Optometry in US Health Care System Flashcards
Overview of Patient Protection and ACA
- Significant increases in patient numbers
- More seniors will gain access to care
- More children will gain access to care
- Some young adults will have coverage longer
- More patients may qualify for Medicaid
What 3 things changed in optometry when ACA was passed? Why is this important?
1) Establishment of Children’s Vision Benefit as one of the 11 Essential Benefits of ACA-compliant health insurance plans.
2) Harkin Amendment: first federal provider non-discrimination standards
3) Optometry as a Primary Care Profession
Important because it gave optometry an enhanced integration into the medical community.
What is accountable care of organizations (ACOs)
“Groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated, high-quality care to their Medicare patients”
What is the goal of coordinated care?
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
What do Accountable Care Organizations do?
- A minimum of 5000 beneficiaries
- Requirements for advancing evidence-based practices
- Promote preventative services
- Reduce waste
- Avoid redundancies
In a Managed Care Organization, where does the patient go to receive care?
Wherever the HMO tells them to go.
For Managed Care organizations, how do they save money?
Restriction on utilization
For Managed Care organizations, the savings are shared between who?
Payers
In an Accountable Care Organization, how do they get cost savings?
Improved coordinated care management and population health
In an Accountable Care Organization, who are the savings shared between?
Practitioners and facilities
Does health insurance include vision?
No.
What is the best approach to billing?
Always bill for the visit, not the patient. Always gather BOTH the vision and the major medical insurance info at the front end.
How many vision plans can you usually choose from?
5 to 7
What was the AOA’s State of the Optometric Profession in 2013?
Jobson Medical Information was commissioned to review the “current state of optometry in the delivery of eye care to the American public”
Analysis divided into 6 sections: output, supply, demand, government, payers, and technology
An aging US population will increase demand for Tx eye care at a faster rate than refractive eye care
An increasing number of patients served, coupled with reimbursement limits will require what?
maximum efficiency of service delivery by ODs
