‘The State of the Optometric Profession: 2013’ Identifies Trends, Issues

SAN DIEGO—Dramatic changes impacting the practice of optometry and eyecare professional’s fast-paced reactions necessary to navigate them were analyzed during the presentation of a special report on “The State of the Optometric Profession: 2013,” presented on June 26 here by AOA Excel and Jobson Medical Information LLC. Sponsored by Essilor and VisionWeb, approximately 200 industry leaders and representatives of the national American Optometric Association (AOA) and its state affiliates attended the event at the Marriott Marquis & Marina hotel here at the start of the AOA’s annual Optometry’s Meeting.

Introduced by Marc Ferrara, CEO of the Information Services Division of Jobson Medical Information, and Barry Barresi, OD, PhD, AOA Excel CEO and AOA executive director, the presentation featured speakers Mark Wright, OD, FCOVD; Stephen Montaquila, OD, FAAO; Paul E. McRae, senior corporate vice president of health care emerging technologies for AT&T Business Solutions, and Joe E. Ellis, OD, chairman of the board of AOAExcel.

Identifying both the challenges and opportunities that lie ahead for the optometric profession, the presentation drew upon a wealth of data in a Jobson report commissioned by the AOA to review the current status of optometry in the delivery of eyecare to the American public and the strategies optometrists must embrace to seize the opportunities in the emerging vision care environment. Encompassing optometrists working in all practice settings, including independent practices, corporate-affliated offices, and other medical offices and institutions, the report considers current trends among ECPs and assesses future conditions that will shape optometry’s role in vision care.

The analysis was divided into six sections—Output: optometry’s current annual production of products and services that quantify optometrists’ market position; Supply: the supply of eyecare providers that currently exists and will evolve over the next decade; Demand: a forecast of patient demand for eyecare over the next decade for each major revenue category; Government: anticipated changes in government regulation that will affect optometrists’ scope of practice; Payers: changes anticipated in reimbursments to optometrists by third-party payers as a result of federal health care legislation; and Technology: how new diagnostic and information technology is reshaping daily operations in optometric practices. After extensive statistical analysis of the current and future status of optometry, actionable strategies were presented at the end of each section.

Much of the extensive research and statistics found in the report, which will be available for download on the Review of Optometric Business website shown, were presented to the select audience of key opinion leaders. Highlights included:
Output: Optometry dominates American primary eyecare. ODs perform an estimated 88 million refractive eye exams annually, representing 85 percent of the total 104 million performed, and they prescribe at least 90 percent of vision correction devices. These remain the principal sources of OD revenue, typically accounting for 80 percent or more of collected billings among independent practice ODs.

If ODs were to reduce the average interval between eye exams from 25 months to 18 months, ODs would perform an additional 34 million eye exams annually, a 39 percent increase. Medical eyecare services have become a larger source of OD revenue, but most ODs have not fully developed this revenue source. While independent practice ODs represent 32 percent of total eyeglasses sold annually and commercial providers have a 54 percent market share, independent practice ODs’ share has slowly increased. Also, ODs’ dominance of contact lens dispensing is greater than that for eyewear, accounting for nearly 90 percent of contact lens prescriptions written annually.

Supply: The number of practicing ODs will grow faster than vision care demand but more slowly than demand for medical eyecare. During 2012, there were 58,000 eyecare professionals licensed to perform comprehensive eye exams and in practice in the U.S., including approximately 40,000 ODs and 18,000 ophthalmologists. That’s one licensed ECP for every 3,500 people using vision correction. Available information suggests that the number of practicing optometrists will grow approximately 2 percent annually through 2020 and reach 46,300 that year, while the number of practicing ophthalmologists is expected to be stable.

Demand: Optometry’s largest opportunity is to increase eyecare demand among existing patients, expanding care to elderly and other populations at risk to treatable eye diseases. It is estimated that nearly 65 percent of the total U.S. population, or 200 million Americans, wear some type of vision correction device. In 2012 the primary eyecare market was estimated to total $31.4 billion, representing per capita spending of $100 annually. Through 2020 it is projected that sales of vision correction devices will increase 1.6 percent annually, including 0.7 percent annual growth in eyewear sales and 5.0 percent growth in contact lens sales. Demand for therapeutic eyecare services will increase more rapidly.

Government: Optometry’s scope of practice continues to broaden. The AOA is optimistic that state governments will continue to approve expansion of OD scope of practice in the future as the supply of ophthalmologists fails to expand at the pace of demand for medical eyecare services, as the number of primary care physicians declines and as the pressure mounts to contain growth in health care costs.

Payers: Third-party reimbursement accounts for a growing share of OD revenue. The Affordable Care Act is likely to precipitate further shifts in reimbursement for services received by ODs. As the Baby Boom generation ages, Medicare beneficiaries will expand rapidly. An important emerging development in health care is the formation of Accountable Care Organizations (ACOs)—large groups of medical professionals, combining generalists and specialists, which provide a full range of health care services to defined populations. The AOA is acting to incorporate ODs into ACOs to assure continued access to this growing patient base.

Technology: New digital technologies will expand diagnostic capabilities and improve patient management and communications. As of 2012, 49 percent of ODs reported using an electronic health record system in their primary practice, up from 41 percent in 2011. An additional 18 percent of ODs indicated they plan to add EHR this year. Digital communication by ODs is growing rapidly with 69 percent of all practices having a website and 80 percent or more of independent practices having one.

However, just one in three OD websites have appointment scheduling functionality, and just one in five enable patients to order products online. A total of 42 percent of practices us their EHR system to generate patient communications other than recall notices, up from 30 percent in 2003.

Ellis described how AOAExcel is providing access by connecting optometrists to the health information highway via OcuHub. “It is very apparent, in the future, connectivity will be access, and access will be connectivity."