Access to Ophthalmologists in States Where Optometrists Have Expanded Scope of Practice

Abstract

IMPORTANCE As the United States considers how to best structure its health care services, specialty care availability is receiving increased focus. This study assesses whether patients lack reasonable access to ophthalmologists in states where optometrists have been granted expanded scope of practice. OBJECTIVE To determine the estimated travel time (ETT) to the nearest ophthalmologist office for persons residing in states that have expanded scope of practice for optometrists, and to quantify ETT to the nearest ophthalmologist for Medicare beneficiaries who received surgical care from optometrists in those states between 2008 and 2014. DESIGN, SETTING, AND PARTICIPANTS This study used data from the 2010 US census, a 2016 American Academy of Ophthalmology member database, and a data set of claims data for a random sample of 20% of beneficiaries enrolled in Medicare nationwide from 2008 to 2014 (n=14 063 725). Combining these sources with geographic information systems analysis, the ETT to the nearest ophthalmologist office was calculated for every resident of Kentucky, Oklahoma, and New Mexico. This study also assessed ETT to the nearest ophthalmologist for Medicare beneficiaries in those states who had received surgery from an optometrist from 2008 to 2014. Data analyses were conducted from July 2016 to July 2017. MAIN OUTCOMES AND MEASURES The proportion of residents of Kentucky, Oklahoma, and New Mexico who live within an ETT of 10, 30, 45, 60, or 90 minutes of the nearest ophthalmologist office. RESULTS The study included 4 339 367 Kentucky residents, 3 751 351 Oklahoma residents, and 2 059 179 New Mexico residents. Of these, 5 140 547 (50.6%) were female. Racial/ethnic composition included 7 154 847 people (70.5%) who were white, 640 608 (6.3%) who were black, and 1 418 246 (14.0%) who were Hispanic. The mean (SD) age was 37.8 (22.8) years. More than 75% of residents in the 3 states lived within an ETT of 30 minutes to the nearest ophthalmology office, and 94% to 99% of residents lived within an ETT of 60 minutes to the nearest ophthalmology office. Among Medicare beneficiaries who received surgery by optometrists, 58.3%, 51.1%, and 46.9% in Kentucky, Oklahoma, and New Mexico, respectively, lived within an ETT of 30 minutes from the nearest ophthalmologist office. CONCLUSIONS AND RELEVANCE In the states where optometrists have expanded scope of practice, most residents lived within an ETT of 30 minutes of the nearest ophthalmologist office, as do half of Medicare beneficiaries who received surgical care from optometrists. These results can help inform policy makers when weighing the pros and cons of scope of practice expansion for optometrists.

Differences in Characteristics of Medicare Patients Treated by Ophthalmologists and Optometrists

“…Diagnostic procedures and treatments are performed by both professions, but because of differences in education, training, and licensure, scopes of practice differ between the two specialties both within states and between states. 5 Not surprisingly, the geographic distribution of ophthalmologists and optometrists is not uniform within states, which has led some observers to argue that regional access problems exist for the provision of some services and the performance of some procedures. 5,6 Over the last several years, some states have expanded optometric scope of practice, ostensibly to improve patients' access to eye care.…”

“…5 Not surprisingly, the geographic distribution of ophthalmologists and optometrists is not uniform within states, which has led some observers to argue that regional access problems exist for the provision of some services and the performance of some procedures. 5,6 Over the last several years, some states have expanded optometric scope of practice, ostensibly to improve patients' access to eye care. Newly granted privileges include laser photocoagulation and photoablative procedures, intraocular injections, and eyelid surgeries.…”

“…Newly granted privileges include laser photocoagulation and photoablative procedures, intraocular injections, and eyelid surgeries. 5 Data showing that these expanded privileges have improved patients' access to care is lacking and some recent studies have concluded that access to care has not changed in states such as Oklahoma that have allowed optometrists to perform laser procedures. 5,6,7,8 Additionally, data showing that expanded privileges have enabled patients with more advanced eye diseases and higher risks of vision loss to increasingly obtain care from optometrists is also lacking.…”

“…5 Data showing that these expanded privileges have improved patients' access to care is lacking and some recent studies have concluded that access to care has not changed in states such as Oklahoma that have allowed optometrists to perform laser procedures. 5,6,7,8 Additionally, data showing that expanded privileges have enabled patients with more advanced eye diseases and higher risks of vision loss to increasingly obtain care from optometrists is also lacking. To better guide those state legislatures that are considering expanding privileges of optometrists and other non-ophthalmologists, it is critical to understand the characteristics of patients who seek care from ophthalmologists and optometrists.…”

Optometry outreach for diverse middle school students

“…Developing these skills is critical because the problems that we face today such as climate change, food deserts and cyber awareness require a diverse and functional skill set that is embodied in STEM degrees 4 . Graduating more U.S. college students in STEM has practical importance nationally, as fewer Americans fill skilled scientific and technical careers, damaging American economic competitiveness and potentially harming national security 5 . STEM education emphasizes an integrative strategy of teaching instead of the traditional silo approach, and skills such as teamwork, effective communication and innovation can be fostered.…”