June 23rd, 2017
While the latest disruption capturing public attention may be Amazon’s entree into the grocery business, a major transformation is being debated within the Massachusetts Legislature over eye care - who can treat glaucoma as well as minor eye infections.
The political maneuvering is pitting optometrists, doctors carrying an O.D. degree obtained after a four-year, post-college study at an institutions like MCPHS University, which has a campus in downtown Worcester; and ophthalmologists, physicians carrying an M.D. obtained after four years of post-college study in medical schools, such as UMass Medical School in Worcester, and who undergo a one-year internship, and then three-to-five years of residency/fellowship in their specialty.
The existing symbiosis in which optometrists refer patients to ophthalmologists could be altered for some patients with glaucoma, as well as those with routine eye infections. Optometrists want the ability to provide immediate, first-line treatment of glaucoma with eye drops that reduce the condition’s elevated eye pressure and to treat minor eye infections such as styes and dry eye with oral antibiotics.
The Massachusetts Senate has approved this expansion in some form at least six times, only to see it die in the House. The Senate’s latest version has been incorporated into the July 1 budget proposal by the Baker Administration under the assumption it will save the state’s MassHealth (Medicaid) system $20 million a year. But what gets to the governor’s desk also depends on what the House does.
Making this all the more remarkable in its political maneuvering is that 49 states have all allowed optometrists to treat glaucoma in this fashion. The U.S. Veterans Administration medical system allows optometrists to provide this first-line treatment. (Three states even allow optometrists to perform laser surgery – although the other side says they’re rural states where medical access can be an issue.) Last year, the Obama Administration Justice Department’s Antitrust Division and the Federal Trade Commission bureaus of Competition and of Economics weighed in supporting a Massachusetts change.
Deanna Ricker, M.D., president of the Massachusetts Society of Eye Physicians and Surgeons, says the measure’s wording is too vague. A specified prohibition against “invasive surgical procedures,” for instance, leaves open a possibility that optometrists might be allowed to perform laser surgery, as “non-invasive,” just for one. She has said the $20-million MassHealth savings, from a study done for optometrists by a former MassHealth director, “falsely inflates” savings in assumptions of how people would access care.
Matthew Forgues, O.D., who is president of the Massachusetts Society of Optometrists and who practices in Worcester and Shrewsbury, points to the experience of all the other states, going back as far as 40 years, without issue. He says the fact that optometrist malpractice insurance rates in Massachusetts are no different from elsewhere shows that the expanded treatments aren’t causing problems.
Charles F. Monahan Jr., president of MCPHS University, where about 280 students studying optometry out of 2,000 in the city, lives this 49-to-1 split. Students come from all over the U.S., Canada and overseas. Their accredited training includes treatment for glaucoma and eye infection. They graduate, go home and put that education into practice, except for those graduates remaining in Massachusetts.
Shlomit Schaal, M.D., chair of the Department of Ophthalmology at UMass Memorial Medical Center and UMass Med, cited the disruptive nature of these moves across the country – not surprising given that politically there are significantly more optometrists than ophthalmologists. But because glaucoma is a progressive disease, she points out that even questions of when to stop a treatment and make a referral for surgery by a glaucoma specialist can be very challenging. Dr. Schaal is pioneering efforts to bring ophthalmologists and optometrists together in a UMass/MCPHS “eye to eye” symposium twice a year on patient care, as well as in monthly seminars. She finds that each group brings perspectives that benefit the other.
It’s time Massachusetts joins the rest of the country. It will improve access to care and lower costs. We’d like to see a thorough reading of practices allowed in each state, and adjustments to the legislation’s wording to avoid any unintended fallout.