It was our privilege to present at the National Press Club in Washington DC in summer, 2015, regarding retinal screening for diabetic patients in the primary care clinic. Organized by Prevent Blindness America and focused on the future of vision care, the meeting opened with an important presentation by the Institute of Medicine (IOM) called “Catalyzing Change.” The IOM has launched a massive study on the future of vision care in the U.S., to be completed by the end of 2016. This meeting brought together organizations on the cutting edge of evolving and improving eye care, including its integration into primary care. In fact, the EyePACS system offers a glimpse into that future.
The Robert Wood Johnson Foundation (RWJF) presented information from the Centers for Medicare and Medicaid Services (CMS) and its impact on eye care, including the implications of Medicaid expansion under the Affordable Act. With the lowest uninsured rate since the 1970s, we now see, in the “expansion states,” a 23% surge in diagnoses of diabetes as more patients are getting the primary care they need, often financed by Medicaid. This produces an influx of patients into the FQHC – exactly where EyePACS telemedicine solution can help maintain quality procedures during a surge of new patients.
The transition to “pay for performance” was an important topic also covered by RWJF. Trying to bill for encounters under the current system while preparing for future reimbursement based on improved health outcomes is like “having a foot in two canoes”, as Susan Denzer, senior policy advisor, commented. It is our conviction that the EyePACS system in the primary care setting can lead the clinic to fiscal sustainability during and after this period of transition. To ensure success under the future system, we are adding some additional data to our EyePACS reports to position health centers for incentives and revenue opportunities.
The Centers for Disease Control’s Pamela Alweiss, MD, spoke of the importance of a fully integrated patient-centered medical home in achieving success with diabetes management. A guide is now available to facilitate the cross-communication team approach needed to reduce risk factors and complications from diabetes. This guide, along with other very helpful new publications for patients, is meant to integrate PPOD - pharmacy, podiatry, optometry/ophthalmology and dentistry - for the diabetic population. Such integration could shift the focus from treatment to education and prevention, presumably with improved outcomes for the patient.
The American Academy of Ophthalmology showcased a database called IRIS: Intelligent Research in Sight. This outpatient registry can provide objective data to efficiently identify successful interventions across very large populations. Registries like this will provide the medical community, including the healthcare safety net clinics, with affordable, accessible information to make evidence-based decisions that drive clinical quality.
A fascinating presentation about the effects of space travel on the vision of astronauts introduced the concept of programmable lenses adaptable to temporary or permanent vision changes. Development of this futuristic product could allow for a one-touch reprogram to adapt to various power zones. It could be a game changer for the optical industry.
EyePACS had an opportunity to explain to the audience the vicious cycle in which patients blame the treatment for their blindness, instead of their disease and their own lack of adherence to recommendations and referrals. Because diabetic retinopathy is asymptomatic until it is in an advanced stage, it may be difficult to convince patients to be evaluated and treated before symptoms arise. Once the symptoms arise and the patient seeks help, it is often too late for the treatment to be effective. Thus ensues the vicious cycle of disenchanted patients blaming the treatment instead of behaving proactively on behalf of their own vision health.
EyePACS’ future focus, therefore, will be on interventions that can improve adherence to diabetes care. As we develop new tools and programs, we will keep in mind the vicious cycle that interferes with successful outcomes. We are convinced that convenient and cost-effective screening at the primary care level will lead to better patient outcomes through commitment to regular retinal exams.
View the EyePACS Learning Community presentation