To Grow or Not to Grow – That Is the Question

By Dr. David Anderson,

In 2011 we were faced with this question.  I had been in my practice for seven years and was really busy.  My wife had joined our office three years prior and was also becoming quite busy.  My partner, Dr. Keith Basinger, had been seeing patients at our office for over 13 years, and his schedule was packed.  We were faced with a choice — get busier or risk being out of business.  Neither sounded attractive.  I felt I was working hard as it was, and I didn’t want my seven years of hard work to be lost as decreasing payment for services and pressures all around were taking hold.  We had seen a dramatic increase in the number of patients with managed care plans; therefore, fewer patients were paying full price for our services and products. We had not seen an increase in reimbursement for services since I joined the practice. Expenses were going up, but our fees for service were not rising accordingly.  So we had to find a way to increase revenue to overcome a potential decrease in overall net profit.

Simply adding more patients to our schedule was not the answer.  I did not want to compromise patient care by having to hurry through a patient visit in an effort to stay reasonably on time.  Besides, with the layout of our office, there seemed to be a daily bottleneck at the pre-test room.  Often people would be worked up and ready to see the doctor but then had to spend time waiting in the reception area because all the exam rooms were full.

We had not yet implemented EHRs into our practice.  The wheels were in motion, but we really did not know how we could do this with our current patient flow.  We thought we would have to see fewer patients or stay later to finish records because of the extra time to input the information in the EHR.  

At a business meeting, the speaker raved about incorporating scribes in the exam room.  He discussed benefits, including improved patient care and a better experience for the patient.  This resonated loud and clear – “better experience, better care.”  We saw a way incorporate scribes when we switched to EHR and possibly grow our practice by getting busier.  If I could perform an eye exam and trust a scribe to record the visit in the EHR, it would free up some of my time.  If I became more efficient, I could see more patients in the same amount of time.

After two months we realized the concept worked.  We had enough patient flow to get busier by seeing more patients per day.  We saw more medical patients, such as glaucoma follow-ups or eye emergencies throughout the day.  There was more time to add a contact lens fit into the schedule.  We did not use specific time slots for these items but simply worked these patients in throughout the day between scheduled exams.

Our staff costs went up, but our revenue went up to more than compensate.  Soon after we made this change, we realized our office was too small, our parking lot was too full and our patients had no room in our office.  We needed more space to accommodate this change.  Again, the question arose – “To grow or not to grow?”

We chose to grow and built a new office, expanding from 3800 square feet to 7400 square feet.  Most importantly, we now have ten patient care rooms and two pre-testing rooms.  The up-front cost was a challenge, similar to adding one additional staff per doctor to be their scribe.  However, there are many days during the week when all patient rooms are full and two other patients are being pre-tested.  Having each patient already in the exam room and ready for the doctor increases our efficiency and helps keep us on time.  We no longer have to waste time waiting for a patient to be pre-tested or moved into an exam room from the reception area.

To grow or not to grow – we chose to grow.  We currently have enough space for patient care with room for future growth.  We have 16 full-time and three part-time employees.  Our schedules are booked ahead for over one month.  We are seeing over 700 patients a month without adding any doctor hours compared to four years ago.  We have maximized our schedule, delegated to our highly trained staff and added space to handle the work load.

We have grown because we chose to grow.  With the assistance of our scribes, we easily managed the more difficult requirements for Meaningful Use 2.  When the ACA went into effect, more patients with medical coverage were seeking care.  This had a positive effect as we were ready to increase our patient volume.  In the foreseeable future, as diabetic patients and an aging population need medical care, we will be poised to meet these challenges.

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The Practicality of the Medical Model

By: Jason R. Miller, OD, MBA

The medical model…the medical model…the medical model is a term that is frequently used within optometry and the question is why?  Why do we as practitioners need to be involved and what impact does it have on our practice?  Traditionally, optometry is known as the primary eye care provider who provides not only vision care, but medical eye care as well.  We are all highly trained in the diagnosis and management of ocular disease, yet only 17% of practice revenue is derived from medical eye care.1  The question is why is this number so low?  The medical model can have a positive impact on our patients and our practice.

For Survival

There are numerous threats to our profession that will have an impact on our practice survival.  Online retailers (both glasses and contact lenses) will continue to offer affordable options to our patients.   We know that many patients who make purchases online are less frequently coming into our practices for their routine care.  Insurance plans, both vision and medical, will continue to find ways to attract their customer base while providing less reimbursement for our services.  Get involved and support your local, state and national associations either physically or financially.  These are the groups that help fight and secure your ability to practice medical optometry.

You are the Expert!

We are the experts and it’s important to establish that perspective of ourselves in such a manner.  Although we all have different comfort levels in ocular disease management, there are numerous educational resources available to help us along including continuing education and webinars.  In those cases outside of our comfort level, we have colleagues that we can refer to for secondary and tertiary referral.  Nonetheless, the majority of ocular disease can be managed within any optometric practice.  Our role is to educate our patients on what we do and our role within medical eye care.

Technology Integration

Although advanced technology isn’t necessary for all ocular disease cases, evaluate your current patient base to see what types of patients are already within your practice.  For complex diseases such as glaucoma and macular degeneration, state-of-the-art technology will be a must.  There are numerous technologies that we all have on our “practice wish list” however we know that the decision needs to make economic sense before any purchase.  Determining what percentage of your patients comes to your practice for medical eye care is important.  Utilize your EMR system to data mine common diagnoses or patient segments that may benefit from specific services.  One example would be determining whether or not to purchase a fundus camera.  The first step would be to look at the number of patients within your practice who have diabetes or glaucoma.  Next, evaluate the current trends and prevalence of the various disease states to see how you compare.  Is your practice prevalence pattern higher or lower than these averages?  If it’s lower, there may be numerous patients that may have been potentially overlooked in the past or just wasn’t followed since the technology wasn’t available.  Lastly, perform a breakeven analysis (projected gross income minus projected annual expense) to see how long it will take for you to pay off the technology.  If it all adds up, then purchase the equipment.  If not, there are other ways to provide these services such as co-ownership of technologies where the cost is shared or comanaging with our optometric colleagues for special testing services only.

Write the Rx

One last note on developing yourself as an expert in medical eye care is practice of prescribing versus sampling.  Although samples are available for us to offer our patients, we must use them wisely.  In our practices, we use samples for our patients who may not be able to afford them or to determine efficacy for chronic conditions such as glaucoma.  By having patients purchase their medications, they will have to take ownership in their condition which will also help with patient compliance.  Since they have made in investment in their care, they will understand the value in their treatment and more likely follow the prescribe regimen.

In Conclusion

From the initial phone call to schedule an appointment to the examination to the checkout process, everything that we say, do and not do (non-verbal communication) contributes to the overall patient experience.  Technology is constantly changing the way that we practice optometry and contributes to the “WOW Experience”.   Whatever your passion is in medical eye care from ocular surface disease to glaucoma to retina, there are numerous technologies that have impacted the way that we care for our patients today.  Each time we perform testing, we need to maximize the opportunity to discuss the reason for doing each test. Invest in adopting the medical model and the practice will win.

References

  1. Management and Business Academy. Key Metrics: Assessing Optometric Practice Performance.  2013.  Accessed from http://www.mba-ce.com/data/sites/1/paa_keymetrics_0813.pdf on March 23, 2014.

Patient Portals and Direct Messaging, how do they affect me?

By Dr. Rod Snow,

The OOA has been receiving questions concerning “practice portals” of Electronic Medical Records versus “patient portals”, along with some confusion around direct messaging.  Is there a difference with these things and how do they affect me?  There may be some minor differences between each EMR, but here is some information on these terms that may be helpful:

There is a difference between the “practice portal” and the “patient portal”.

  1. The practice portal is the practice’s command center. It is where many of the essential functions of the EMR are set-up.  It is also where employees can message each other.  It has the “inbox” messages received from patients and from other doctor’s offices (called DIRECT messaging) because they are located on an encrypted server.
  2. The patient portal is a “subset” of the practice portal. This is where patients can log in and see some of their exam information. They will see the clinical summaries (CCD’s) that the doctor has created for that patient.  The patient can use this portal to send a message to the doctor and possibly schedule appointments through this portal.

“DIRECT” messaging is different than typical email.  Doctor to doctor communications via email should always be through “DIRECT”.  That is because DIRECT is associated with the doctor’s practice portal and will then be encrypted.

Important:  If a doctor uses private email to discuss health concerns, that is a HIPAA privacy violation as that information is not encrypted!

Doctors can exchange patient information through the DIRECT messaging account, which goes directly to the practice portal which is automatically encrypted for privacy.  Additionally, patients can email through the patient portal, which will connect to the practice portal where it will be viewed by the doctor.  It also is automatically encrypted.

Blogs or Books? Guesses or Guidelines? It’s time to get serious about good medical records.

By: Charles B. Brownlow, OD  (drbrownlow@pmi-eyes.com)

Several years ago, I found myself jumping from one eye care chat room to another, trying in vain to correct bad information about patient care and record keeping that kept popping up there.  It seemed that my colleagues in eye care would rather ‘take a poll’ of other ODs and staff (who didn’t know the answer either) rather than go to the only true authorities.  After getting totally frustrated in that ‘Whack a Mole’ environment, I respectfully and quietly withdrew from the milieu, and I haven’t missed it one bit.

Over a decade ago, during the ramp up to HIPAA, the rules changed essentially clarifying that Current Procedural Terminology (©American Medical Association), ICD-9, and the Documentation Guidelines for the Evaluation and Management Services (99000 visit codes) were the sole acceptable references for codes and definitions for the vast majority of health care services.  That thought clarifies nearly everything in health care…All a health care provider needs to do to learn about the logic of health care delivery, good medical record keeping, and accurate choices of procedure, visit and diagnosis codes is purchase the current year’s CPT and a fresh ICD manual and download the 1997 Documentation Guidelines from CMS.gov.

Based on the questions that I get every day from ODs and staff from around the country, it’s pretty clear that a majority of those offices do not have those key references available in-house, or they are not current, or they just don’t refer to them when question arise.  That’s pretty sad, I think.  CPT is available through our AOA.org/marketplace at $100 a copy.  The Documentation Guidelines are a free download (.pdf or Word) at cms.gov.  ICD-9 and ICD-10 are available as complete manuals for around $100.  So, for between $200 and $250 per year, key staff and doctors could become ‘experts’ on the chat room scene real quickly.

I’ll provide a couple of examples to support my point.  One of the long-raging arguments among eye doctors; at least twenty years; has been whether the CPT definition of the comprehensive ophthalmological service (92004/92014) includes a dilated fundus examination as a requirement.  The definition has not changed since 1992 and it has never included that requirement!  The CPT definition clearly lists “…examination with cycloplegia or mydriasis” among the tests that the service “…often includes, as indicated”.  “Often includes” does not equate to “includes” or “is required.”

I think the confusion may come from the requirements for the ‘comprehensive physical examination’ for the evaluation and management services (99000 codes), but it was made very clear back when the 99000 codes were introduced nearly twenty years ago that the CPT definitions are unique and distinct for each set of visit codes and that there are no crosswalks or comparisons between the two.  In short, “external and ophthalmoscopic examinations” are required elements for 92004/92014…Dilation is not.

One of the national speakers in the medical record area continued to state that dilation was a requirement. Every year I would hear that, refer to my then current CPT book for confirmation that I was still right, and shoot off an email to suggest that the speaker ‘change his tune’.  Months later, I’d hear that the message had not changed.  Finally, early one year, with the ink barely dry on my current copy of CPT, I heard again that dilation was required.  Instead of emailing again, I picked up the phone and called. “Hey, how are you doing?  Keeping out of trouble?  Family doing fine”, etc.  After about 30 seconds of small talk I dropped my challenge.  “It’s right there in the definition”, the speaker replied. Then it hit me and I responded, “Which CPT book says that?”  “Why, the (Brand X) CPT, of course”, he parried.  FLASH!  The lights snapped on.  He wasn’t using the only official CPT book, the AMA CPT, he was using a cheap imitation, the book that continues to confuse the issues, the (Brand X) CPT!

As with so many things, we must accept no substitutes.  If I’m ever in court, I’ll want an attorney who knows the laws and, when pressed, is able to refer to the current, official statutes that pertain to the case.  I’m not going to be very comfortable if the attorney attempts to reassure me by saying that she got the information off a blog or chat room, or that he called a couple of friends or read it in a novel.  The same is true with medical records.  The care you provide had better be consistent with accepted modes of practice; the standards of care; and the medical records you keep must demonstrate clear connections between the needs of the patient and what was done, and your choices of procedure and visit codes must have been chosen by comparing the content of the chart and the definitions in AMA CPT and the current ICD listings.

Relying upon trusted resources and references can help us avoid hassles and sometimes disasters.  I know you’ve been putting this off for a long time.  Just do it today.  Get your 2015 copies of CPT and ICD-9 (and ICD-10).  Read the introductions at the front of the CPT book and the front of the 1997 Documentation Guidelines.  And then refer to those key references when questions pop up.  You’ll sleep better…You’ll find yourself chuckling quietly when you ‘listen’ in on a discussion in a chat room or read somebody’s blog…Then, without typing a response, you’ll go to the references, double check your understanding of the question, and live happily ever after.  You’re welcome.

Ocular Nutrition

By Dr. Katherine Bickle

Shortly before writing this, I had a conversation with a new patient regarding nutritional supplements. Her history was positive for pigmentary changes in the maculae, and she reported the use of a nutritional supplement. Since the patient is a current smoker, I discussed with her the importance of taking a supplement without beta-carotene.  She recalled this conversation with previous optometrists, and we discussed the presence of beta-carotene in several formulations. From this conversation, both the patient and I developed a better understanding of the various commercially available formulations. The importance of these discussions with our patients cannot be overlooked. Not only can your patients learn from your expertise, but you can also expand your knowledge.

You may know the formulation of certain brands you commonly recommend to your patients. For those you aren’t familiar with, how do you easily distinguish among the marketed brands?  What are we doing on a daily basis to provide our patients with optimal care while striving to improve each patient’s quality of life?

Discussion with your patient

Recommending the proper nutritional supplement for your patient with AMD, MGD, and/or dry eye disease requires a thorough medical history, examination, and discussion with your patient.

Questions to consider asking your patient include:

  • Do you have a personal history of AMD, MGD, or dry eye disease?
  • What has been the impact of previous and current condition(s) and treatment(s) on your quality of life?
  • Which supplements, if any, have you used previously?
  • Which supplements have resulted in bothersome side effects for you?
  • How often do you take the recommended nutritional supplements (if previously prescribed)?
  • What are your short and long-term goals related to vision, comfort, and health?

AMD, MGD, and Dry Eye

Practitioners have differing philosophies on prescribing nutritional supplements for conditions. The AREDS (Age-Related Eye Disease Study) and AREDS2 have provided us with valuable information that we can incorporate into our daily patient care. More information regarding the AREDS2 can be found at http://www.areds2.org. While the AREDS2 reported that the addition of omega-3 fatty acids was not beneficial in the treatment of AMD, the literature suggests that omega-3 fatty acids may be beneficial for those with MGD and/or dry eye disease.  The International Workshop on MGD lists increasing dietary omega-3 fatty acid intake in the treatment algorithm for MGD. If you’re considering recommending omega-3’s to a patient, it is important to ask your patient about the use of blood thinners. Omega-3’s have been shown to cause additional anticoagulation effects when used with blood thinners. It is important to recommend an appropriate dose of omega-3’s that do not significantly raise the patients’ international normalized ratio (INR).

There are several commercially available supplements available for our patients. Do you have one supplement you recommend or do you give the patient options, and let the patient choose?  Do you make your recommendations from reading the literature, speaking with colleagues, or from your personal experience? While supplements may be less expensive or have less side effects than some prescription medications, your patients may not perceive the value in taking these supplements unless you discuss the potential benefits with the patient.  I encourage you to follow-up with your patients regularly regardless of your recommended treatment. When treating a patient for MGD and/or dry eye, discuss how their symptoms have changed since beginning the treatment. These are questions you can ask your patients directly or have your staff provide questionnaires for the patient to complete.

Patients appreciate the personalized care you provide them, the time you spend addressing their needs, and the appropriate treatment options you prescribe. Incorporating ocular nutritional supplements into your treatment plan can improve your patients’ ocular health and quality of life.

Your Opportunity to Provide for Patients with Visual Disabilities

By: Dr. Gregory Hopkins

I think it’s fair to say that we, as optometrists, are all in the business of helping people. Much professional satisfaction can be gained from correcting patients back to 20/20 with the right glasses, contacts or successful surgical co-management! For your patients for whom nothing more can be done refractively (or otherwise), it’s probably the case that they are concerned about continuing to lead quality lives. Maybe they’ve expressed worry about renewing their driving privileges, keeping their jobs or purchasing the right magnifier.

Opportunities for Ohioans with Disabilities (OOD) is the agency that directs our state’s Bureau of Services for the Visually Impaired (BSVI). BSVI is a vital referral resource to have at your fingertips, whether you offer low vision services in your practice or not. Upon your recommendation, BSVI will interview your patient and can potentially “open a case” for them. Your patients will receive the support necessary to use their remaining vision to succeed at work and at home. None of us like sending patients out the door without hope or solutions to their vision problems. Earn their gratitude and continue to gain professional satisfaction from these patient encounters by taking the time to download and use the referral resources below!

What BSVI is all about

BSVI Referral Form for Low Vision Services

PDF BSVI Eye Report (Fillable)

Visit http://www.ood.ohio.gov/ to find out more!

 

Medicare Update for 2015

Medicare Update for 2015

Dr Brownlow

10 and 90 day global periods will be eliminated for minor surgical procedures in 2017 and for major surgical procedures in 2018.  Current 0, 10, and 90 day post op periods are still in effect for 2015!  Lots of ODs and staff have been asking me about the potential impact of all global periods going to 0 days.  Actually, I think it will be an advantage, as doctors providing post op care will no longer be limited by the meager CMS payments for post op periods, and will be submit claims for whatever visits and procedures are necessary during the post op period, just as they are during any other time they are caring for the patient.  Another interesting thing I’ve noticed about this issue…I’ve been getting more questions regarding these changes; though they won’t go into effect for two or three years; than I get on issues that should be of concern to doctors and staff currently and/or should have been of concern to docs and staff for years…Go figure!

Medicare Fee Schedule

The 2015 Medicare Fee Schedule has been published and it does include some changes, resulting in small net increases across the board for services ODs provide most commonly. Medicare’s fees are calculated based on relative values assigned for each service and the Conversion Factor, set by Congress each year.  The formula for calculating the fee for each services is Relative Value x Conversion Factor = Fee.  The conversion factor will be slightly lower at the beginning of 2015, though some of the relative values have increased, so the net impact will be very small.  However, a very large decrease in the conversion factor is slated to go into effect April 1, 2015, unless Congress acts prior to that date.  For those of you who have watched this strange scenario play out in previous years, this is no surprise.  My prediction?  Congress will act in the 11th hour to avoid the big cuts and leave the fee schedule pretty much as it is in 2014.

Act Now to Avoid PQRS Penalties in the Future

AOA has been successful in convincing CMS that small group practices (1-9 doctors) should not be penalized for PQRS issues, but should be eligible for the PQRS bonus payments.  2017 PQRS bonuses will be earned by PQRS participation in 2015, so gear up now to be sure you qualify.  You can continue to report PQRS measures on your Medicare claims, although AOA will be providing members with an easier way to accomplish that reporting, referred to as ‘registry reporting’, early in 2015.  Watch for more PQRS information from AOA in December.  If you decide to begin (or continue) to use the traditional method of reporting PQRS measures on each Medicare claim, you may do that as well.  There are lots of PQRS changes for 2015, so please refer to all of the information that has been created by the AOA Third Party Center. It’s all available to AOA members at aoa.org/pqrs.  The major change for this year is that you must now report nine measures 50% of the time the related diagnoses appear on a claim.  Prior to his year you could have qualified by reporting only three PQRS measures 50% of the time the related diagnoses appear on a claim.  My advice at this point is to wait for AOA’s ‘Registry’ for PQRS reporting, which will make the process much more workable.

Medicare’s Impact on Optometry

CMS estimates that ODs provided services and were reimbursed over $1 billion in 2014 and predicts the total payments will rise in again for ODs in 2015.

Pretty amazing! And clear testimony of the value of your membership in the state association and AOA.  Without the hard work of organized optometry during the past thirty years and currently, we would not have been prepared to provide medical care to anyone, and we certainly would not have been granted full parity in Medicare, nor would we be providing full scope eye care services and being reimbursed by Medicare and other medical insurers today!

Charles B. Brownlow, OD, OS, OU

How to Appeal a Decision by Your Health Plan Issuer

The Ohio Department of Insurance has released a graphic depicting Individual/Patient/Member appeal rights and process flow, including external review.  You may find this helpful to supply this to your patients when you are aware they are not in agreement with their health insurer.  It may also help complement and reinforce an appeal you as a provider have initiated.

Flow Chart

The Sunshine Act – What Optometrists Need to Know

Dr. Elizabeth MuckleyBy Elizabeth Muckley, OD – Overview: The Sunshine Act, also referred to as the “Open Payments” Initiative, requires certain manufacturers that produce drugs, medical supplies and devices to publicly report payments or “other transfers of value” they made to physicians (including optometrists) and teaching hospitals.  Certain Group Purchasing Organizations (GPOs) will also be required to report annually to CMS ownerships or investments held by physicians or their immediate family, in addition to, payments and other transfers of value from the GPO to a physician that holds an ownership or investment interest in the GPO.

Impact on ODs: The Sunshine Act will affect optometrists because manufacturers will be required to track and report payments and transfers of value made to optometrists.  Manufacturer reports will be submitted to the Centers for Medicare & Medicaid Services (CMS) and CMS will ultimately make these reports publically available. Patients who are treated by optometrists may review this data.  It is important to emphasize that the burden of compliance falls to manufacturers. ODs are not required to report any information to CMS. However, to ensure that manufacturer and GPO reports are accurate, ODs may want to register to access their data prior to public posting and keep a record of payments and transfers of value received from manufacturers and GPOs.

Open Payments encourages physicians and hospitals to participate by tracking their financial relationships with applicable manufacturers and applicable GPOs and by reviewing data reported about them to ensure the accuracy of the information.

Key Dates: Manufacturers and GPOs began collecting data on Aug. 1, 2013.  Manufacturers and GPOs must report data to CMS as of March 31, 2014, and public reporting is scheduled to begin September 30, 2014. ODs can register, view and dispute July 14 – August 27, 2014.

Do you want to review Open Payments data reported about you before it is available to the public? Get started now by registering in CMS’ Enterprise Portal.

For more information visit:

http://www.aoa.org/advocacy/health-care-reform/the-sunshine-act?sso=y

http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/index.html

To register visit:

http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/Program-Registration.html

or

http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/Physicians.html

Changes in Prescribing Narcotics

By Elizabeth Muckley, OD – Dr. Elizabeth MuckleyOhio Optometrists need to be aware of new regulations in Ohio regarding prescription pain medications. Ohio professional licensing boards, including the Ohio Board of Optometry, have been active participants in the various working groups led by the Governor’s Cabinet Opiate Action Team (GCOAT) in efforts to address public safety concerns associated with inappropriate prescribing of opioids, other controlled substances, and tramadol.

There are two changes that affect Ohio ODs:

1) Tramadol

Effective August 18, 2014, tramadol and products containing tramadol will now be classified by the DEA as Schedule IV controlled substances. Previously, tramadol was not a classified narcotic. Pharmaceuticals classified in schedules 1, 2, 4 and 5 are not within Ohio optometric scope of practice. As of August 18, 2014, you will no longer be able to write a prescription for Tramadol.

2) Hydrocodone

The FDA most likely will also move hydrocodone from a Schedule III controlled substance to Schedule II controlled substance. The final recommendation when this is to occur has not yet been released. Our current law allows for only select Schedule 3 narcotics to be prescribed. Hydrocodone currently is one of the two agents ODs are authorized to prescribe in this class.

When this occurs, optometrists would be unable to prescribe hydrocodone and tramadol.  The only narcotic available for DEA certified ODs to prescribe would be Codeine (used in Tylenol 3).

The OOA has been proactive in anticipating these proposed changes and has legislation pending (unanimously voted out of House Health Committee) to accommodate the FDA’s changes to restore our prescribing authority for tramadol and hydrocodone.  This legislation should move forward in the autumn when the legislature returns. This could take up to 30 days for Governor to sign, then 90 days to become a law. When this becomes a law, you would need a DEA number if you wish to prescribe tramadol. Previously, a DEA number was not necessary since it was not classified as a narcotic.

The OOA encourages all ODs to obtain a DEA license even if you rarely prescribe narcotics. DEA numbers are nationally recognized and generally utilized by pharmacists compared to your TPA number. DEA numbers are used to track optometric prescribing habits. This helps further scope expansion initiatives as well as help ODs receive pharmaceutical samples from drug manufacturers and reps as appropriate.

Lastly, the OOA also wants to remind you about a recent rule added to our administrative code regarding the Ohio Automated Rx Reporting System (OARRS), 4725-16-04.  OARRS was created to help providers minimize the potential for prescription drug abuse and misuse and to help reduce the number of unintentional complications associated with pain medications. Any pharmacy that is licensed by the Ohio State Board of Pharmacy, even if located outside of Ohio, is required to report the dispensing of all Schedule II through Schedule V controlled substances plus tramadol products to the OARRS database at least weekly. DEA certified optometrists will be required to review the OARRS system and register for the program per the Optometry Board for the upcoming license renewal period.  You must also submit your DEA number with expiration date to the State Board.

To register for an OARRS account:

  • Visit the website at ohiopmp.gov
  • Click on “Register” and follow the prompts.
  • Complete the on-line portion and print. Sign and date in the presence of a Notary public.
  • Mail the completed application and any required documents to the OARRS office.
  • Once the completed application has been received at the OARRS office and credentials are verified, an email will be sent containing your user name. A password will be mailed to your home.

A detailed handout on OARRS can also be found at the Ohio Board of Optometry’s website: https://www.ohiopmp.gov/portal/brochure.pdf