Home health care meeting site of the latest skirmish in the “Eyeball Wars”


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

The House Professions and Public Health subcommittee hosted a roundtable on Wednesday that included two optometrists and two ophthalmologists.

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

Vice President of the Florida Board of Optometry David rouse told lawmakers that since optometrists were given oral therapy privileges in 2013, no formal complaints have been made to the state licensing board.

“I’m here to, essentially, testify to the fact that as a current member of the Council of State, we have not had any complaints lodged with our council since the creation of the statutory authority on oral medicines,” Rouse said. “We also haven’t received complaints from across the country from other regulatory bodies that have laser therapy privileges, advanced surgical privileges, and certainly expanses beyond what we have in the industry. ‘State of Florida. “

Corn Darby D. Miller, an ophthalmologist who works at the Mayo Clinic in Jacksonville, told lawmakers that board-certified ophthalmologists have been in school for 12 years and, if they have a scholarship, can add an additional 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 working on their own.

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

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

“It baffles me to think potentially how many times this could happen, that our patients are going through unnecessary surgeries,” said MIller.

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

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

Opthamologist Ahad Mahootchi also minimized the issue of access to care.

“The access problem is made by bad insurance. Making surgeons non-surgeons will not solve these problems, ”he said, adding that Medicaid managed care plans should not be able to contract with a single ophthalmologist in a county. Plus, giving optometrists additional medical privileges, he said, won’t change the way managed care plans run their business.

“The idea is to save the money they get by not providing the services,” he said. As an example, he noted that Hillsborough County has one of the largest eye banks in the world. Still, 40% of the county’s residents are enrolled in a particular health plan which, he said, does not allow cornea transplants.

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

representing Ana EskamanI asked panelists if the Eyeball Wars are generational and if people enrolled in medical and optometric schools believe young professionals are more open to change.

“I’m curious about the generational change we might see in an academic setting,” she said.

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

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

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

“Are they getting involved or are they kind of just sitting on the sidelines and watching you all fight?” She asked, only half joking.

Marciano said he didn’t know.

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