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Optometric Practice I > Optometry in the Healthcare System > Flashcards

Optometry in the Healthcare System Flashcards

1
Q

How did ACA positively impact optometry?

A

increase in pt #, more seniors and children gained access, young adults have coverage longer, more pt may qualify for Medicaid

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2
Q

T/F the ACA enhanced integration into the medical community

A

true

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3
Q

What is the goal of coordinated care?

A

to ensure that patients, especially the chronically ill, get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors

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4
Q

What are the criteria for accountable care organizations?

A

minimum 5000 beneficiaries, advancing evidence-based practices, promoting preventative services, reduce waste, avoid redundancies

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5
Q

Explain patient choice in accountable care organization vs managed care organization

A

in ACO pt free to choose provider; in MCO/HMO pt must select from panel of providers (referral)

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6
Q

Example of ACO

A

Medicare shared savings plan, advanced payment ACO, Pioneer ACO, ACO: Accelerated Development Learning Session

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7
Q

Example of MCO/HMO

A

medicare advantage plan

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8
Q

What is the medicare advantage plan?

A

beneficiary lets insurance company manage it, no co-pay but now in HMO and give up some individual rights

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9
Q

What are the cost savings in ACO?

A

improved coordinated care management and population health

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10
Q

What is the cost saving in MCO?

A

restrictions on utilization

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11
Q

Who are the savings shared between in ACO?

A

practitioners and facilities

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12
Q

Who are the savings shared between in MCO?

A

payers (insurance companies/HMOs)

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13
Q

What do optometrists need to do to prepare for ACO participation?

A

use eRx, join AOA clinical data registry, exchange health info with other practitioners, follow AOA evidence-based clinical guidelines, use other AOA excel tools to grow and enhance your practice

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14
Q

Steps to advocate for inclusion in ACOs

A

promote highly specialized education and training, explain role w/ chronic disease, early detection of systemic diseases, gateway to health systems, reducing readmissions, reducing falls in the elderly, diversion of emergency services

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15
Q

What % of total healthcare spending is attributed to eyecare?

A

1-2%

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16
Q

How much did the US spend on health in 2017?

A

$3.5 trillion

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17
Q

What percent of healthcare spending comes from insurance?

A

75%

18
Q

What is in the health insurance category?

A

Medicare, Medicaid (state and federal), private health insurance, and VA

19
Q

Where did the money go?

A

33% hospital, 20% clinic, 10% prescriptions, 5% dental, etc 3% other professional services

20
Q

What are some professions in other professional services?

A

nurses, chiropractors, podiatrist, optometrists, PT, OT, speech therapists

21
Q

What do health plans cover in optometry?

A

medical conditions- evaluation and treatment of (ACA includes routine vision for kids)

22
Q

What do vision plans cover in optometry?

A

routine eye exams and optical materials, often self purchased benefit

23
Q

You should ALWAYS bill for the ___ not the ____

A

visit, patient

24
Q

How many vision plans do most practices accept?

A

5-7

25
Q

How many insurance plans do most practices accept?

A

15-30

26
Q

What insurance does the eye center accept?

A

> 100 vision plans and >500 medical plans

27
Q

What topics does the AOA’s State of Optometry discuss?

A

output, supply, demand, government, payers, and technology

28
Q

What percent of comprehensive exams are done by optometrists?

A

85%

29
Q

How many million comprehensive eye exams are done by ODs and MDs?

A

88 million and 16 million respectively

30
Q

How many optometrists are in practice?

A

40,000

31
Q

How many ophthalmologists are in practice?

A

18,000

32
Q

What is the ration of comprehensive eye exams vs medical eye care for ODs?

A

79.3% and 17.6%

33
Q

What % of Medicare reimbursement for comprehensive eye exams do optometrists receive?

A

45%

34
Q

What is the primary eye care revenue?

A

$31.4 billion

35
Q

What is the US vision correction population?

A

201.9 million

36
Q

What is the per capita primary eye care spending?

A

$100

37
Q

What is the ODs source of revenue consist of?

A

Direct patient payment 33%, vision insurance 31%, medical insurance 17%, government 17%

38
Q

Did the percent of patients receiving 3rd party discounted services increase or decrease in the past 20 years?

A

increase

39
Q

How did the ACA transform the insurance industry and eye care?

A

more patients seeking care and greater pressure to contain costs

40
Q

T/F Market dynamics do not favor a continued expansion of optometric scope

A

false

41
Q

What is a significant growth opportunity for ODs?

A

expansion of medical eye care services

Optometric Practice I (11 decks)

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