Key ophthalmic organisations have revealed their federal election wish lists, drawing attention to issues such as workforce maldistribution and access for rural and remote communities, which optometrists say could be partially alleviated with an expedited decision around oral medication prescribing and involvement in intravitreal injection (IVI) services.
The sector’s other headline proposals include strengthening the Visiting Optometrists Scheme (VOS), greater Medicare reimbursement for optometric domiciliary services, full specialist MBS billing rights for some final year ophthalmology trainees and a ’90-day rule’ for public cataract surgery.
Optometry Australia (OA), RANZCO and Vision 2020 Australia – the national peak body representing over 50 ophthalmic organisations – separately provided their recommendations ahead of the election to be held before 21 May.
To highlight the importance of the sector, modelling was provided showing those considered blind or vision impaired had increased from 453,000 in 2016 to 840,000 now, which could exceed 1.04 million by 2030. The social and economic burden is estimated to be $27 billion annually or $46,950 per person with vision loss aged over 40.
In its submission, OA stated an ageing population and “a failure to fix entrenched shortcomings” means urgent action is now required “to avert a looming eye health crisis”. The first of its initiatives included the need for qualified optometrists to prescribe oral medications for common eye conditions. Although this is allowed in countries like New Zealand, the UK and US, ophthalmology bodies are opposed to this in Australia. The need for optometry patients to visit a second health practitioner for such prescriptions could potentially result in additional out-of-pocket costs.
“The Optometry Board of Australia has begun considering whether optometrists should be able to prescribe oral medications with a final decision to be taken by federal and state and territory ministers,” OA said.
“With indications that consideration could take a further two years or longer, there is a need to expedite through a clear indication that this issue warrants an early decision in the interests of enhancing patient access and convenience.”
The organisation also proposed improvements to Medicare items 10931-10933, which cover domiciliary services in the form of a loading, in recompense for “travel costs and packing and unpacking of equipment”.
Millions needed for indigenous eye health
With the current fee at $24.20, OA’s modelling suggests this grossly under-recognises the true cost, discouraging optometrists. It believes a more realistic figure would be $85 per visit. It would come at a minimal budget cost of $500,000 annually due to their infrequency, but could increase service delivery by 10%.
Elsewhere, the organisation proposed $18.1 million over five years for VOS, whose services have tripled during the past decade. By putting the scheme on a firm financial footing, it would reach more First Nations people, with indications more than 21,000 additional VOS-supported eye examinations per annum are needed.
Geographic access to eyecare also forms part of the basis for OA’s next proposal on intravitreal injection (IVI) services. At a cost of $500,000 over two years, OA believes there’s the opportunity to pilot collaborative care models to enhance access to IVIs in regional and rural areas.
Although ophthalmology bodies are against optometrists physically administering IVIs, OA stated the pilot would see local optometrists work with visiting ophthalmologists for treatment planning, patient management and support, as well as conducting and electronically transmitting OCT scans.
“It is envisaged that the pilot would be undertaken in two separate locations, including one that would enhance access to IVIs in remote Indigenous communities, working in partnership with local Aboriginal Health Services,” OA stated.
“The pilot would be developed … with relevant local health providers, health professional groups and patient representatives, and would be independently evaluated with a view to informing a broader rollout of innovative IVI care models.”
Elsewhere, OA recommended the government invest $500,000 over two years, which it would match dollar-for-dollar, to continue its ‘Good vision for life’ public awareness campaign. It also proposed $500,000 over two years to build eye health awareness among primary health professionals such as GPs, practice nurses, specialists and allied health professionals.
90-day cataract surgery rule
In its submission, Vision 2020 Australia outlined 11 recommendations.
At the top of its list was $65 million in additional funding to support the government’s commitment to end avoidable blindness in Indigenous communities by 2025, through full implementation of the ‘Strong Eyes, Strong Communities’ recommendations.
Another important proposal called for funding of ophthalmology staff specialist positions in the public system and new eye health workforce strategies that improve access to cataract surgery and intravitreal injections in regional, rural and remote areas.
“Vision 2020 Australia recommends implementing a 90-day rule for cataract surgery, whereby patients are to be seen within 90 days of requesting an outpatient visit for assessment and operated on within 90 days of booking – and reporting of performance against this.
“[We also propose] an increase in publicly funded and/or affordable access to intravitreal injection and benchmarks implemented that measure reach and timeliness. For this to be successful, mandated improvements are needed to the collection and reporting of outpatient/specialist clinic data. This would provide greater clarity on the expediency of initial appointments and treatment and ongoing access to sight saving treatment.”
The organisation’s other recommendations included:
- $26.4 million over four years to tackle “the blindness crisis” in Papua New Guinea.
- Additional $14 million per annum for disability inclusion in Australia’s aid program.
- $5.04 million over four years to trial an on-call eye health and vision coaching and support service for disability and aged care workers and assessors.
- A dedicated vision mission within the Medical Research Future Fund of $150 million over 10 years.
- A national evidence-based framework for the early identification and management of vision and eye health problems in 3.5 to 5 year-old children.
Ophthalmology proposals
RANZCO head of advocacy Mr Gerhard Schlenther provided a list of recommendations from the college split into five areas.
Among its four proposals under ‘service delivery and preventative healthcare’, RANZCO called for measures to improve timely access to geographically available, publicly funded ophthalmology outpatient services, which it recently highlighted as a major issue in NSW.
In its six ‘Close the gap’ initiatives, it said funding was required for an adequate number of Aboriginal and Torres Strait Islander health workers/liaison officers, to coordinate and facilitate services. Institutionalisation of Indigenous community control into funding schemes and service delivery models is also needed to ensure Aboriginal Community Controlled Health Services are part of the decision-making process. It also reiterated the need for funding of scholarships and enrolment in specialist training programs to grow the Indigenous workforce and leadership development.
The college’s five ‘workforce and training’ proposals included investment in more urban training posts in the public system, and the Regionally Enhanced Training Network (RETN), which is essential to sustainably address workforce maldistribution.
“[RANZCO also calls for the granting of] full specialist MBS billing rights to fifth (final) year ophthalmology trainees working under supervision in regional and remote areas to address the maldistribution of doctors.
“Also, set reportable KPIs for all specialty training – not just ophthalmology – as well as for outpatient and inpatient service delivery, making state governments and local health districts more accountable for training and outpatient service delivery.”
Its six-point ‘sustainability and climate change’ proposal featured the establishment of a national Sustainable Healthcare unit and a Climate Solutions Fund to support sustainable practices in healthcare and reduce the sector’s significant emissions.
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