House health care meeting site of latest skirmish in ‘eyeball wars’

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Optometrists again want to expand their scope of practice.

There was another skirmish in Florida’s “eyeball wars” on Wednesday as members of a House health care panel witnessed a spirited back and forth between ophthalmologists and optometrists, with the latter renewing their push to expand services they are allowed to provide under law.

The House Professions & Public Health Subcommittee held a panel discussion Wednesday that included two optometrists and two ophthalmologists.

Palm Beach Gardens optometrist Mark T. Marciano told panel members his research showed that Medicaid beneficiaries enrolled in a number of health plans in Okeechobee County have to drive long distances to an ophthalmologist. He told panel members that optometrists provide 72% of the eye care in the state. “That’s a lot,” he said.

Vice Chairman of the Florida Board of Optometry David Rouse told lawmakers that since the optometrists were given oral therapeutic privileges in 2013, there have been no official complaints filed before the state licensing board. 

“I am here to, basically, testify to the fact that as an existing state board member, we have not had any complaints filed with our board since the inception of the oral medications statutory authority,” Rouse said. “Nor have we had complaints from across the nation from other regulatory boards that have laser therapeutic privileges, advanced surgical privileges and certainly scopes  beyond what we have in the state of Florida.”

But Darby D. Miller, an ophthalmologist who works at the Mayo Clinic in Jacksonville, told legislators board certified ophthalmologists are in school for 12 years and, if they have a fellowship, can add another four years of training to that. That’s about 17,000 hours of clinical training, Miller said, adding that ophthalmologists treat “hundreds if not thousands” of patients before they work on their own.

By comparison, he said, optometrists have about 2,000 hours of clinical training.

“It’s not just the training, but judgment that’s at issue,” Miller said, telling committee members that a patient was recently referred to him for laser surgery, but was suffering from dry eye instead.

“It does baffle me to think potentially how many times this could happen, that our patients are subjected to surgeries that are unnecessary,” MIller said.

Miller also took aim at the optometrists’ argument that there is an access problem, telling lawmakers that 99.9% of the people in Florida are within 40 minutes of an ophthalmologist.

“That’s closer than the nearest Walmart, by the way,” he said.

Opthamologist Ahad Mahootchi also downplayed the access to care issue.

“The access problem is manufactured by poor insurance. Making non-surgeons surgeons won’t fix those issues,” he said, adding that Medicaid managed care plans shouldn’t be able to contract with just one ophthalmologist in a county. Moreover, giving optometrists additional medical privileges, he said, won’t change how managed care plans operate their businesses.

“The idea is to save the money that they are getting paid by not delivering the services,” he said. As an example, he noted that Hillsborough County has one of the largest eye banks in the world. Yet 40% of the residents in the county are enrolled in a particular health plan that, he said, doesn’t authorize cornea transplants.

“That’s like going to your obstetrician and having 3,000 boys in a row. It just doesn’t work that way,” he said.

Rep. Ana Eskamani asked panel members whether the eyeball wars were generational, and whether people enrolled in medical school and optometry school feel younger professionals were more open to change.

“I’m curious about the generational shift that we might be seeing in an academic setting,” she said.

Rouse, whose wife, Linda S. Rouse, is the dean of the Nova Southeastern College of Optometry, said optometric students today are being exposed to laser therapies and eye diseases and he thinks “there is a trend for optometry to become more disease and procedural based.” 

But Mahootchi, not surprisingly, disagreed. He said the definition of primary eye care would remain exams and tests and “not so much about procedural stuff.”

Eskamani noted Florida also has licensed “opticians” and asked where those professionals stood on the issue of expanding the scope of practice for optometrists.

“Do they get involved or do they kind of sit on the sidelines and watch you all duke it out?” she asked, only half jokingly.

Marciano said he didn’t know.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


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