As a profession, optometry is uniquely suited to bridge the gap in the healthcare system between patients who do not routinely access care with the medical attention they need. Community Health Centers (CHCs) are multidisciplinary healthcare practices where this interconnection between medical providers is essential to its functioning. Across the United States, optometry is dramatically under-represented in community health centers.
This article will explain why all CHCs nationwide would benefit from adding optometric services to enhance the ocular and overall health of the communities they serve as well as the benefits to optometrists and the health centers themselves.
What is a community health center?
Community Health Centers, also known as Federally Qualified Health Centers, FQHCs, are multidisciplinary healthcare organizations that provide affordable, cost-effective, high-quality primary and preventative care to medically underserved populations. CHC’s may offer limited services such as primary care and dental only or may be as expansive to include other specialties such as optometry, behavioral health, pharmacy, radiology, pediatrics.
CHCs have been shown to reduce health disparities and manage chronic illnesses in a cost-effective manner as well as reduce emergency room visits. Given that CHCs are designed to provide healthcare where barriers to care exist in medically underserved communities, they are ideally positioned for improving access to comprehensive eyecare services. This can benefit their populations’ ocular, visual and systemic health.
Stats on optometry in community health
According to the National Association of Community Health Centers, optometry’s presence in community health centers has increased from 17% in 2010 to 25% in 2018. While trending in a positive direction, this number is still very low compared with other specialties. As an example, dental services are offered in 82% of all CHCs.
According to the Health Resources and Services Administration (HRSA) 2019 National Report, of the roughly 41,000 optometrists practicing in the United States only 398 of them were practicing in community health centers, or less than 1%.
The lack of eyecare services is well recognized on a national level. The Healthy People Campaign includes 14 vision specific objectives. Some pertinent ones include: reduce vision loss from diabetic retinopathy, glaucoma, macular degeneration, and cataracts. One objective recognized as a high priority public health issue is to increase access to comprehensive vision services in community health centers. Yet a lot of work remains to be done.
Importance of eyecare services in multidisciplinary settings
CHCs improve health quality metrics for the communities they serve and are therefore aptly positioned to also improve the ocular and visual health needs of these same patients across the nation. CHCs nationwide should therefore be eager for optometrists to work in-house. This will increase the overall health of their patient population.
Poor vision not only means worse school and work performance, and more risk for falls in the elderly. In many cases vision impairment is caused by systemic diseases that need to be addressed by their primary medical team. Many residents in low-income areas do not have the ability to travel far to reach an optometrist outside of their community and will be more likely to be seen at their health center where they are accustomed to having their medical care than traveling elsewhere for an eye exam.
Despite the Centers for Disease Control and Prevention declaring vision loss a public health crisis, legislative initiatives to increase the delivery of eyecare services are largely absent.
For example, Medicare historically does not cover eye exams or glasses for its beneficiaries (although a bill to overturn this is currently being debated). This leaves a great economic burden for elderly patients, many of whom are on fixed incomes. Medicaid coverage varies greatly by state; some states cover eye exams and glasses for both adults and children annually and others cover only eye exams once every two to four years.
Primary care and primary eyecare working together
Optometrists can be a first entry point for many patients into the healthcare system. Patients who may not have seen any medical provider for many years, may present to an optometrist due to perceived need for glasses. During their eye exam, their optometrist can explain signs of systemic diseases like diabetes and hypertension that they find in the exam or notify the patient of conditions they may be at risk for based on their history. The optometrist can easily connect the patient to a primary care provider within the CHC to address these systemic concerns.
Working in a community health center is the perfect environment for comprehensive patient care.
Primary care providers (PCPs) can also provide significant referrals to optometrists as all FQHCs must meet certain requirements for diabetic retinal eye exams to maintain compliance with federal programs such as GPRA and HEDIS. Additionally,urgent eye problems like ocular injuries, foreign bodies and red eyes can be examined the same day by the in-house optometrist.
Benefits to a new optometry graduate working in such a setting
Community health centers are an exciting place to work. Optometrists are viewed as a valued member of the healthcare team and are able to practice full scope optometric care. New grads will work closely with other medical departments and become familiar with working with a diverse community. They can gain experience with a high volume of ocular disease that they may not have as much access to working in other settings. This can propel their careers forward allowing them to gain confidence working with complex medical conditions faster.
Not only do community health centers serve patients in need and provide professional satisfaction, they also offer public service loan forgiveness or other federal student loan repayment programs like Indian Health Service Loan Repayment - big selling points for new grads in debt.
Insurance/billing considerations
CHCs are a cost-effective means of providing care. CHCs receive federal, state and local funding to subsidize a portion of the services provided. Medicare and private insurances reimburse the same as for another practice in the same area.
Additionally, since CHCs are reimbursed by Medicaid at a flat, government-negotiated rate per encounter in any department, optometry exams will enhance reimbursement for the health center as a whole. Not only can exams be billed, but revenue will be increased due to the sale of glasses and contact lenses.
Networking with health centers
Given that the majority of health centers in the country do not offer vision care services, there is great need for optometrists to work with community health centers to help establish optometry departments. After locating a health center in need of optometry, find a way to make contact with the CEO or Chief Medical Officer. If you are able to meet someone who works with the health center in a different capacity, ask them to make introductions for you.
Plan a meeting to discuss the mutual benefits of starting an optometry department for the health center and the ways that ocular health represents a crucial aspect of systemic health. This article and its associated resources can provide talking points to highlight these benefits.
Once the CHC is interested in developing an optometry department, there will be some logistics to work out. If you are an optometrist interested in working with a health center to open an optometry department, you will find more specific information on logistics of how to do so in my other article here.
If a CHC is interested in developing an optometry department, I would suggest reaching out to local optometrists in their area to see if any would be able to provide care on a part-time basis. This can expand to a full time position as demand for services increases.
Another way health centers can connect to optometrists is by networking with a local optometry school. Student doctors and attending optometrists can provide eye care to an entire city. Optometry schools can also link health centers with recent graduates who may be interested in helping the CHC develop an optometry department.
Challenges and rewards
One of the biggest challenges working in a community health center can also be what makes it so rewarding. Many patients have multiple complex health conditions going on, many that they not even be aware of.
As an optometrist, you get to work with a healthcare team to determine what the underlying cause is and help this patient maintain their vision to the extent possible and even save their life.
Call to action
For optometry students:
- Select rotations within community health centers.
- If your school doesn’t offer many rotations within CHCs, encourage your school to form relationships with nearby health centers in need of optometry services.
- Pursue a residency in a community health center so you can gain greater understanding of how CHCs operate and then help open an optometry department in another CHC after residency. (Community Health was previously its own category of residency program. Now you can find residencies within community health centers under Primary Care Optometry as well as Ocular Disease).
For optometrists:
- Research CHCs in your desired community to see whether they offer optometry services, if not, connect with the Chief Executive Officer, Chief Operating Officer or Chief Financial Officer to begin the conversation regarding opening an optometry department.
- Share this article and other resources regarding the benefits of optometry in CHCs.
- Here’s a great resource from Prevent Blindness America regarding costs and benefits in opening an optometry department.
- Consider partnering with an optometry school in your state to join together to provide optometry services in a nearby CHC
- Connect with your local AOA chapter to push for including optometry in the National Health Service Corps Loan Repayment Program.
For CHCs:
- Broaden your understanding of the benefits optometry services can provide to your health center and your patients.
- Connect with the Dean of Academic Affairs at an optometry school (it doesn’t even have to be in the same state as your CHC) to discuss opening an eye clinic in your health center to more fully serve your patients whole body health care needs.
- Optometry schools can also connect you with graduates of their residency programs who may be ideally suited to work in the CHC environment.
- Read this article which will provide more insight as to the step-by-step that will be needed to open your optometry department.
- Assess your health center’s readiness for opening an optometry department.
- Find out whether you may be eligible for a grant to help develop an optometry department.
Conclusion
CHCs are ideally positioned to reduce disparities in access to comprehensive eyecare and enhance the ocular health needs of the populations they serve. Optometrists are the primary eyecare providers and should be partnering with CHCs nationwide in this effort to bring affordable, high-quality eyecare to every community health center in the country. When we improve the vision and ocular health of our patients, we can also enhance their systemic health and overall well-being.
