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Administrator’s Update

Why Eye MDs Need Certified
Ophthalmic Medical Personnel

By Jessica Barr,COMT,ROUB

Would you see a doctor who wasn't board certified? Would you fly on a plane with a pilot who didn’t have his license? Do you want an accountant who isn't certified handling all of your personal finances? The obvious answer is no. This is because certification, licensing and education are a testament to the time invested and knowledge learned in the professional arena. 

With regards to ophthalmic medical personnel (OMP), there exists no mandatory training or certifications. It is optional. For those who choose to become certified, it is a reflection of an investment in their career and the enthusiasm they have for the field of ophthalmology. Through the certification process, OMPs gain a greater depth of knowledge and superior skills than their non-certified counterparts. This results in improved clinical judgment, increased productivity, enhanced efficiency and ultimately higher revenue for physicians.

To become certified at one of the core levels (COA, COT, COMT), OMPs must pass rigorous written exams and must prove their practical skills for the higher level credentials. What this means is that OMPs must acquire a wider range of knowledge and skills beyond what they may be exposed to by clinical experience alone. Furthermore, regular continuing education is required to maintain these credentials. This keeps OMPs current with the latest developments and treatments in ophthalmology and exposes them to new material. In fact, a recent study shows that there is no clinical area where a non-certified OMP outperforms a certified OMP. On the contrary, certified OMPs ranked higher in half of the clinical categories evaluated and equal in the other half of clinical categories evaluated. It is worth noting, to eye MDs out there, that the OMPs in this study were evaluated by their supervising ophthalmologists. 

Moving forward, there is a chance that certification for OMPs may become mandatory in order for physicians to be reimbursed for the services rendered by OMPs. In a recent report from the Department of Health and Human Services, Office of the Inspector General (OIG) to The Centers for Medicare and Medicaid Services (CMS), two strong points were made regarding OMPs. First, they indicated that one third of the services billed in ophthalmology were performed by non-physicians. Second, they indicated that of those services, one third of them were being performed by non-certified and unqualified personnel. The OIG recommendation to CMS is that they only allow, “nonphysicians who have the necessary training, certification, and/or licensure . . . perform the services under the direct supervision of a licensed physician.” It is worthwhile for ophthalmologists to consider staying ahead of these recommendations by hiring and maintaining a staff of certified OMPs. In this consideration, remember that certification is a lengthy and rigorous process for OMPs and this does not occur overnight. If CMS makes certification of OMPs mandatory in order for physicians to receive reimbursement, there will undoubtedly be a shortage of certified OMPs.

In conclusion, certified OMPs are a greater asset to any ophthalmology practice than non-certified OMPs. Through the certification process and continuing education, certified OMPs bring a greater scope of knowledge and skills which means enhanced efficiency and productivity. The ultimate result can be increased revenue for the practice. To be well prepared for the future of ophthalmology and the role of OMPs, it is advisable for eye MDs to consider the importance and relevance of having certified personnel. 

References:
Woodworth, KE, Donshik, PC, Ehlers, WH, Pucel, DJ, & Anderson, LD. (2008). A comparative study of the impact of certified and noncertified ophthalmic medical personnel on practice qualtiy and productivity. Eye & Contact Lens, 1(34), 28-34

Woodworth, KE, Campbell, RC, Dean, CA, DuBois, LG, & Ledord, JK. (1995). Analysis of tasks peformed by certified ophthalmic medical personnel. Ophthalmology, 102, 1973-1986. 

Levinson, DR. Department of Health and Human Services, Office of Inspector General. (2009). Prevalence and qualifications of nonphysicians who performed medicare physician services (OE-09-06-00430). USA

Evans, PY. (1982). Role of paraprofessionals in eye care: present and future. Ophthalmology, 89, 49A-54A.

JCAHPO. (2011, July). Retrieved from www.JCAHPO.org 


Improving Your OCT Technique
Julia Monsonego

If you are having a difficult time obtaining a clear image while performing an OCT, try this....

1. Check the lens for smudges or tears.

2. Give the patient of drop of refresh. A dry cornea can cause lower signal strength.

3. Check the patient’s positioning. Make sure their chin is in the cup and forehead completely forward and straight.

4. Find the "sweet spot." If the patient has a cataract, focus anteriorly on the cataract first before focusing on the retina and find an area where you can make your way around it. Most of the time there is an area where it is less dense, usually superiorly where there will be a clearer view. 

5. Check your focus. If the retinal vessels are not in focus, the signal strength will be lower. Even a few diopters can make a big difference.

6. Patch the fellow eye if the patient is having trouble fixating or having double vision,. This method could also work if the patient's dilation is starting to wear off. It can help to open the pupil up a small amount which may just be enough to obtain a better scan.

7.Position nystagmus patients so the acquisition occurs at its edge. The patient normally holds their eye still for a moment longer at this point and you will have a better opportunity in getting a more reliable scan here than in the center.

8. If using the Zeiss Cirrus OCT and you are finding that not all of your scans are centered in the acquisition box and some are being cut off, try moving your scan off center in the pupil by clicking directly on the pupil on the screen. Click around until the scans straighten out. Depending on the shape of the patient's eye, an off centered pupil may give you an on center scan. However, in patients with high myopia it may be impossible to avoid cut off. In this case, concentrate on your horizontal and vertical scans through the optic nerve and allow for cut off in the periphery (lower boxes)

9. Every office has an OCT protocol, but if the patient is next to impossible to scan, and we all have them-

Start with the scan that will give the most valuable information to the physician. Whether it be due to patient cooperation, whether they're 99 or 3, or caused by their diagnosis, the best scans you will be able to obtain with difficult patients will usually be the first scans. So if it is a neuro or glaucoma patient, start with the RNFL scan. A retina patient, start with a line scan straight through the fovea. Even if you are unable to get a macular thickness map, a lot of OCT's can give thickness calculations from a single line scan. Then try to get the rest of your scans. But if you can't, at least you were able to get the scans that mattered most.

10. Above all, give your patients clear instructions. Communicate with them throughout the test. Tell them when they can blink freely, when they are doing a good job. If they are tired give them a break between testing each eye. Use the time to print while they take a moment to rest. Many times the patient gets to us at the end of a long day and they are tired, hungry, and possibly frustrated. Ask for assistance when you need it and remember to take a break yourself!