News ReviewSelf-Referral Ban Threatens New Jersey O.D.s More Diabetes Than Ever are Getting Comprehensive Eye Exams National Panel: Optometrists Prefer Bush Over Gore O.D.s and Ophthalmologists Unite on California TPA Bill Allergan Sues to Nix Santen’s Quixin New Optometry Hall of Famers |
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Optometrists in New Jersey fear they may
be prohibited from dispensing eyewear and other goods to their own patients.
Proposed legislation—already unanimously approved in committee—could
be interpreted to do just that. Sounds absurd? It’s no joke. Behind it is
the unified support of ophthalmologists, opticians and corporate optical.
It all started when the New Jersey State Board of Optometry changed its regulations to mandate that independent optometrists have leasing arrangements that reasonably reflect the value of the real estate market. The board did this to prevent an owner from charging an optometrist rent based on anything else, such as the number of prescriptions the optometrist generates. In response, the Opticians Association of New Jersey spurred legislation to counteract the Board’s regulation. Then corporate optical and the New Jersey Academy of Ophthalmology (NJAO) were able to contribute language to amend the bill further. The amended language mirrors that of M.D.s’ self-referral ban in their medical practice act. “If optometrists want to be physicians and want to do surgeries and [get] hospital privileges and everything, then they have to play by the same rules as the real doctors,” says Samuel Morgenstern, president of the Opticians Association of New Jersey. “That’s what these amendments are about.” Yet “what they didn’t offer in amendment is that there is also an exemption for the services provided by the physicians in their own practice,” says Christopher J. Quinn, O.D., legislative chair and president-elect of the New Jersey Society of Optometric Physicians (NJSOP). “It would be like saying to an ophthalmologist, ‘You can diagnose a cataract, but you can’t do it because there’s an incentive to profit from providing the service.’ So this is obviously an attempt by organized ophthalmology to essentially gut the traditional practice of optometry.” The medical practice act does prohibit self-referral, but also has an amendment that says the self-referral ban does not apply if the practitioner provides the service in-office and directly bills the patient for it. “If there’s no problem with in-office referral, then why would the medical society have gone to such great lengths to secure an exemption for in-office practice?” says David Grimm, executive director of NJSOP. Reni Erdos, executive director of the NJAO says, “Really, what it’s saying is, no, you really can’t steer people to your own optical dispensary. You’ve got to give them a prescription.” “How is that different now than what they would like this law to accomplish?” Dr. Quinn asks. “[As an optometrist] you’re required to give a patient a prescription. I think her comment confirms our fear: They don’t want you to sell glasses to people for whom you write prescriptions.” In the end, this unprecedented bill could never pass, right? “Not true,” says Dr. Quinn. “We’re extremely concerned that this in fact could pass, dramatically changing the face of optometry in the state of New Jersey. And obviously if they had success in New Jersey, they’d take this to other states.” The bill is not yet scheduled for vote in the state General Assembly, but the NJSOP promises to fight it assiduously. Rk, Ab More Diabetic Eye Exams, And More Diabetics, too More diabetics than ever are getting comprehensive eye exams, and more Americans than ever are getting diabetes—about 33% more over the past decade. In its report, “State of Managed Care Quality,” the National Committee for Quality Assurance says that about 45% of diagnosed diabetics in the United States got comprehensive eye exams in 1999 vs. about 38% in 1996. NCQA, however, says that rise is probably reflected in how it measured its sample. (It’s available at www.ncqa.org.) Researchers from the Centers for Disease Control also identified many disturbing trends in diabetes. The most significant: The prevalence of the disease rose from 4.9% in 1990 to 6.5% in 1998.1 Younger and more educated adults are the fastest growing subgroups. The report says that rates soared 76% in the 30-39 age group and 64% among those with “some college.” Two contributing factors are rising rates of obesity in the general population, and growing public awareness about the disease. Still, the authors say their methods may have underestimated the true rates of diabetes. One’s risk of diabetes rises 9% for every kilogram gained in self-reported weight, the study says.
National Panel: Optometrists Prefer Bush Over Gore If only you and your colleagues voted, Texas Gov. George W. Bush would be a shoo-in to live in the White House come January. Of course, real life isn’t that way but our quadrennial National Panel, Doctors of Optometry, presidential survey bears out what O.D.s will be thinking when they go to vote next month. You’ll be thinking things such as character, tax cuts, health care reform and prescription drug coverage. That’s what the 210 doctors (21% of our sample) who responded to our latest survey say, anyway. O.D.s prefer Gov. Bush over Vice President Gore, 61%-36%. (Only about 2% chose Ralph Nader; none voted for Pat Buchanan.) Responses show that 28% of you rate character and ethics as the most important issue in the 2000 campaign, while 21% say it’s tax cuts and 17% say health care reform is paramount. In fact, 78% of optometrists favor a prescription drug benefit for Medicare patients. Many of you have different ideas about what such a plan should include and accomplish, but it’s not as simple as being for or against a plan. Says optometrist Blake Peterson of Cleveland, Tenn: “Medicare patients do need help with their prescription needs, but it needs to come in the form of lower prices from the drug companies.” Nationally, voters are not as concerned with health care reform as optometrists. In a recent ABC News/Washington Post poll, voters rated education, Social Security and the economy as the most important issues. The poll also revealed that Gov. Bush and Vice President Gore are running neck-and-neck, each with about 47% from likely voters. Theoretically, the voters who are still undecided will break the tie. Does it really matter to O.D.s which candidate is elected? “Probably not,” says John T. Archer, O.D., of Bowling Green, Ohio. More than two-thirds of the registered voters surveyed by ABC/Washington Post said that either candidate would make a good president. Optometrists share that ambivalence. Charleston, S.C., optometrist Michael Schall says that he might not vote “because none of the candidates share my views.” Says James Bradley, O.D., of Oceanside, Calif.: “I would like to see a box on the ballot that said ‘None of the above.’ If None of the above won, a new election would be run. The candidates on the ballot who lost to None of the above could not run again.” By the way, 35% of optometrists rate the departing Clinton administration a good one, but many say this disregards the President’s personal behavior and applies only to policy issues. O.D.s are, in general, dissatisfied with President Clinton’s ethics. “Economic advances ... can’t offset the moral decline his administration has led and endorsed,” Dr. Peterson says. Rk,JM O.D.s and Ophthalmologists Unite on California TPA BillCalifornia O.D.s are crying “Eureka!” On September 26, Governor Gray Davis signed a TPA bill (SB 929) that drastically expands California optometrists’ scope of practice. The California Optometric Association took a novel approach to getting the bill passed. After introducing the bill about two years ago, it immediately went into negotiations with the California Academy of Ophthalmology. In that time, the two associations discussed every drug application down to the last detail, the COA says. Despite their settlement, the California Medical Association—which had deferred to the California Academy of Ophthalmology to handle the negotiations—came out in opposition to the agreed-upon bill. But the CMA was able to make little impact. The bill takes effect January 1, 2001. Among the bill’s main points, the two associations found common ground in their use of medical assistants. Both optometrists and ophthalmologists in California use optical and medical assistants to do testing and other duties—a practice not legally allowed. But this legislation finally spells out the procedures that assistants can perform under a doctor’s supervision. Furthermore, the bill also makes California the 45th glaucoma state. Specifically, it adds permission for TPA-certified doctors to treat:
Allergan Sues to Nix Santen’s Quixin It’s the battle of Ocuflox vs. Quixin. Allergan has filed a lawsuit of patent infringement against Santen, the original maker of Allergan’s drug. Allergan licenses ofloxacin (marketed as Ocuflox) from Santen’s parent company in Japan. But when Santen’s U.S. subsidiary, Santen Inc., introduced levofloxacin (to be marketed as Quixin), Allergan filed suit. “ Allergan firmly believes that the license covers the ophthalmic use of levofloxacin and that the sale by Santen U.S. of levofloxacin infringes the patents Allergan has licensed,” Allergan says. “We disagree and we’re going to defend that litigation completely, totally,” says Santen CEO Jerry Hansen. In response to Allergan’s charges of patent infringement, Mr. Hansen says, “There is a separate patent, period.” The lawsuit has not changed Santen’s plans to put Quixin on the market in November, Mr. Hansen says. Rk, Ab
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| © Review of Optometry OnLine October 15, 2000 |
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