Optometry Australia has warned that if passed as proposed, the federal government’s 2014 budget will significantly impact the optometry profession and delivery of eye health services.
Andrew Harris, President of Optometry Australia, said the changes offer both positives and negatives from a government determined to control the budget deficit and prepare to meet the health needs of an ageing population.
Mr. Harris said it was extremely disappointing to see the government reduce its investment in public eye health by continuing its freeze on the indexation of eye examination fees and reducing the rebate on schedule fees for optometry items funded under Medicare from 85 to 80 per cent, effective 1 January 2015.
He said this would make it difficult for practices that choose to bulk bill to continue to provide a wide range of services required by the Australian communities they serve. He stated that this would be front and centre in Optometry’s discussions with the Department and politicians.
Additionally, asymptomatic people under 65 will only be entitled to a Medicare rebateable comprehensive eye examination every three years as opposed to every two years. Asymptomatic people over 65 will be able to access a Medicare rebateable comprehensive eye examination every year.
Genevieve Quilty, CEO of Optometry Australia said the association is currently in discussions with the government about the finer points of the budget recommendations.
She said Optometry Australia recognised the push towards providing extra services to people in the population who are over 65 is a good outcome, however the rationale behind the decision to only offer three-yearly rebateable eye examinations for those under 65 was “not yet clear” given that people often begin to experience more significant changes to their vision and show early signs of eye disease from their 40s. She said Optometry Australia would be discussing this matter with the department and government, including the clinical evidence to support the decision.
Julie Heraghty, CEO of the Macular Disease Foundation Australia, welcomed the government’s decision to enable asymptomatic people over 65 years to have Medicare funded annual eye checks. “This is the care for older Australians we need, not just for macular degeneration, which is the leading cause of blindness and severe vision loss in older Australians, but also for the overall management of cataracts and other eye diseases. A special one-to-one relationship is often established between the optometrist and our macular degeneration clients and, in the course of their care, the optometrist can discuss the important areas of diet and lifestyle changes (such as smoking cessation), the use of the Amsler grid and how to pick up sudden changes such as when dry AMD turns to wet,” said Ms. Heraghty.
“On the other hand, the basis for the decision for Medicare funding of eye testing for under 65-year-olds being reduced to a three-year interval is unclear. There would obviously need to be solid evidence-based reasoning behind this decision. In addition, the definition of ‘asymptomatic’ needs clarification.
“In the under 65-year-old bracket especially, for those at risk (over 50) for macular degeneration, we know that you can have the early signs without knowing. Working at the prevention side (upstream) – having an eye test and educating on necessary diet and lifestyle changes can save on costs (downstream), as we prevent people losing sight in older years. We have less chance of this on a three-year cycle of testing. Picking up people earlier, especially those with a family history of macular degeneration, is going to have overall health and cost benefits,” she said.
As a Foundation focused on all macular diseases, including diabetic retinopathy, Ms. Heraghty said she also has significant concerns about the impact of the proposed three-year testing for people with diabetes.
“Individuals with diabetes are often unaware that they have retinopathy and the disease may progress to the advanced stage without any effects on vision; it is essential that people with diabetes have regular eye examinations so that treatment can be delivered before irreversible vision loss occurs.”
NHMRC guidelines for the management of diabetic retinopathy state that a dilated fundus exam should be conducted at least every two years.
“Up to 21 per cent of patients with type 2 diabetes have retinopathy at the time of first diagnosis of diabetes, and most develop some degree of retinopathy over time. Moreover many people with diabetes obtain their initial diagnosis as a result of an eye exam,” she said.1
“Diabetes is a major health concern… prevention and early intervention is the key to minimising its impact. We must also develop and implement effective diabetic eye screening programs and I have major concerns about the impact of this change.”
Ms. Heraghty said the saving from extending the period between eye examinations “is miniscule compared to the actual cost of managing vision loss”.
One Big Win
Ms. Quilty said the federal government’s decision to remove caps on fees was a ‘big win’ for optometry and one Optometry Australia has advocated for, for some years.
“This decision by the government to lift the fee cap imposed on Australian optometrists means our profession can operate in the same way every other health practitioner eligible under Medicare operates,” said Ms. Quilty. “It provides Australian optometrists with the choice of the fees they set. Each optometrist will need to decide what if any private fees are charged. For some optometrists this will give them the opportunity to charge fees better matched to the costs of providing care and help ensure they can keep providing those services in a sustainable way.”
Ms. Quilty said the government’s decision to remove the cap as at 1 Jan 2015 would provide the profession and individual optometrists with time to think through the opportunities and challenges the change will bring.
“Optometry Australia will assist members with tools to consider what changes they may choose to implement to their billing practices as well as practical approaches to introducing changes in billing practices. This will include tools to help determine fair fees for their services that cover the costs involved in providing care,” said Ms. Quilty.
Ms. Heraghty said she looked forward to Optometry Australia working with optometrists to develop appropriate and transparent pricing structures so that consumers could compare services and make fully informed decisions when choosing an eye care provider.
1. Ref 10.2337/diacare.27.2007.S84 Diabetes Care January 2004 vol. 27 no. suppl 1 s84-s87)