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HomemioptometryFunding the Future of Optometry

Funding the Future of Optometry

Optometry Australia has recently commenced a refresh of its Optometry 2040 project, as Skye Cappuccio explains.

Optometry Australia’s Optometry 2040 project is working to identify preferred, plausible futures for optometry. Several factors assumed in the original project undertaken in 2018 are evolving at different paces than anticipated. Technological advancements, telemedicine adoption, and changes in healthcare delivery are progressing faster, for example. Meanwhile, some aspects, like regulatory changes and scope of practice, are advancing more slowly.

Updating the potential scenarios for optometry in Australia ensures we are tracking towards a clear preferred future for the profession – crucial if we are to remain agile and responsive. Importantly, we need to determine what needs to be done now and in coming years.

One area we need to explore in greater depth is how we can work toward a robust funding system that supports optometry’s evolution and delivers for communities.

Funding systems play an integral role in shaping almost every aspect of the profession, from scope of practice to average salary, to integration across the healthcare system. The thought experiment of how optometry might have developed in Australia if direct access to optometric care hadn’t been funded since the early days of Medicare, is telling. Undoubtedly, Medicare coverage of optometry services has supported high community access to primary eye and vision care and enabled the continual growth of a strong optometry workforce. It’s for these reasons, optometry’s Medicare access is the envy of many allied health professions. Yet, it is perhaps because of the profession’s relationship with Medicare that very few practices are paid for the true cost of providing clinical care and rely on optical retail for business sustainability. Likewise, the profession’s relationship with Medicare largely explains the widespread discomfort with providing services that don’t attract Medicare rebates.

REALISTIC EXPECTATIONS

As a profession, we need to be realistic about the likely future of Medicare coverage. While there has long been a gap between rebates and the cost of providing care, this was increased with fee cuts in 2015 and, most significantly, with the lengthy Medicare-wide freezes on indexation of rebates that followed. Optometry Australia, alongside the likes of the Australian Medical Association has, and will continue to, advocate for fairer indexation of Medicare item fees. Realistically, we are unlikely to achieve this under the current system.

Optometry Australia has been part of the ongoing review of the Medicare Benefits Scheme for many years. For optometry, the (extremely long and protracted) process is coming to a close. We have been advocating for, and expect, positive changes to optometry items as a result of the review. We expect changes that better align the schedule to contemporary practice. These aren’t, however, revolutionary, and certainly won’t adjust fees to match the true cost of providing care in a sustainable way.

The challenge for the profession is to think about funding models that align with where we want to be into the future. While a strong optical retail market may continue to crosssubsidise traditional practice models, how do we provide sustainable funding models for practices that evolve to have a greater focus on disease management or advanced practice in a specific area? And how do we support sustainable provision of clinical optometric care if the optical retail market is disrupted?

LOOKING LONG TERM

Part of the answer is working cleverly within the funding system constraints we have. One of the approaches that has become increasingly common is to privately bill for testing not covered by Medicare or to limit bulkbilling. Optometry Australia has developed a range of resources1 to support members in setting clinical fees, including for ongoing disease management.

We also need a long-term vision. To be plausible, this must consider emerging trends. The current Government has made clear it is pursuing further uptake of blended funding models for primary healthcare, that is, models that move beyond singular, fee-for-service Medicare items. It is also pursuing reforms to support better integrated, multi-disciplinary primary healthcare. These changes are centred on general practice, and while progress isn’t quick, we need to consider what opportunities this may offer for funding community access to continually evolving optometric care.

This isn’t an abstract conversation, but a future we need to start making strategic steps toward now, which is what we are doing via the Optometry 2040 refresh underway. Details are available at optometry.org.au/ about-us/our-current-focus/optometry-2040. For information on how you can contribute, keep an eye on Optometry Australia’s socials, or reach out directly to Optometry Australia on [email protected]

Skye Cappuccio is the Chief Executive Officer of Optometry Australia.

Reference 

  1. See further: optometry.org.au/practice-professional-support/medicare-private-billing-health-funds/private-billing-guidelines-fee-setting [accessed 6 Oct 2023].