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COPE Tightens Standards for Commercial Support of CE

SEPARATING PROMOTIONAL MESSAGES AND EDUCATION

By Melissa Short, contributing editor

New Council on Optometric Practitioner Education (COPE) standards for commercial support of continuing education courses and events have evoked both praise and skepticism from the optometric community. Although the standards previously permitted commercial sponsorship of speakers and lectures, the modifications will limit such involvement in future COPE-accredited courses.

The objective is not to eliminate commercial support, said an announcement from the Association of Regulatory Boards of Optometry (ARBO), but rather limit potential commercial conflicts of interest. Specifically, COPE aims to maintain bias-free educational materials.

Instructors' “influence over clinical decision-making and patient care is immense and should not be subject to market pressure,” says Sheldon H. Kreda, O.D., Lauderhill, Fla, who applauds the new standards.

Commercial entities will no longer be permitted to submit courses for COPE accreditation, although they can offer an educational grants. Additionally, CE faculty will be required to present balanced coverage of treatment options and to disclose off-label or experimental information.

The measures are meant to present a transparent and fair delivery of CE materials, says ARBO. Accordingly, CE instructors must ensure that educational materials are free of promotional messages or advertisements. “There is nothing more disappointing than attending a lecture that advertises rather than educates,” says Dianne Anderson, O.D., Naperville, Ill.

Potential impact

Some O.D.s question the limits imposed by the new standards. “The supply side of optometry is the only place to get financial support,” says Richard S. Kattouf, O.D., D.O.S., Warren, Ohio. “As long as disclosures are given prior to the lecture, I see no problem in industry sponsorship.”

Pamela Miller, O.D., F.A.A.O., J.D., D.P.N.A.P., of Highland, Calif., agrees, noting the requirement for “balanced coverage” would preclude valuable education on specific product lines. “Every audience has the right to attend a CE [course] on any product or product line, and everyone in the audience knows when a speaker is hired as a spokesperson for any industry product. It's not a big secret,” she says.

Dr. Miller believes the new standards would create a layer of subterfuge in the CE approval process and may discourage industry support. “Every school, every organization, every entity depends on the industry to support the speakers,” she adds.

While acknowledging the “possibility” that commercial support of CE activities may decrease with the implementation of the new rules, a COPE “FAQ” document states, “the experience of other professions indicates this is unlikely to occur.”

New rules on financial support

Under the new rules, COPE will separate financial support from the control of key organizational decisions related to CE events. For example, commercial entities will no longer be permitted to select speakers and topics, develop presentation materials or distribute promotional materials.

According to COPE's guidelines, “commercial support of a COPE-approved CE event can only occur through an unrestricted grant to a COPE-approved Administrator/ Provider,” who will have complete control over every aspect of the CE event, including topics, speaker selection, scientific content, marketing and promotion.

The bottom line: There must be a clear separation between promotional and educational activities. Although previous COPE-approved courses may have adequately disclosed the nature of their commercial sponsorship, the new standards seek to eliminate any ambiguities.

According to ARBO, commercial conflict of interest is not the only issue at stake: “Continued improvement and protection of the integrity of this system is important for our profession and the public welfare to ensure continued competence.”

Implementation timeline

According to COPE, the new standards should be fully implemented by the start of next year. From January through June 2010, COPE will initiate a training period, which will be followed by a six-month implementation period. During 2010, oversight and enforcement will consist of notifications of noncompliance and assistance with compliance issues. By Jan. 1, 2011, full compliance with the COPE-accredited CE standards will be required.

For more information and updates on COPE's standards for continuing education, visit www.arbo.org.

Will The Temporary Freeze in Medicare Payments Buy Time to Fix Problems?

LAST-MINUTE REPRIEVE

By Lou Mancinelli, contributing editor

■ Physicians were spared an imminent 21.2% reduction in 2010 Medicare fees when Congress tacked a 60-day extension of the current payment schedule onto a bipartisan defense appropriations bill, signed by the President last month. Lawmakers believe the additional time will allow them to work out a new formula for determining Medicare physician fees to replace the Sustainable Growth Rate (SGR) formula, which indexes reimbursements to gross domestic product.

The SGR was devised as a cost-containment measure. If growth in payments per beneficiary outpaces the economy, the SGR dictates an across-the-board reduction in payments to doctors. The American Optometric Association (AOA) and other physician groups maintain this formula is flawed — every year or so Congress has had to step in to block Medicare pay cuts — and have been working to find an equitable and lasting replacement for it.

According to the AOA, doctors still face uncertainty with regard to Medicare reimbursement because it appears Congressional leaders have decided to consider long-term Medicare physician payment reform separately from healthcare reform. Without permanent and lasting reform of the Medicare payment formula, O.D.s and other physicians face an overall cut of 40% by 2016.

“Optometry now faces enormous challenges in our efforts to ensure fair treatment and compensation for O.D.s serving America's seniors throughout the nation,” said Randolph E. Brooks, O.D., AOA President, in a Dec. 7 statement.

O.D.s must decide what, if anything, they should do to prepare for possible cuts in Medicare reimbursement, which appear to be inevitable.

According to coding expert Riva Lee Asbell, accurate coding and billing will be even more critical for appropriate reimbursement. “Optometrists need to make sure their chart documentation is perfect and learn which codes to use for various clinical scenarios,” Ms. Asbell says. “With the audit environment heating up, they need to remain in compliance and not be paying back money.”

The spectre of reduced revenue may mean course corrections are in order at some practices.

“Clinicians will have to be more effective, more focused and more attuned to managing costs and running a more efficient practice,” says J. James Thimons, O.D., medical director and a founding partner of Ophthalmic Consultants of Connecticut. “If there is a 10% cut [in Medicare reimbursements], then instead of seeing 10 patients a day, they may have to see 11. Maybe they have to add hours or change purchasing patterns.”

Seeing more patients, increasing hours and cutting back on inventory may net some short-term benefits, but Dr. Thimons believes the best way for optometrists to combat reduced reimbursement long-term is to adjust their business model more toward medical eye care. For example, practitioners who offer glaucoma therapy and pre- and post-op cataract care — in addition to the traditional spectacles and contact lenses — will find that patients appreciate this comprehensive “one-stop” care, and practice revenues will increase, says Dr. Thimons.

Congress Supports InfantSEE Program

NEWS FROM THE AOA

■ The Fiscal Year 2010 Consolidated Appropriations Act of 2009, which was approved by the U.S. House and Senate and signed by President Barack Obama, includes a measure that provides $590,000 in federal resources to help expand the scope and impact of InfantSEE, the public health program of the American Optometrie Association (AOA).

Sen. Robert C. Byrd (D-W.Va.) sponsored the first direct appropriation, totaling $500,000, which will support expansion and outreach of the program. The second direct appropriation totaling $90,000 was sponsored by Sen. Tom Harkin (D-IA) and will support program expansion through outreach in Iowa.

Support for naming rehab center in honor of Dr. Soltes

In other news, the AOA announced its support to name the future Blind Rehabilitation Center at the U.S. Department of Veterans Affairs (VA) Long Beach Medical Center in honor of the Major Charles Robert Soltes, Jr., O.D., the first Army optometrist killed in action while on active duty.

Dr. Soltes served as a public health officer with the 426th Civil Affairs Battalion, U.S. Army Reserve, in Iraq. He died in 2004, when a vehicle-borne Improvised Explosive Device hit his humvee as his convoy returned from a meeting with local Iraqi health officials.

Reps. John Campbell (R-CA), Dana Rohrabacher (R-CA) and Bob Filner (D-CA), chairman of the House Committee on Veterans' Affairs, originally introduced the bipartisan legislation (H.R. 4360).