The Massachusetts Society of Optometrists is working with practitioners, residents and state legislators to ensure its optometric scope of practice is in line with the rest of the country, according to Matthew Forgues, OD, president of the Massachusetts Society of Optometrists, in an interview with Primary Care Optometry News.
Massachusetts optometrists would have the authority to treat glaucoma and ocular abnormalities of the human eye and the adjoining and adjacent tissue, as well as prescribe all necessary eye-related medications including all anti-infective agents, in proposed legislation H.1169 and S.1242.
The House and Senate versions take the current law and simply add glaucoma drops and oral antibiotics for treatment of eye-related issues, Forgues said.
Each bill does not allow optometric utilization or prescription of therapeutic pharmaceutical agents for the treatment of systemic diseases; invasive surgical procedures; pharmaceutical agents administered by subdermal, intramuscular, intravenous, subcutaneous or retrobulbar injection; nor opioid medications, according to the Commonwealth of Massachusetts website.
This week, Forgues testified in front of the Joint Public Health Committee for the standalone bill along with Gary Chu, OD, MPH, FAAO, senior director of public health and community collaborations at New England College of Optometry, and Michael A. Purdy, OD, a practitioner in Northampton and MSO chair.
Purdy and Forgues commented on the merits of the bill, the access and choice components and the cost savings to the state health care system, according to Forgues.
In addition, they addressed “the improved health care delivery system it would create, stressing this is for patients and the doctor/patient relationship. We stressed that Massachusetts residents deserve the same standard of care that is offered everywhere else in the country,” Forgues added.
Chu addressed the education issue and stressed the impact this has on students deciding to stay and practice in the state.
A state budget issue
MSO conquered its first big hurdle for scope expansion more than a week ago when the Senate released its version of the state budget, and the modernized scope was included, Forgues added.
Now the MSO is working with the House to come up with its version of the health care portion of the state budget to include the same improved scope of practice.
Similar legislation has passed in the Senate six times and has always been held up in the House, he said.
Forty-one years since the first optometric glaucoma legislation passed in West Virginia, it may finally be time for the state to modernize. Thirty-nine states have possessed glaucoma treatment rights for 20 years or more, according to documents provided by MSO.
Cost savings, OD student retention
One benefit of the legislation is cost savings. MSO organized an independent cost analysis with the firm Health Management Associates (HMA) to determine the depth of cost savings for the state if the legislation were approved.
Conservatively, HMA determined that it would save Massachusetts Medicaid $20 million dollars alone.
“So, that’s why we’ve become part of the state budget,” Forgues said.
As optometrists are on the front line of patient care, “we see the majority of patients, and when we identify there’s glaucoma, we have to send them out needlessly,” he continued.
Often, the patient is given duplicate testing (with double copays) from a higher cost specialist, requiring more time away from work and care access issues, according to Forgues.
In addition, he said many legislators are finally hearing the message as to how the current scope of practice affects optometry schools and its graduates.
“We have Massachusetts College of Pharmacy and New England College of Optometry,” said Forgues, a third-generation optometrist. “Some students have told me, ‘Why would I stay here when I can’t fully practice? This is the only state that really limits what I do.’”
He continued: “This has a long-lasting impact – good providers going to other states – and you can’t blame them.”
It also has an impact on a school’s recruitment success, he said.
Successful advocacy efforts
MSO stepped up its public awareness and advocacy efforts, through the Visionary Campaign, to alert the public to the potential cost savings of the bill, Forgues said, in addition to polling residents regarding their support of the legislation.
The results were staggering, he said, with 86% of residents in favor.
“It’s pretty easy to be in favor of something when you learn every other state does it,” Forgues said.
The MSO also employed radio and newspaper advertising to raise awareness.
“I really feel like our profession in Massachusetts is a lot more understood, and we have a lot of legislators pushing for us,” Forgues added.
He said MSO learned a lot from the polling panels.
“Residents here have an excellent level of trust with their optometrists, and this was wonderful to confirm,” he said.
In 2016 to 2017, the Federal Trade Commission and Department of Justice issued a federal paper in support of this scope of practice issue in the state, Forgues said. The Boston Globe and The Boston Herald also support it.
“We have a lot of advocates, including the Governor’s office.” he said.
Forgues said they should hear what is next for the health care budget on the House side in the first quarter of 2018, as early as January or February.
If for any reason the bill does not make it as a part of the state budget, the separate bill (H.1169 and S.1242), introduced in January 2017, would still have a chance in the traditional legislative cycle, ending next summer, he added. – by Abigail Sutton
Disclosure: Forgues is president of the MSO.