HomeMy WebLinkAboutMINUTES - 06081993 - 1.135 CA ASSN OPHTH 415-777-1082 P.01
MAI 2 6 1993
CALIFORNIAALASSOCIATION OF OP1T===- ORS
1
605 Market Street,Suite 1109 P San Francisco,CA 94105.3213 •415-777.3937
Attention Board Clerk/Secretary: Please copy and distribute to all board Members,
Fax Direction Sheet
To: U Grp v e Yu LC.0 Y%
Fax number:
Froth: Barry Roeder
Number of pages faxed (including cover sheet).- 5-
Date: 5 --/_26 CAO Fax number: (415) 777 - 1082
Action requested:
As requested: PLEASE VOICE YOUR OPPOSITION TO THIS BILL! !
For your information:
Please approve and call me a.s.a.p.:
Please review and call me a.s.a.p.:
Comments, other action to be taken:
WE ARE GREATLY CONCERNED ABOUT AB 2020, A BILL TO EXPAND THE SCOPE OF
PRACTICE FOR OPTOMETRY IN THE STATE OF CALIFORNIA.
THIS BILL IS A SERIOUS THREAT TO THE QUALITY OFEYECARE IN CALIFORNIA AND,
BY EXTENSION, TO THE PUBLIC HEALTH OF ALL CALLIMLNIANLS.
PLEASE VOICE YOUR OPPOSITION TO THIS BILL BY COMING OUT AGAINST IT AND BY
INFORMING YOUR ASSEMBLYPERSON AND YOUR SENATOR OF YOUR OPPOSITION.
CALL ME AT THE NUMBER ABOVE IF YOU WOULD LIKE MORE INFORMAIjON.
THANK YOU! ! !
CA ASSN OPHTH 415-777-1082 05-25-13 P.12
261993
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
CALIFORNIA ASSOCIATION OF OPHTHALMOLOGY
605 Market Street,Suite 1109■San Francisco,CA 94105.3213 ■415-777.3937
EXECUTIVE COUNCIL
• Fhl L.I-oq.MD
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• IIAAeI•E.Pryor MD
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• DA+Ia H.AWVN.MD
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• J.FrABnIe6 111"911 MD May 25, 1993
Ghmel• Ponta N.9shwan,,MD
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We Pn,O'�M of E11
GLe; -d A' ,,„°• Dear Member of the Board of Supervisors:
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A.6:"We'"w'e"ft D,E-arli.,-1 On behalf of the California Association of
Mona.L Fiehnu,I.MO
Hoo n I'd A d L.yryMnr.1 M-1 Ophthalmology, g y pp 7�p
Rto•rAraA Nwr6r.MU We urge YOU to oppose A$ 2020, which
Af!'JI6nr IWI.h..nn!nr5,.1.IA°glrwyAPIA would permit optometrists to diagnose and treat eye
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A.IMMnt vAy P•ylaenl or 8nro LApI,M6w All..,,.
N+roaD Mprlan6,Mp disease in California.
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hvplow ft �°° M° As limited license providers, optometrists play a
vloe*i t pea o PrA+Ro.:ow
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CA ASSN OPHTH 415-777-1082 05-25-93 17:25 P.03
CALIFORNIA ASSOCIATION OF OPHTHALMOLOGY
605 Mcrket Street,Suite 1109 ■ San Francisco,CA 94105-3213 ■ 415-777-3937
The claim that optometric therapeutic care would save the public
money is also erroneous. AB 2020's impact on state finances,
particularly Medi-Cal., could be enormous. The rule in medical
economics is that when providers are added, unit costs per service
do not degrease while total expenditures go uup ,substantia lly. As
Ohio Blue Cross/Blue Shield attested in 1991, "In our experience,
contrary to the usual free-market impact. . . increasing the supply of
availability of health care services does not reduce the overall of
total cost of that service. Typically, the impact of increasing
the number of providers on unit prices is negligible, while the
overall number of services performed increases substantially. "
Preliminary data from Iowa, Kentucky, Missouri, and Washington
support this. They indicate that Medicaid expenditures for
optometric services increase after passage of an optometric
practice expansion bill, and continue to escalate at a higher rate
than the number of Medicaid recipients who seek optometric care.
No corresponding decrease in Medicaid onlay for ophthalmology
services has been seen.
There are no savings in providing substandard care to Medi-Cal
patients, since Medi-cal would reimburse optometrists and
ophthalmologists at exactly the same rate for "therapeutic"
services. (Medi-Cal is already well-served by ophthalmologists;
88% gee Medi-Cal patients, as compared to only 61% of
optometrists. )
According to the State Board of Optometry, should AB 2020 pass
effective January 1, 1994, an estimated 6,000 optometrists are
expected to be certified in therapeutic practice within a year.
This is in addition to the 2,000 ophthalmologists now practicing in
the state. In effect, AB 2020 would guadrunle the number of
medical eye care providers, and Medi-cal expenditures can be
expect2d to rise as W211.
There are also hidden costs of substandard medical treatment. In
1992, the American Academy of Ophthalmology reviewed 627 cases of
problems resulting from optometric care, mostly in states
permitting optometrists to treat disease. It is significant that
failure to diagnose was found in 65% of the cases and misdiagnosis
in 43% of the cases. In 83% of the cases there was a failure to
refer the patient for proper medical care. Fully 25% of the
patients suffered irreversible loss of sigma. And when patients
were finally treated by an ophthalmologist, their conditions were
more severe and required longer, more expensive, and more intensive
treatments--another #actor that will increase the cost of AB 2020.
CA ASSN OPHTH 415-777-1082 Ob-25-93 17:Zb P.04
CALIFORNIA ASSOCIATION OF OPHTHALMOLOGY
605 Market Street,Suite 1109■ San Francisco.CA 94105-3213 ■ 415-777-3937
put the public at risk of misdiagnosis and substandard treatment,
threatening the most precious gift of sight for thousands of
people.
AS 2020, which is sponsored by the California Optometric
Association, is the most expansive legislation of its kind in the
nation. 811 but one other state dealing with this type of
legislation haye substantially limited its scope in consideration
of the danger to public health. Among other broad provisions, Ab
2020's list of drugs includes antibiotics, steroids, antivirals,
antifungals, and glaucoma medications--all powerful prescription
drugs with potentially serious and even fatal side effects. And in
additional education, AB 2020 requires that optometrists attend
only 60 hours of lectures and 40 hours of clinical training in
order to practice medicine in our state.
Contrary to ontom ry's assertions. there is no evidence that
optometric therapeutic practice is safe. Successful optometric
practice at Veterans Administration and military facilities is
often cited in support of AB 2020. Although VA and military health
administration varies from site to site, in general their
optometrists are permitted to diagnose and treat only under the
supervision of a physician. The central policy of the Veterans
Administration, which has not been superseded since 1981, is that
"any treatment of patients with ocular disease is [to be] provided
by or supervised by an ophthalmologist" (DMS Circular 10-81-83 :
"Treatment and Care of Eye Patients") . The VA policy specifically
excludes surgery and the independent prescribing of drugs from
optometric practice.
One of the few studies available on optometric therapeutic
practice, "Patient Outcomes with Co-managed Postoperative Care
After Cataract Surgery" by the Battelle Medical Technology
Assessment and Policy Research Center (Journal of Clinical
Epidemiology, January 1993) indicates that Optometrists missed un
to 40% of complications in patients after cataract surgery, and
when they recovered, the optometrists' patients had lower visual
acuity and poorer outcomes compared to the ophthalmologists'
patients.
The Battelle study also found that overutilization of services is
likely in optometric medical care. Patients managed by
optometrists returned for 33% more visits for postoperative care
that the patients managed by ophthalmologists. in other words,
optometric medical care could be 33% more expensive than
ophthalmologic care. (Incidentally, this study was funded by the
American Optometric Association. )
CA ASSN OPHTH 415-777-1NHG V5-G5-93 .17;Zb P.05
CALIFORNIA ASSOCIATION OF OPHTHALMOLOGY
605 Market Street.Suite 1109 a San Francisca.CA 94105-3213 ■ 415-777-3937
optometrists have a place in our health system as allied health
professionals, not medical practitioners. The ophthalmologists and
other physicians of California urge you to oppose AB 2020. Its
cost in dollars and the health of our citizens is more that we Can
afford.
Sincerely,
Ma tin L> Fishman MD
hili L. , D t
P p vY
President VP, Legislative Affairs