The Integrated Ophthalmic Managed Eyecare Delivery Model (IOMED) is an integrated eyecare model in which optometrists and ophthalmologists work together. In an integrated eyecare model, ODs and MDs share the same ideals and principles of practice, and sometimes even the same building.
The American Society of Cataract and Refractive Surgeons (ASCRS) recently announced a new program at the organization’s upcoming 2013 annual meeting to which certain categories of optometrists are welcome.
According to a press release by ASCRS, the organization will offer a non-surgical educational program to advance an integrated eyecare model in which optometrists and ophthalmologists work together. This model, called the Integrated Ophthalmic Managed Eyecare Delivery Model (IOMED) was created by the ASCRS IOMED task force, which included three ophthalmologists and five optometrists.
The new educational track will be held at ASCRS’s upcoming annual meeting in April, and optometrists who register for the track must certify that they meet one of the following categories:
Note that as of 3 years ago, these categories of optometrists were permitted to attend the ASCRS annual meeting through the organization’s administrators association, American Society of Ophthalmic Administrators (AOSA). Those ODs attending were required to attest that they would not use what they learned beyond the scope of practice in optometry.
Optometrists who attend this year’s track will earn continuing education (CE) credits, unlike years past. “In the past, ASCRS would allow ODs to attend but not offer CE credits,” says Marlane J. Brown, OD, FAAO, of Minneapolis and member of the IOMED task force. “The other difference is that optometrists have been actively invited in, rather than simply ‘allowed.’ I feel the task force had a great deal to do with this.”
ASCRS’s initiative to create an integrated education track is about 5 years in the making, according to IOMED task force chairperson Stephen S. Lane, MD, of St. Paul, MN. “There’s going to be an explosion of patients who will need care,” he says. “With the cutback in ophthalmology residency positions, from a manpower standpoint ophthalmologists alone or optometrists alone cannot possibly see all of the patients who will need care in the next decade or two.”
Dr. Lane explained that a better model is needed in order to effectively and efficiently see patients. “There’s an opportunity to have patients seen with a seamless continuity of care between optometry and ophthalmology-care can be more effective and efficient if done within an integrated model,” he says.
Dr. Lane does not refer to co-management, the traditional way that optometrists and ophthalmologists have shared patient care. In an integrated eyecare model, he says, MD and OD share the same ideals and principles of practice, and sometimes even the same building. “Patients stay within a single care model that’s not splintered,” he says, “and this allows for a friendly working relationship between optometrist and ophthalmologist rather than some of the antagonistic ways that have occurred in the past.”
However, some optometrists don’t see the initiative as integrated.
Says Birmingham, AL, private-practice optometrist Jack Schaeffer: “They are saying by their actions that this is a business decision to employ ODs to help their practices, not to educate ODs to help patients. Education is the key. It should never be restricted.”
Dr. Lane acknowledges that independent optometrists were not included because they aren’t part of an integrated care model. “The independent non-integrated OD, like the independent non-integrated ophthalmologist, is, in my opinion, a breed that with the expansion in population growth will have an ever increasingly difficult time caring for the number of patients who need to be seen,” he said.
Political concerns are another reason that independent ODs were not included. In the past, optometrists in Kentucky and Oklahoma used education they received at ophthalmology meetings as a jumping-off point to expand scope of practice.
Says Dr. Lane: “ASCRS does not want to provide an opportunity have that fight so it can be used against our own members. It’s unfortunate because I believe the vast majority of optometrists have no interest in doing surgery.”
Dr. Schaeffer claims that ASCRS members are looking to change a model that works perfectly well. “ODs are integrated already with MDs,” he says. “Our practice and many others work with retina, ocular plastics, pediatric, and general ophthalmologists. Is ASCRS saying these relationships deliver a lower level of care? Will all ASCRS practices incorporate this new model?”
The majority of ASCRS members employ ODs, according to Dr. Lane, and it follows to provide education to those employees. “That doesn’t include every optometrist in the United States,” says Dr. Lane. “We welcome our members who want to educate all members of their staff, including administrators, technicians, and yes, optometrists. This isn’t all that different from having our administrators attend our meeting. This concept may progress to where there may potentially be an AOSA-like group of optometrists who have an independent meeting inside our meeting.”
Dr. Brown also hopes that this year’s educational track is a small start of larger change. “I don’t disagree with concern and anger of private practice optometrists,” she says. “But I don’t agree with the fact that this anger should exclude all ODs from being involved in an educational forum. The more we learn, the more we can share. I am looking at this as baby steps to integrate all of optometry with all of ophthalmology. I think the ODs who see this as an insult are a very small percentage. Many ODs who want to attend a meeting like ASCRS may not be in private practice.”
The IOMED task force is looking to see how this year’s track is received and attended before making more changes. “I personally hope we can allow more optometrists to attend in the future,” says Dr. Lane. “We need to be patient and have an open mind. We have to satisfy the needs of our membership, and this is a wonderful first start.”ODT