon the distance between patients,
we perform two or three exams an afternoon, plus one or two dispensing visits.
|
Billing
Codes for Private and Nursing Home Visits |
|
|
PRIVATE
HOMES |
|
NURSING HOMES |
|
|
|
New |
Est. |
New |
Est. |
|
Level 1 |
99341 |
99347 |
99307 |
None |
|
Level 2 |
99342 |
99348 |
99308 |
None |
|
Level 3 |
99343 |
99349 |
99309 |
None |
|
Level 4 |
� |
� |
99310 |
None |
|
Source: Current Procedural
Terminology, professional edition. American Medical Association, Chicago, 2006. |
Every exam is different
We can only determine the type and sequence of
testing after we meet the patient and any caregiver or family member who may be
available in person or by phone. Some patients with Alzheimer's disease,
Amyotrophic Lateral Sclerosis (ALS) or previous strokes are not able to
participate in subjective testing, so we do what we can objectively. Others are
fully capable of determining whether "lens one or two" is better, so we can
perform most standard optometric tests within the limitations of our
environments.
We always attempt to provide a thorough
optometric and medical history, including a review of systems, previous eye care
and correction, past hospitalizations and surgeries, current medications and
allergies. We perform entrance visual acuity testing, often with only five or 10 feet of space in which to measure distance acuity.
We perform near acuities with the help of a spotlight since many homebound patients
live in poorly-illuminated residences. We check pupils, ocular alignment and confrontation
visual fields before using the hand-held slit lamp and applanation tonometer. We
dilate and perform ophthalmoscopy with a direct ophthalmoscope and/or a binocular
indirect ophthalmoscope. We help patients select a frame if necessary and discuss
our findings with them and their caregivers or family members.
|
Recommended Equipment for a Home Visit |
Direct ophthalmoscope
Indirect
ophthalmoscope (with small pupil feature)
Condensing lenses
Retinoscope
Portable hand-held slit lamp
Portable hand-held tonometer
Amsler grid
Color vision test
Contrast sensitivity test
Distance and near visual
acuity charts
Trial frame and lenses
+/- 0.75D Jackson flip
cross-cylinder
Halberg or Janelli clips
Portable lensmeter
Ophthalmic diagnostic agents |
Ophthalmic therapeutic
agents
Optical tools and frame parts
Facial tissues
Alcohol swabs
Basic low vision aids
Electric spotlight
Tape measures (for distance
and near)
Prescription pads
PD stick
Cilia forceps
Surgical gloves
Mydriatic sunglasses
Retinoscopy bars
Recording form
Order form for glasses |
Billing for private residence and nursing home patients is not
difficult (see table above).
The fees are typically 35-50% higher than in-office care to cover
the additional expenses of travel, some special equipment and inherent logistical
inefficiencies. Note that we do not use any code higher than a Level 3 for private
home care. There are no codes for established patients in nursing homes. The rewards
are many: meeting nice people, providing eye care to an underserved population,
preventing vision loss, participating in interdisciplinary healthcare and increasing
quality of life for very appreciative patients. Home visits are also an important
part of the University's outreach mission.
The need is great
According to the U.S. Census Bureau, the U.S. population will
increase 29% between 2000 and 2030. But the proportion of Americans over the age
of 65 will increase more than 100% during the same 30 years. In the states of Alaska,
Arizona, and Nevada, the over-65 group will increase more than 200%! With these
projected increases in our elderly population, delivering primary eye and vision
care at home is an area with almost unlimited growth potential.
Dr. Newcomb
is a Professor of Clinical Optometry at the OSU College of Optometry. He can be
reached at 614-292-6019 or newcomb.2@osu.edu. References available upon request.
Optometric Management, Issue: June 2006