Optometry as practiced in health plans within different state jurisdictions

This study was conducted to determine how managed care plans use optometrists to provide vision and eye care. The study documents the variety of optometric practice patterns found within six health plans in several states, each having different organizational characteristics, professional staffing patterns, and payment arrangements, and each regulated by dissimilar state licensure laws. A 15-item patient encounter form was developed and completed for all patients examined by the optometrists at each site during a four-week period. The instrument included information on patient demographics, medical/ocular history, reason for the visit, procedures performed, diagnosis, therapy provided, ocular medications prescribed, prognosis, disposition, referrals, and duration of the visit. A variety of patterns were found, some of which did not necessarily closely follow the legal boundaries of optometric care. This study documented that optometrists provide a substantial volume and range of vision care, and their scope of practice is influenced by legal, financial, and organizational factors. In some plans, optometrists' skills were underutilized relative to their legal authority in certain situations; in others, creative, cooperative arrangements extended the benefits of optometry beyond the existent practice laws. Licensure is certainly a major influence on the scope of practice of health providers. This study revealed, however, that licensure alone does not appear to be the only determinant of use, delegation, and division of labor among health professionals, and that organizational factors seem to play a very significant role.