DEA License Is Important to ODs

By Dr. Elizabeth Muckley

While it is not mandatory, I encourage Ohio ODs to obtain a DEA license.  This national identification number issued by the U.S. Department of Justice Drug Enforcement Administration Office of Diversion Control is used by drug companies to track OD prescribing habits, It is especially important to these companies when allocating funds to optometry for research or support of CE meetings.  Insurance companies and pharmacies also use DEA numbers to track optometry’s prescribing habits.

Ohio optometrists receive a TPA (therapeutic pharmaceutical agent) number from the Ohio State Board of Optometry at the time of licensure; however, TPA numbers are unique to Ohio and many national entities and certifying boards are not familiar with them. OOA members worked hard during the last scope update to obtain the privilege for ODs to receive a DEA license and prescribe narcotics when appropriate.

Please go to https://ohioeyes.org/2015/11/20/scheduled-narcotics/ for information on how to obtain your DEA license.

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November Legislative Update

Written by: Executive Director Keith Kerns, Esq.

HB 213

This month, the Ohio House Commerce and Labor Committee began deliberations on House Bill 213, a measure that would require that all professional licenses be renewed on a biennial basis.  HB 213 was introduced by State Representative Tom Brinkman (R-Cincinnati) last spring.

The bill would impact several regulated professions, including: auctioneers, pawn brokers, real estate agents and appraisers, sanitarians, hearing aide dealers, private investigators, nursing home administrators, contractors, dieticians, pharmacists and opticians and optometrists.  Physicians, dentists and other health professionals currently renew on a biennial basis and are not included in the bill.

The OOA has serious concerns with the legislation and has requested to have optometry removed from HB 213.  This week, I submitted testimony to the House Commerce and Labor Committee on behalf of the OOA on this issue.  To view the testimony, click here.  Be sure to visit www.ooa.org to view the latest updates this and other important legislative issues.

Sales Tax Repeal Bill Pending In Ohio Senate

Recently, State Senators Dave Burke (R-Marysville) and Randy Gardner (R-Bowling Green) introduced Senate Bill 216 into the Ohio legislature.  SB 216 would exempt the first $500 of the sale of a prescriptive optical aide or component from the state sales tax. The Ohio Optometric Association strongly supports the legislation.  The bill has been assigned to the Ohio Senate Ways and Means Committee for deliberations.

Ohio currently requires retailers of prescriptive eyewear to collect and remit sales tax on prescriptive eyewear and other optical aids which creates an unnecessary barrier for patients and places Ohio-based retailers at a competitive disadvantage. 42 states exempt these products from sales tax.

To learn more about SB 216 and to get involved, Read More about SB 216 

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Scheduled Narcotics

Written by: Dr. Elizabeth Muckley

As you should be aware of by now, the FDA rescheduled hydrocodone from a Schedule III controlled substance to Schedule II controlled substance.  Our law was amended to address this issue and became law on March 23, 2015 (see below), so you didn’t lose any prescribing rights that you previously had before the change. YOU MUST NOW UPDATE YOUR DEA CERTIFICATE.

If you go to DEA’s website, www.DEAdiversion.usdoj.gov and review the mid-level practitioner chart (see below) you will find that DEA has already identified O.D.s in Ohio as having schedule II, III and IV authority.

Since the law has now been amended and you have authority to handle schedule II narcotic controlled substances (if you have a valid DEA certificate), then you can use the following web link to add schedule II to your DEA registration.  You should also add Schedule IV because Tramadol was rescheduled also by the FDA.

You will need information obtained from your DEA certificate in order to log on.

https://www.deadiversion.usdoj.gov/webforms/jsp/regapps/common/updateLogin.jsp

If you need assistance with the log on, please call 1-800-882-9539.

If you don’t complete the update, your scripts may get denied by the pharmacy. 

Everything else regarding your prescribing authority remains the same as before the change.

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The Rudiments of Leadership

By Dr. Gregory Hopkins

Hopkins Blog PictureWe have, as optometrists, so many opportunities to display leadership! Take a look at the “word cloud” pictured above. Perhaps you would like for those characteristics to describe your habitual demeanor in the exam room with patients, during staff meetings, teaching students/residents, managing your household, raising your children (if applicable), etc.? Leadership is certainly an important topic—a google search will net >151,000,000 books on the subject (and counting). Leadership is the process of dealing with change, and our world is changing at an ever-accelerating pace. Certainly, we all do our best to manage this change, but there is a difference between leadership and management. We need both processes to succeed, and all of us have a distinct set of strengths and values to bring to the table. Let the unique reasons “WHY” you practice optometry drive “HOW” you set the culture of your practice. In the end, “WHAT” you do in your office reflects on your beliefs regarding the style of eye care you provide. Work outwards from the vision you have for your practice and you’ll be sure to attract loyal patients and staff—best of luck!

Opportunities abound to develop our leadership skills! Find mentors in your community, attend local zone meetings, volunteer to give RealEyes Presentations, serve your zone or seek positions on OOA committees or the board. There’s always great CE to be found on the topic of leadership at EastWest Eye Conference. The OOA Board runs a Leadership Academy for New Optometrists, with 40 new member-doctors poised to spend the coming year performing committee work and attending OOA events. If you graduated in optometry 2008 or later and would like to be part of the Leadership Academy, contact the OOA.

House Bill 213

By Executive Director Keith Kerns, Esq.

State Representative Tom Brinkman (R-Cincinnati) recently introduced House Bill 213 into the Ohio General Assembly.  HB 213 would require that all professional licenses be renewed on a biennial basis.

The bill would impact several regulated professions, including: auctioneers, pawn brokers, real estate agents and appraisers, sanitarians, hearing aid dealers, private investigators, nursing home administrators, contractors, dieticians, pharmacists and opticians and optometrists.  Physicians, dentists and other health professionals currently renew on a biennial basis and are not included in the bill.

The bill would essentially bring all professions into alignment with a two-year renewal process, yet the benefit behind such a change appears unclear.  In fact, the change could prove to be detrimental for licensees.  A long gap between renewal periods carries several logistical challenges.  Changes in practice location that are not properly recorded with the appropriate licensing agency may result in licensees failing to receive renewal notices.  Additionally, licensees may simply forget when a license is to be renewed because of the amount of time between renewals.

Failing to renew a license can be a significant problem in some professions.  For example, in the dental industry, which maintains a biennial renewal process, several hundred dentists would fail to renew their licenses every two years resulting in an automatic suspension from practice.  Not only did this result in the dentists experiencing licensure discipline, it also caused some dentists to be canceled from insurance contracts because they did not maintain a license free from encumbrances.  The problem was so significant that the legislature stepped in to create a grace period for renewals in dentistry.

In contrast, the annual licensure renewal process that exists for optometrists is a system that works.  OOA members and others within the profession understand and comply with the current renewal process.  In fact, the State Board of Optometry reports no significant problem with optometrists failing to renew licenses in a timely manner.

The State Board of Optometry operates at a high professional level within their operating budget and is well-equipped to perform the licensure renewal process on an annual basis.  While there might be other professions and licensing boards for which biennial licensure may be helpful, in optometry there is no known benefit to the public, the licensees or the state.

The OOA has requested to have optometry removed from HB 213 and will continue to monitor the bill as it is debated in the legislature.   Be sure to visit www.ooa.org to view the latest updates on HB 213 and other important legislative issues.

House Bill 157

By Executive Director Keith Kerns Esq.

This Bill would change Ohio’s medical liability system.

House Bill 157, introduced by State Representative Jim Butler (R-Oakwood), would dramatically alter Ohio’s medical injury compensation program and make other changes to how Ohio administers the Medicaid program. Rep. Butler hopes to accomplish three primary goals with the legislation: lowering Medicaid spending, lowering overall healthcare spending and applying Medicaid savings to care for needy populations.

To accomplish this mission, his bill would create hospital ER diversion programs, institute price transparency for healthcare services, promote small business health coverage through Multiple Employer Welfare Arrangements (MEWAs), incentivize Medicaid recipients to utilize preventative services and reduce defensive medicine by establishing a new Medical Injury Compensation System.  The 386 page bill is aggressive and would impact nearly every stakeholder in the healthcare industry.  For optometry, one provision in the bill stood out as a cause for concern.

HB 157 calls for the creation of a new Health Care Professional Standards Board.  This board would be comprised of three members appointed by the state medical board, one member appointed by the state dental board, one member appointed by the state chiropractic board, one member appointed by the state board of pharmacy, two members appointed by the state board of nursing, and one member appointed by the state board of optometry.  The new board would have immense authority.  It would be charged with investigating malpractice claims brought against providers, imposing discipline against providers, maintaining a database of claims and complaints and establishing the standard of care for health professionals.

While important functions, all of these activities are currently being performed within state or federal government.  State regulatory boards, including the Ohio State Board of Optometry, maintain access to the National Practitioners Data Bank (NPDB) in order to review and investigate malpractice awards.  The boards also establish the standard of care for a profession and impose discipline when warranted.  Finally, the Ohio Licensure System provides public information on formal actions taken against health care providers and the NPDB tracks similar information for use by government entities and insurers.  Simply stated, the functions delegated to the Health Care Professional Standards Board are duplicative and would only serve to create another costly level of bureaucracy within health care system.

The OOA has communicated these concerns to Rep. Butler and other members of the House of Representatives.  At the same time, the OOA acknowledges that medical liability laws are a key component to establishing a cost-effective health care delivery system that keeps medical professionals in Ohio.  But recent tort reform efforts, including the establishment of caps on damages and the creation of a statute of repose, are already helping to achieve these goals.  For optometry, malpractice rates and the number of licensed optometrists are stable in Ohio.  So while there is always value in searching for ways to improve our medical liability system, the current structure appears to be working.  Dramatic changes, such as the creation of a Healthcare Professional Standards Board, could disrupt this stability.

The OOA will continue to monitor HB 157 and other bills impacting the practice of optometry.  Be sure to visit www.ooa.org to view the latest updates on these important legislative issues and to get involved in the OOA’s Key OD grassroots advocacy program.

ICD-10; Transition Tips from inside the Trenches

OOA President-Elect Dr. Jason Miller will be the featured speaker at each of the Zone President’s Nights in the fall. In addition, new OOA Executive Director Keith Kerns will provide a legislative update and looks forward to meeting the members in each Zone.

Dr. Miller will speak about ICD-10. A summary (one hour practice management ce)

ICD-10; Transition Tips from inside the Trenches

The conversion to ICD-10 will change many aspects of Optometric practice. It requires improved record documentation and plays a larger role in the delivery of health care. This course will discuss steps to help make the conversion a success. From the front office to the examination room to the billing office, it will uncover tips to help with that transition leading up to October 1, 2015 and into the future.

Mark your calendar and plan to attend your Zone’s President’s Night.

President’s Night Zone meeting dates are as follows:

Zone 1 (Mansfield) – September 14

Zone 2 (Cleveland) – September 9

Zone 3 (Canton-Akron)- September 2

Zone 4 (Youngstown)- August 24

Zone 5 (Zanesville)- September 24 

Zone 6 (Athens)- September 21

Zone 7 (Portsmouth)- September 3

Zone 8 (Cincinnati)- August 26

Zone 9 (Dayton)- August 27

Zone 10 (Lima)- September 16

Zone 11 (Toledo)- October 14

Zone 12 (Worthington)- September 23

 

 

 

Referral Programs

By Keith Kerns, Esq.

In an effort to increase patient visits, many offices offer incentives to current patients who refer friends and family to the office.  Optometry offices which engage in this practice should be aware of a key provision in Ohio law before instituting such an incentive program.

Ohio has maintained an anti-kickback law for many years.  The law is intended to help protect patients and healthcare payers against fraud and abuse and to prevent financial incentives from influencing health care providers treatment recommendations and decisions.  Though the focus of the law is seemingly meant to address provider-to-provider and agent/broker-to-provider referral corruption, the law is written broadly and actually applies to everyone.  Therefore, offices that are considering establishing a referral incentive program for current and new patients must be familiar with this law in order to avoid pitfalls.

Ohio Revised Code section 3999.22 makes it illegal for anyone to “knowingly solicit, offer, pay, or receive any kickback, bribe, or rebate … in cash or in-kind, in return for referring an individual for the furnishing of healthcare services…for which whole or partial reimbursement…may be made by a healthcare insurer.”  Any violations of this section are considered felonies under the law.

Despite this broad prohibition against any kind of payments – gift cards, cash, gifts, etc. – in exchange for referrals, there are several important exceptions outlined in the law which may still allow offices to pursue a patient referral program.  First, the law excepts those referral payments that are authorized by an health insurance contract and does not apply to deductibles or copayments.  The law also does not apply to a health care practitioner who provides services that are not covered by the patient’s health insurance plan.

Finally, and most importantly, the restriction does not apply to the offering of discounts or reductions in prices.  This exception provides a simple avenue for optometrists to offer incentives to patients who refer their friends and family into the practice.  A discount off of future services, or new pricing structures for certain procedures can be offered in exchange for the referral of new patients under Ohio law.

Optometrists seeking to step up their marketing campaign and attract new patients are strongly encouraged to seek advice from legal counsel prior to instituting a referral incentive program or an advertising campaign to discuss these issues and avoid any difficulties which may arise.

A Follow- up on Direct Messaging

**A follow up to an earlier Blog post by Dr. Snow (Patient-portals-and-direct-messaging-how-do-they-affect-me) 

By Dr. Jay Henry,

Q: How would direct email messaging assist optometrists?   Explain why it’s important for ODs to talk directly with the primary care physician (PCP) through  Direct protocols.    What could optometrists share that would be mutually beneficial to other physicians?

A: Direct messaging would allow optometrists, the primary eye care providers, to discuss results and information of shared patients with PCPs and other specialists.   Every diabetic patient gets a report sent to the PCP with results of the eye exam.   Many times it is the Optometrist who makes the first diagnosis of Hypertension, Thyroid disease, Diabetes, MS, high cholesterol, strokes, and  other systemic conditions.   When these situations occur, Optometrists need to be able to reach out to the patient’s PCP to coordinate care.

Optometrists also see many patients who need to be sent to a specialist or ophthalmologist.   ODs refer patients to a specialist / sub specialist and need to send  the testing results from the patient’s office visit or a clinical summary from their office visit.   A great example is when a patient is sent to a cataract surgeon for cataract surgery.   ODs do the majority of the patient’s pre-op testing and the post-op care from day 1 after the surgery.   ODs need to share this information back and forth with the surgeon.

For a patient with a retinal concern the OD may need to send clinical notes, photos, images, visual field results, OCT results and other information to the retinal specialist so the patient may receive further treatment or surgical intervention.     

All of these could be done via direct messaging.

Q: My eye doctor will be examining my eyes next week, and my neurologist wants him to test me because I’ve had an increase in migraines recently. He said he wanted to know about my “pressures.” Can you explain what this means?

A: This scenario would be the same for an Optometrist or Ophthalmologist.   Often a specialist or PCP wants  further testing done on a patient that the specialist or PCP may not do.   In this case the neurologist is concerned that  intraocular pressure is high and causing headaches to be worse or that preventative medicine you are taking is causing your eye pressure to be high and this can cause vision loss which is the disease of glaucoma.

Medical Homes are the Best Source of Reimbursement for Optometrists

By Mark A. Ridenour

This could very well be a headline in the future given the direction of changes in the healthcare industry today.  Many Primary Care Physician (PCP) practices have converted to the Patient-Centered Medical Home (PCMH) practice model.  There are now more the 7000 accredited Medical Home practices nationwide with 535 in Ohio.  PCPs have embraced this model because it allows them more practice freedom, offers the opportunity for increased reimbursement, improves their patient’s outcomes, and increases their patient satisfaction; not necessarily in that order.  PCP practices must meet numerous criteria to be considered a Medical Home, including 24-hour remote patient access, next day appointments, coordination of patient’s care with other providers, and team-based provider care with specific expertise around nutrition and behavioral change.  Physicians who have successful migrated to this model report greater job satisfaction themselves, because they are put into more of a CEO role, where the more complicated cases and decisions come to them and more routine care is seen by mid-level staff.  Patient response to this transformation has been mixed, but many insurers are now incentivizing their members to use Medical Homes via reduced co-pays and benefit design.

Payers (insurance companies, employers, and government) have discovered PCPs operating as Medical Homes lowers their costs.  Reducing emergency room admission rates and eliminating duplication of diagnostic tests are examples of quick payoffs.  Typically, they will pay these practices extra for care coordination and case management and/or pay bonuses for improved patient population health outcomes.  Many payers have shifted their risk to the Medical Home; i.e., they have given the Medical Home a percentage of the employer/employee premium to manage the patient.  The Medical Home, in turn, must manage the expenses of the patients, leading them to become more discerning about referrals.  Insurers will supplement this because a parallel objective they have is to reduce the most expensive care they pay for – hospital and specialty care.  This is one of these reasons the OOA continues to stress the importance of your relationship to your PCP referral sources.  Medical Homes will likely establish criteria for referrals to Optometrists.  Which practices supply me with the best and timely information about my patients?  Do I consistently receive exam results on my diabetic patients?  Are they encouraging them to maintain healthy behaviors?  Are they accessible for eye care emergencies?

This movement in the provider payment landscape is part of the reason the OOA continues to promote the Optometrist as the primary eye care provider.  Along with dental and behavioral care, optometric services are generally perceived as essential preventive care.  As long as fee-for-service reimbursement dominates, it is beneficial to be aligned as a primary care provider.  Payers are favoring reimbursement codes for these services over specialty care codes.  Plus, any alternative payment models will be based on the premise of investing in preventive care to avoid greater catastrophic costs.

So you may not be getting reimbursement checks from PCPs yet,….. but it may not be far down the road.  Now is the time to recognize this shift and solidify our relationships via active interactions and demonstrations of value.  Are PCPs likely to value Optometrists more than the insurance companies?  Now is the time to start influencing the answer.

For more information on the Medical Home model and specific information on those in Ohio go to the Ohio Department of Health website at http://www.odh.ohio.gov/pcmh.