Future of Optometry: Discussed by Optometry Australia NSW/ACT Members

The significance of the evening, which attracted almost 70 mbers, was underlined by the presence of both the chairman of the Optometry Board of Australia, Mr Ian Bluntish (SA), and the current national director and chairman of the Board of Directors of OA, Mr Andrew Hogan (TAS).Initially, attendees broke into separate groups to discuss topics they felt were critical in shaping optometry now and into the future. The most common concerns revolved around workforce oversupply, Medicare issues, scope of practice, and oral drug prescribing rights.The deliberations that followed the group presentations were assisted by a panel consisting of Bluntish and Hogan, who were joined by NSW OA president Ms Christine Craigie, state vice-president Mr Luke Cahill, and national board mber Dr Steve Zantos.Delegates break into discussions groupsOversupply: The number of new graduates being produced and the possibility of yet another course entering the fray from the ACT prompted worries over workforce numbers. Losing some of the gains in professional status and professional advancent achieved over the last few decades due to the claimed influence of corporate operators in the optometry education sector was also a matter of great concern.The group acknowledged the ongoing probl of maldistribution with regard to city versus country-based optometrists. Research has shown that the best way to help redress the imbalance is to recruit students from the country, as they are more likely to return from whence they came. In view of the perceived oversupply and underployment of many optometrists, the group saw the solutions as being a decrease in the number of graduates and/or an increase in the number of jobs available.To effect the latter, they suggested that; the scope of practice be expanded beyond the current; optometrists be deployed in local hospitals; overseas optometrists be discouraged from coming to Australia; and that consideration be given to introducing minimum standards of practice and/or minimum times for a consultation. It was hoped minimum times would circumvent the tptation to perform 10-minute ‘full’ consultations simply to generate prescriptions, potentially to the detriment of patient eye health.Well-known rural practice advocate, Dr Phil Anderton, spoke briefly of initiatives that have proved successful, such as senior optometry students being sent to rural practices as part of their training. Some 50% of those that undertook rural experience chose to return after graduation. He also reported greater professional satisfaction in rural optometrists because of the much closer professional relationships they struck with local GPs, ophthalmologists, and other health professionals.The former long-term university acadic stated that universities regard optometry courses as “cash cows” and predicted issues with debt recovery should graduates leave acadia with a large education debt but little or no job prospects.Mode of Practice: The group noted that, within the profession, there was a spectrum of ability that was independent of where practitioners were ployed. They did agree however, that pressures in corporate chains related to KPIs and overbearing superiors brought additional pressures, which had the potential to impact negatively on patient outcomes.Despite these pressures, the group reinforced the fact that the national law overrode any pressures from ‘others’, that managent was not in the legal firing line if probls did arise, and that ultimately, the practitioner had full and final responsibility for their actions. To reinforce that message, the group said undergraduates should be educated about their responsibilities and liabilities when in practice, and suggested that a short course be undertaken such as that offered by the Australian Institute of Company Directors.They also agreed that corporate managent need to be held responsible for the actions of their staff, which is not the present situation. However, even if they were held responsible, they acknowledged that identifying and pursuing those responsible would probably prove to be difficult.


Margaret Lam Ian Bluntish Carina Trinh Andrew Hogan Michael Yapp Andrew McKinnon

Fee structureCurrently, six out of seven patients are still being bulked billed on Medicare. As a result, some in attendance believed that new patients – which generally comprise 20% of a practice’s business – could be seen as an opportunity to introduce full, or even higher fees, now that the fee cap has been roved. The cessation of fee indexation was seen as a significant issue, as were the actual fees thselves, which were considered too low – especially when compared with other non-professional fees.Furthermore, the group claimed the 10907 Medicare it number, which relates to cases where a patient has been examined elsewhere less than three years ago, was not a well-defined benefit. Another identified billing issue was the inability for certain combinations of it numbers to be claimed together from one attendance. For example, in the case of a foreign body roval (It 10944) that might require further tests at the time, those other tests are not billable.There was universal agreent that the limit of three years between visits was unjustifiable. While some organisations are promoting one and two year reviews, Medicare is pursuing a three-year examination cycle. The group suggested that the age at which a 12-month re-examination became possible should be lowered from 65 to 50 years of age.Additionally, the group wanted to see It 10905 – referral for a comprehensive initial eye examination by another (unrelated) optometrist – extended to cover GP referrals as well. Co-payments were also seen as an issue.Meanwhile, it was revealed that the amount spent annually funding the leading anti-VEGF drug, was about the same as the total amount spent on all optometric services annually. The group advised practitioners to become less dependent on Medicare, noting that the Medicare rebate is in reality what the patient gets reimbursed and not an optometric income source. Ms Craigie suggested that optometrists needed to continually educate their patients about the value of their eyes and eyecare in general.SpecialtySome of the possible specialties aired included: CLs, behavioural optometry, low vision, dry eye, therapeutics, occupational optometry, aviation, sports, and myopia control.The questions they asked included: ‘Is accreditation a possibility to define a specialty?’ – and – ‘What relationship might a specialist have with their professional colleagues, especially other optometrists and ophthalmologists?’The expectation was that formal specialisation would allow higher fees to be charged for the services provided. Possible accreditation authorities included OCANZ, OA, and special-interest organisations, such as the CCLSA.However, Bluntish said that because optometry was viewed as a primary care profession it was not a good fit with ‘specialisation’. He questioned what the aim of specialisation in optometry was trying to achieve – more money, more status, less competition, etc – and instead suggested that rather than specialisation, areas of interest, expertise, and focused targeting of consumers could be a more appropriate path to take.Recognition of a specialty requires a complex process including impact statents, government committees, donstration of any change being in the public interest, examination of competition issues, and justification to a COAG regulation process. The government and AHPRA have preferences for minimum regulatory force.Furthermore, the current lack of an intra-professional referral ‘culture’ within the profession of optometry is a barrier. It is reasonable to surmise that specialisation within optometry is not going to happen in the short-term at least, if ever. There is nothing preventing intra-profession referrals, but its insignificant level currently, and the complexities of Medicare billing, auger against it happening in the current circumstances.An overview of health regulationMr Bluntish gave a brief overview of the history leading up to the formation of the Australian Health Practitioner Regulation Agency (AHPRA) in 2010. That event saw 97 state and national boards condensed into just 14 with national responsibility, the reduction of 78 separate state acts into just one national act, the creation of a single register of authorised professionals, eight optometry boards rolled into one, and eight separate healthcare complaints authorities reduced to just three (NSW and QLD retained state-based authorities).AHPRA now has about 620,000 health professionals on the national register under its National Registration and Accreditation Sche (NRAS). AHPRA itself is a corporate entity that administers funding to, and supports the activities of, the 14 boards and their various committees.The OBA has assigned responsibility for accreditation of optometry courses to the Optometry Council of Australia and New Zealand (OCANZ). However, the OBA is still responsible for registration decision-making, the registration of optometrists and students, handling patient complaints (except for NSW and QLD), and approving accreditation standards.Bluntish reiterated the OBA’s role, which he defined as the protection of the health and safety of the public through a risk-managent model.Philosophically, it is committed to using a minimum of regulatory force.According to Bluntish, the OBA has conducted public consultations on various optometric matters, including the schedule of medicines optometrists are permitted to use, and will conduct a public consultation on the standard for CPD for practitioners. While the previous and the current chairmen of the OBA have been optometrists, there is no guarantee that that will always be the case.Optometry Australia guides the professionMr Hogan revealed that more than 80% of Australian optometrists are mbers of OA, a figure higher or much higher than most of the other organised health professions. The goals of OA are to lead, engage, and promote optometry in Australia.Hogan detailed the professional indnity insurance offered by Avant Insurance through OA noting that it is a nil-deductibles policy that offers a 24/7 medico-legal hotline with access to 70 experts. He gave the achievents of OA as the leading of the profession, the roval of the fee cap, the expansion of the PBS listing for endorsed optometrists, and the launch of the Good Vision for Life website. He also said that the Future of Optometry evening was an example of OA ‘doing it better’, a trend he wanted to see continued in other states.Discussions that followedThe issue of corporate interference in professional matters was discussed and the predictable scenario in which non-compliant optometrists were simply replaced by compliant ones was aired. In such situations, professional ethics was given as the broader issue and again, education of undergraduates by acadia, OA, and others was seen as a possible partial answer. Ultimately, the answer lies with the individual practitioner.The question of ‘what is an optometrist?’ was followed by ‘what will an optometrist become in the future?’ It was agreed that as time progresses, the overlap between optometry and some other professions, especially ophthalmology, will increase.Optometry needs to be a part of the healthcare safety net whereby no Australian goes without adequate healthcare, including eyecare. Such a process will necessitate greater involvent in public hospitals and poor socio-economic areas until the stage is reached where optometry is the source of all primary eyecare.Internet sales{{image8-a:r-w:300}}Despite contact lenses (CLs) being a medical device/therapeutic good, the use of CL package labelling as a ‘prescription’ was rife. The lower costs of internet products, many of which are standard products, was considered a motivating factor for consumers who circumvent the prescriber’s eyecare and supply chain. Grey-market imports add to the mix and are one step beyond the control of Australian authorities, such as the TGA.The group believes that legislation controlling the prescribing and supply of CLs is neither policed nor enforced. Therefore, optometrists have a role in explaining the risks to their patients in the internet era. According to the group, only SA and Tasmania regulate who can sell and supply CLs, as even though under national law and consumer law some control still exists, it is not exercised.Given other pressing border control issues still exist it was considered there was little chance of customs officials turning their attention to lesser issues such as grey-market CL importation.Technology advances:It was decided that the best way to deal with advances in technology, such as smartphone-based self-prescribing and eye disease self-diagnosis apps, was to brace th and make th ubiquitous.Rather than considering it a probl, the group saw such apps as part of a solution, and certainly part of the future. Overuse and over-servicing were seen as a potential probl with technology, especially in the hands of the less qualified, but it was thought most of the issues associated with the technology were beyond their control.Eye health{{image9-a:r-w:300}}A key recommendation from this group was that optometrists should get involved in the education of GPs and pharmacists at the undergraduate and CPD levels. They said it was important to communicate the ease of access and the lower cost of optometric services and the appropriate right of referral for those needing further care. It was also suggested government funding could be spent more efficiently by using optometry as a primary care provider and filter, reducing the overuse of specialist medical services that would result otherwise.The group also believed that patient co-managent with ophthalmology would be enhanced if ophthalmologists better understood optometry’s expertise and standards. This could be facilitated through education and the participation of optometry in the public health syst.It was acknowledged that the NDIS was already on OA’s ‘radar’ and figures suggested that the caseload would increase from a potential 30% to 80% if the NDIS age of eligibility for assistance for vision impairment was lowered from 65 to 60 years. They also estimated that currently, the expenditure on hearing impairment was disproportionate to that of eyecare.Health funds{{image10-a:r-w:300}}The question of the vested interests of health funds and their preferred provider arrangents was raised, with the present situation described as a “massive” conflict of interest.Many in the group reported that the data of health fund mbers, gathered through the normal claims process, was often also used for marketing purposes. This occurred when health funds sent information and direct marketing to mbers aimed at separating th from the original practice in order to direct th to either their own or another, preferred, practice instead.Some delegates also alluded to over-servicing by in-house or preferred providers and said optometry-friendly funds should be promoted to try to negate some of the inherent advantages the other funds enjoy.The group called for a government review into the purported anti-competitive behaviour and abuse of personal data, and also suggested that optometry liaise with other professions, especially dentistry, to deal with this shared probl.

Send this to a friend