Practice pulse TIPS, TRENDS & NEWS YOU CAN USE

West Virginia Passes Scope of Practice Bill in Legislature

BILL ENABLES STATE BOARD OF OPTOMETRY TO REGULATE PROFESSION

■ The West Virginia legislature has passed a bill that would not only broaden optometric scope of practice by clarifying what O.D.s are currently educated in and trained to do, but also give the state's Board of Optometry — without legislatively changing the law further — the authority to expand scope of practice in the future through the state's legislative rule-making process. (See “West Virginia Scope of Practice Expansion Bills Under Study,” Practice pulse, May 2009.)

“The legislative process is extremely cumbersome and takes years. And as I've said to the legislators, the last time we had a legislative code change, you never heard of a flat screen TV and if you had a cell phone, it wouldn't fit in your pocket,” explains optometrist Gregory S. Moore, president of the West Virginia Board of Optometry. “And to think that the profession of optometry does not advance along with technology in that amount of time is just unreasonable. The legislators understood that and recognized that the process was insufficient to allow us to provide the best care to our patients. So, they granted the Board the authority to pose any additional scope-of-practice expansions through the rule-making process, which goes a lot faster.”

Specific practices

In terms of defined practices, the bill would include the following additions to West Virginia Optometric Scope of Practice:

► Medicare-defined minor surgical procedures of foreign body removal (using topical anesthesia), lash epilation via forceps, punctum closure by plug and lacrimal dilation with or without irrigation.
► Diagnostic laser use (e.g. optical coherence tomography, etc.).
► Lab test ordering “rational to the examination, diagnosis and treatment of a disease or condition of the human eye and its appendages (e.g. eyelids, eye brows, conjunctiva and the lacrimal apparatus).”
► Epinephrine injection for emergency anaphylaxis cases.
► The prescription and dispensing of FDA-approved medication-containing contact lenses.
► The administration or prescription of any topical drug for the anterior segment of the eye during the examination, diagnosis or treatment of ocular diseases and conditions.

The bullet points on surgery and laser use — in particular — were greatly contested by ophthalmology, says optometrist B.J. Nibert, and West Virginia Optometric Association legislative chairman.

“The opposition focused on scare tactics and inflammatory language regarding the optometric profession to both the media and legislators. This included hyping the words ‘surgery’ and ‘laser,’ he says.

Board authority

With regard to scope-of-practice authority, the bill would place the formulary for oral prescription drugs solely in the Board of Optometry's hands. Further, it would enable the Board to go through the legislative rule-making process for injections for therapeutic use — excluding globe injections — and additional surgical procedures, provided what the Board proposes is taught at 50% of all accredited optometry schools.

“We feel like this is a real positive because it can serve as an impetus for educational institutions to push forward toward having their graduates educated with the latest skills to take care of patients,” says William L.Ratcliff, O.D. and president of the West Virginia Optometrie Association.

Dr. Moore stresses that credit for the passing of the bill goes to all West Virginia O.D.s, not just those on the front lines:

“This never would've passed had our optometrists not banded together to lobby their delegates and senators,” he says.

Dr. Ratcliff adds, “Hopefully, this will encourage other states that if they get the best lobbyists, as West Virginia had in Nelson and Chad Robinson, and their membership involved in the legislative process, then we will see many more states making similar changes.”

As we go to press, the bill awaits Governor Joe Manchin's signature.

ABO and ABCO Prepare To Accept Board Certification Applications

BIG DIFFERENCES IN CERTIFICATION AND MOC

■ As expected, the American Board of Optometry (ABO) — endorsed by the American Optometric Association (AOA) — has announced it's begun offering board certification (BC), making applications available beginning April 30, with the BC exam expected Spring of 2011. (For details, visit http://americanboardofoptometry.org.)

And in a move that surprised many optometrists, the American Optometric Society (AOS) — formed in protest to the AOA agreement to pursue BC — has now announced it too will endorse a form of BC, namely the American Board of Clinical Optometry (ABCO). ABCO made its debut last month by announcing via its website (www.boardofclinicaloptometry.org) that it would accept applications for BC in general optometric practice.

Change of heart

The AOA's arguments for BC have been well documented (see www.aoa.org/x12522.xml). Although AOS members still believe BC isn't necessary, they also believe it will likely become a requirement for full participation in third-party plans as the result of the AOA's actions, according to the AOS website (www.optometricsociety.org/archive.html). The AOS says a poll of its members revealed support for a form of BC that accepted licensure as evidence of initial competency as well as a Maintenance of Competency (MOC) process (see “Board Certification/Maintenance of Competency Member Survey,” at www.optometricsociety.org/archive.html).

“The AOS board sought the opinion of the membership, then voted to implement a policy that was consistent with that opinion. While the poll was not binding on the Board, if the AOS Board fails to respect the opinion of the membership, the AOS membership has the ability to hold that board accountable and to vote one or more directors out of office,” says AOS President Pam Miller, O.D., J.D. “In this case, the AOS membership, by a large majority, told the AOS board that they should support a board certification process consistent with the structure of the ABCO.”

ABCO President and Executive Director Art Epstein, O.D., who's also an AOS officer, says the genesis of the organization was frustration with the ABO's certification process, which was developed by the AOA, the American Academy of Optometry, American Optometric Student Association, Association of Schools and Colleges of Optometry, Association of Regulatory Boards of Optometry and the National Board of Examiners in Optometry.

Differences in certification

ABCO certification requires graduation from an accredited optometric program, the passing of National Board of Examiners in Optometry examinations, or their equivalent, and licensure by at least one State, Provincial or Territorial licensing body for general optometric certification, according to the organization's website. (ABCO BC is available in the United States and Canada.) The ABCO MOC process consists of meeting specified continuing education standards combined with online learning and self-assessment programs that run in five-year cycles, says an ABCO press release.

In comparison, the ABO certification program goes beyond licensing and continuing education, “most notably, the requirement to pass a valid, computer-based examination designed to assess the ongoing competence of the practitioner who has gained the experience of many patient care encounters after receiving a license to practice,” says the ABO website.

Under ABO BC, MOC requires:

1. Possession of a valid therapeutic license
2. Continuing education and self-assessment modules (SAMs)
3. Passing of a validated computer-based patient assessment and management examination
4. Performance in practice modules.

According to the ABO site, its four-part continuous learning process follows American Board of Medical Specialties (ABMS) standards.

Questioning credibility

While AOA President Randy Brooks, O.D., couldn't be reached for comment at press time, both the AOA and the ABO issued statements that appear to question the credibility of the ABCO BC process.

“This new organization was formed over the course of eight months behind closed doors, and its certification process was developed without the input of most of the organizations that guide and uphold the standards of the profession,” reads the AOA statement. In addition, the statement reads that the ABCO BC program was developed “without undergoing the scrutiny of leading optometric organizations or healthcare policy leaders.”

The ABO, meanwhile, released a statement titled “Credibility — the key to Successful Board Certification,” in which it states that its BC program “has the rigor — including a validated formalized examination — to withstand any question of credibility.” The statement also says that, “Any less demanding program lacks credibility and could function to weaken the profession in the eyes of the public and other healthcare practitioners.”

Dr. Epstein's says the ABO BC program would make optometry the only healthcare profession in which “competence beyond entry level” general practice would be required for board certification. Also, he defends the ABCO BC program.

“We [ABCO Board of Directors] did a tremendous amount of research before doing any of this, and our Board of Directors represent a cross-section of optometric professionals who have contributed greatly to the profession,” he says. “They include optometric educators, Academy of Optometry members, and most are members of the AOA. The bottom line is that this was not done in a vacuum. We are committed to following the guidelines of the ABMS as well as the National Commission for Certifying Agencies.”