The Battle of the Eye Doctors - Bacon's Rebellion

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The Battle of the Eye Doctors Bacon's Rebellion

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[Michael Barris]

Take note of the opportunity to comment. Also note the nine comments that I have just read there.

 

[Jonathan Warner]

The Battle of the Eye Doctors Bacon's Rebellion

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This is some of the most vile bigotry I have seen directed against optometrists by the supporters of OMDs.

 

[Ken Elder]

This is some of the most vile bigotry I have seen directed against optometrists by the supporters of OMDs.

Nothing that I haven't seen in 22 years of practice. Who cares?

 

[Karen T Walker]

I read several of the other articles on "baconsrebellion". Don't take it seriously, or at least don't think reason can be applied to change minds or defend the profession.

It's just another sign of the deep division which has been revealed by the current state of pandemic/trump mania. I presume it's always existed, just not as obvious as now.

https://www.baconsrebellion.com/wp/no-vaccination-no-transplant/#disqus_thread

This guy is refusing to vaccinate to qualify for a kidney transplant based on something he read in the blaze.com (Glenn Beck). The real story is found in the comments.

Shamgar Connors speaks for himself more clearly in the comments and shows the sleight of hand that Bacon has applied in his article.

 

[Michael W Ohlson]

Disclaimer: Politics are ugly, zero-sum games, and truth often has little to do with what’s going on.

So, aren’t the author’s comments and the other comments representative of our reputation?

It’s on us. And, we’ll still have the political fight.

There is no sense complaining if one isn’t an advocacy member. Dues. There’s no sense complaining if our applicant pool is small, if our training lacks comparable, competitive rigor in literature, didactic, and supervised clinical experirnce. There’s no sense complaining if our knowledge, performance in practice, and patient outcomes aren’t the highest level as judged by others. There’s no sense complaining if we’re not even willing to accredit our CE, a minimal standard, competency method for relicensure.

I share the identical frustrations of my fellow ODs. Or more. Who knows? But, one needs to walk the walk. And, the huge majority needs to walk the walk. And, we still require advocacy membership and action.

It’s a lot. Anyone can say that we’re all great. That’s populism. I can do it. I applaud the scope increases. But, I think we’re heading into problems this century.

 

[Weihan Wang OD]

There is no sense complaining if one isn’t an advocacy member. Dues.

Does this mean Pay the AOA ---> AOA puts out a bullshit ad or two ---> ReSuLTs??

I don't see the AOA launching lawsuits against payers or funding individual battles in states. I see them pissing away a ton of money on pure, complete wastes of time.

Can you post the AOA general budget here? Lets comb through it so a prospective member can see what it contains. Oh wait, there's a paywall.

https://www.aoa.org/about-the-aoa/annual-report?sso=y

This is why people have trouble with the AOA. I read your post, try to look up what the AOA would be spending the dues on, and hit a paywall that I'd have to pay $2000 to get through. You know else what I see?

https://www.aoa.org/?sso=y

A picture of some lady looking through a slit lamp without her hand on the slit lamp joystick. Very, very symbolic.

if our training lacks comparable, competitive rigor in literature, didactic, and supervised clinical experirnce. There’s no sense complaining if our knowledge, performance in practice, and patient outcomes aren’t the highest level as judged by others. There’s no sense complaining if we’re not even willing to accredit our CE, a minimal standard, competency method for relicensure.

Sounds like the kids at the front of the classroom in third grade yelping and raising their hand so the teacher calls on them, who then loudly ask for harder test questions and look around to see who is impressed.

The 80% of the ODs in the back of the classroom hearing the nerds in front asking for harder tests... would like nothing better than to give those teacher's pets a good slap in the back of the head.

Totally disconnected from what the bulk of ODs care about. Your average audience member, like me, is a random guy or gal sitting in a sublease eating a sandwich between refractions who would be ecstatic to get $10 more from a VCP per exam. We don't care about the nerds clamoring for more homework so they can pat themselves on the back.

 

[Michael W Ohlson]

Does this mean Pay the AOA ---> AOA puts out a bullshit ad or two ---> ReSuLTs??

I don't see the AOA launching lawsuits against payers or funding individual battles in states. I see them pissing away a ton of money on pure, complete wastes of time.

Can you post the AOA general budget here? Lets comb through it so a prospective member can see what it contains. Oh wait, there's a paywall.

https://www.aoa.org/about-the-aoa/annual-report?sso=y

This is why people have trouble with the AOA. I read your post, try to look up what the AOA would be spending the dues on, and hit a paywall that I'd have to pay $2000 to get through. You know else what I see?

https://www.aoa.org/?sso=y

A picture of some lady looking through a slit lamp without her hand on the slit lamp joystick. Very, very symbolic.


Sounds like the kids at the front of the classroom in third grade yelping and raising their hand so the teacher calls on them, who then loudly ask for harder test questions and look around to see who is impressed.

The 80% of the ODs in the back of the classroom hearing the nerds in front asking for harder tests... would like nothing better than to give those teacher's pets a good slap in the back of the head.

Totally disconnected from what the bulk of ODs care about. Your average audience member, like me, is a random guy or gal sitting in a sublease eating a sandwich between refractions who would be ecstatic to get $10 more from a VCP per exam. We don't care about the nerds clamoring for more homework so they can pat themselves on the back.

Actually, I sat in the back. I still do so. We learn by doing.

While we can criticize from the sidelines, we require strong advocacy. The majority of the dues go to state associations with a smaller aspect going to AOA.

The majority of my career has been rural private practice. So, VCPs, access, and reimbursement concerns were recently daily life. Sadly, I still somewhat deal with them in a hospital setting. There’s no place to run from their effects. Direct. Indirect. No matter.

This century holds different dilemmas for optometry. Technology, high tuition, online this, online that, more competition from every angle, increased transparency, increased accountability, and hopefully increasing scope. As stated, reimbursement has seldom increased significantly. To place patient care first and to seek a thriving profession as well, we will need to alter some courses. We’re not owed. It’s simply up to us.

 

[Weihan Wang OD]

Can you post the general budget linked above?

 

[Michael W Ohlson]

Can you post the general budget linked above?

I’m merely a member. You’d be best served by contacting the org. or your state association.

Their past 990s are available online as with other non-profits.

 

[Weihan Wang OD]

OK. A cursory glance, drawing from Part IX and looking through the referenced schedules:

https://www.aoa.org/AOA/Documents/About the AOA/Annual Report & Financial Information/AOA-2019-Form-990-990.pdf

From 18 million taken in dues (there are other small revenues and expenses):

a. 10 million bucks spent on AOA employees, 1/3 of that on on executive compensation.
b. 4.5 million spent on consultants
c. 2 million spent on travel (????)
d. 0.5 million spent on hotels
e. 1.5 million spent on advertising
f. 0.2 million spent on legal (????) <--------- clearly not doing enough fighting

Compared to results achieved: not impressed. None of this flowed to the state level, either. What exactly did all this pay for?

 

[Michael W Ohlson]

OK. A cursory glance, drawing from Part IX and looking through the referenced schedules:

https://www.aoa.org/AOA/Documents/About the AOA/Annual Report & Financial Information/AOA-2019-Form-990-990.pdf

From 18 million taken in dues (there are other small revenues and expenses):

a. 10 million bucks spent on AOA employees, 1/3 of that on on executive compensation.
b. 4.5 million spent on consultants
c. 2 million spent on travel (????)
d. 0.5 million spent on hotels
e. 1.5 million spent on advertising
f. 0.2 million spent on legal (????) <--------- clearly not doing enough fighting

Compared to results achieved: not impressed. None of this flowed to the state level, either. What exactly did all this pay for?

I’ll let AOA defend their 990s. Considering the size and stature of their competition in health care and how professional trade orgs work, they do some things pretty well. All, no; some, yes. I’ve made errors in practice and when serving on boards. That’s the way of it.

I don’t think you want that particular legal item running high.

This fails to mention the crucial state associations, the recipients of most of the dues. Optometry is a regulated profession. Legislated scope, state level. Small. Not understood even after decades. In the absence of strong advocacy with high membership, we‘ll not thrive overall. A % will do always well; that’s not the large area under a distribution curve.

I‘m unaware of good alternatives for both strong advocacy/vocal membership in a small, regulated profession and increased rigor/performance in practice/professionalism across the spectrum.

 

[Weihan Wang OD]

I’ll let AOA defend their 990s. Considering the size and stature of their competition in health care and how professional trade orgs work, they do some things pretty well. All, no; some, yes. I’ve made errors in practice and when serving on boards. That’s the way of it.

I don’t think you want that particular legal item running high.

This fails to mention the crucial state associations, the recipients of most of the dues. Optometry is a regulated profession. Legislated scope, state level. Small. Not understood even after decades. In the absence of strong advocacy with high membership, we‘ll not thrive overall. A % will do always well; that’s not the large area under a distribution curve.

I‘m unaware of good alternatives for both strong advocacy/vocal membership in a small, regulated profession and increased rigor/performance in practice/professionalism across the spectrum.

I know you are not the AOA, but you repeatedly advocate for "higher standards", more tests, and giving money to the AOA.

Here are some thoughts:

1. High standards significantly result from a desirable profession (read "paid more") needing to put up barriers to keep lower quality folks out. Pushing for increased CE/training rigor in the hopes of increased respect while payment is stagnant is having the tail wag the dog. It'll never work, and will alienate most ODs.

2. Chiropractors have objectively less science behind them. Their legislative effectiveness is MASSIVELY higher per dollar spent than optometry. Most ERISA medical plans now pay for 12-24 chiropractor visits per year with minimal cost sharing. ODs have trouble extracting payment for a single refraction.

See this, the 990 for the American Chiropractic Association: https://tinyurl.com/2p9f5k7b

-- 1.8 million on ACA employee wages, 0.4 million on executive compensation. They represent 70,000 chiropractors, compared to about 58,000 ODs.

3. The AOA pays ten times the executive compensation for 20% less constituents and 1000% less results. It's mathematically a total, abject failure.

4. If one looks hard enough, one will discover that the number of coverage lawsuits initiated and won by chiropractors is MASSIVELY higher than optometrists.

Simply put, that profession has ten times the balls of ODs (might be literal, looking at demographics) while having 1/10th of the science. They didn't get there by giving themselves more homework assignments.

 

[Michael W Ohlson]

I know you are not the AOA, but you repeatedly advocate for "higher standards", more tests, and giving money to the AOA.

Here are some thoughts:

1. High standards significantly result from a desirable profession (read "paid more") needing to put up barriers to keep lower quality folks out. Pushing for increased CE/training rigor in the hopes of increased respect while payment is stagnant is having the tail wag the dog. It'll never work, and will alienate most ODs.

2. Chiropractors have objectively less science behind them. Their legislative effectiveness is MASSIVELY higher per dollar spent than optometry. Most ERISA medical plans now pay for 12-24 chiropractor visits per year with minimal cost sharing. ODs have trouble extracting payment for a single refraction.

See this, the 990 for the American Chiropractic Association: https://tinyurl.com/2p9f5k7b

-- 1.8 million on ACA employee wages, 0.4 million on executive compensation. They represent 70,000 chiropractors, compared to about 58,000 ODs.

3. The AOA pays ten times the executive compensation for 20% less constituents and 1000% less results. It's mathematically a total, abject failure.

4. If one looks hard enough, one will discover that the number of coverage lawsuits initiated and won by chiropractors is MASSIVELY higher than optometrists.

Simply put, that profession has ten times the balls of ODs (might be literal, looking at demographics) while having 1/10th of the science. They didn't get there by giving themselves more homework assignments.

To be clear, adding homework will not increase reimbursement to ODs. However, since we are increasing colleges with a small applicant pool, increasing scope via legislation without increasing supervised clinical training, and avoiding standards of independence/integrity/CE accreditation… that will go poorly. The increasing transparency and accountability are here now. It’s all related.

More homework is inevitable. The degree is the entry point, not the endpoint. Information in medicine grows exponentially. None of us can keep up.

To be more clear, advocacy alone won’t prepare optometry for the remainder of the 21st century. However, our small profession has virtually no chance without fully-loaded, active state and national associations. Those won’t do well unless optometry walks the walk. Lotta tech, AI, and competition coming. No one is going to reimburse highly for a refraction or a quick screening.

We’re not gonna win every time. We’re small, misunderstood, and outgunned.

I certainly don’t mind criticisms of the optometry groups. All are worthy of constructive criticism. Come to think of it, it’s often been me saying the critiques. But, membership and volunteer action are part of the responsibility of being in a regulated health care profession. I’m aware that makes me old and out of it and unaware. I can live with it.

The alternative isn’t good. ODs have said the identical statements about dues and such over my entire career. I’m not particularly an AOA cheerleader. It makes no sense to be against the AOA, however, or to just leave things to others. I’ve seen every group err. No exceptions.

 

[Michael W Ohlson]

I know you are not the AOA, but you repeatedly advocate for "higher standards", more tests, and giving money to the AOA.

Here are some thoughts:

1. High standards significantly result from a desirable profession (read "paid more") needing to put up barriers to keep lower quality folks out. Pushing for increased CE/training rigor in the hopes of increased respect while payment is stagnant is having the tail wag the dog. It'll never work, and will alienate most ODs.

2. Chiropractors have objectively less science behind them. Their legislative effectiveness is MASSIVELY higher per dollar spent than optometry. Most ERISA medical plans now pay for 12-24 chiropractor visits per year with minimal cost sharing. ODs have trouble extracting payment for a single refraction.

See this, the 990 for the American Chiropractic Association: https://tinyurl.com/2p9f5k7b

-- 1.8 million on ACA employee wages, 0.4 million on executive compensation. They represent 70,000 chiropractors, compared to about 58,000 ODs.

3. The AOA pays ten times the executive compensation for 20% less constituents and 1000% less results. It's mathematically a total, abject failure.

4. If one looks hard enough, one will discover that the number of coverage lawsuits initiated and won by chiropractors is MASSIVELY higher than optometrists.

Simply put, that profession has ten times the balls of ODs (might be literal, looking at demographics) while having 1/10th of the science. They didn't get there by giving themselves more homework assignments.

I forgot!

I do advocate for higher standards. Much higher standards. Across the board. This pisses people off because they feel slighted or butt-hurt as if I’ve attacked them or optometry. They’re mistaken and feelings are mere feelings. It’s not about that.

Should I advocate for no, lower, or identical standards?

We often have no standards. We seek less. Standards are enforced. We seek to be reimbursed with federal dollars, yet object to standards for industry for support of CE we use for relicensure. That’ll turn out well. Bias and COI will go well for optometry.

We learn by doing, not watching. The applicant pool/seat ratio is not good at all. Build more colleges. Hmm.

We argue about DFE in 2022. There’s no controversy. It’s pretty sad. I got nuthin’. We don’t know what we don’t know.

It is impossible to stay the same. One grows or… not.

I argue for much higher standards, yes. We chose to be ODs. We’re usually held to the medical standards of care. In Iowa, it’s written into the law. Day one. There is no going back.

As scope increases, the responsibilities increase. I‘m not sure I advocated for more tests. Tests can be used as one tool to assess knowledge to a certain extent, but there are many ways to teach, learn, and assess. Written tests don’t assess improvements to practice or patient outcomes, for example. Finally, I advocate for membership in the state associations and AOA dues are there, yes. If one is unhappy, create change. But, the dues go along with it due to our regulated and small status.

 

[Weihan Wang OD]

I forgot!

I do advocate for higher standards. Much higher standards. Across the board. This pisses people off because they feel slighted or butt-hurt as if I’ve attacked them or optometry. They’re mistaken and feelings are mere feelings. It’s not about that.

Should I advocate for no, lower, or identical standards?

We often have no standards. We seek guidelines. Standards are enforced. We seek to be reimbursed with federal dollars, yet object to standards for industry in support of CE we use for relicensure. That’ll turn out well.

We learn by doing, not watching. The applicant pool/seat ratio is not good at all. Build more colleges. Hmm.

We argue about DFE in 2022. There’s no controversy. It’s pretty sad. I got nuthin’. We don’t know what we don’t know.

It is impossible to stay the same. One grows or… not.

I argue for much higher standards, yes. We chose to be ODs. We’re usually held to the medical standards of care. In Iowa, it’s written into the law. Day one. There is no going back.

Direct question here: how will "higher standards" benefit ODs? How's this going to go down? Thought experiment:

1. We double our CE requirements and have every OD take full proctored NBEOs every 3 years. In addition, 6 minutes of self-flagellation must be logged for each patient encounter that did not involve the instillation of tropicamide.

2. After 5 years of penance, we bring a diary of our accomplishments and flagellations to the Plan Administrators of Amazon, Boeing, GE, etc and request that they cover amniotic membranes without prior authorization because we are more trained now.

3. The Plan Administrators deny the request. We increase to 9 minutes of self flagellation and full proctored NBEOs every 2 years. In addition, all CE must be done in North Carolina in person under Lloyd Pate's direct supervision, where he will administer a 100-question pop neuro-ophthalmology quiz. There will also be a short physical fitness exam of 15 push-ups, a mile under 9 minutes, and a juggling test with each hand so that we can verify each OD can put in punctal plugs ambidextrously in under 30 seconds per plug, no insertion tool allowed. There is also a video BIO test where 90% fundus views must be maintained for 60 continuous seconds per eye while the ora serrata is in view at all times.

4. On the public health side, a 20-year longitudinal study is conducted where it shows that there is a 2 QALY gain on average for persons going to more than 1 optometry appointment per 2 years.

5. A log of these accomplishments is presented to Congress and John Hymes emails the director of OPM, requesting that the FEDVIP plan be eliminated and integrated into the regular FEP medical plan, because of.... reasons. Success?!?!?

6. Several new ODs schools continue to open. After collecting three years of tuition, ASCO administers the enhanced NBEO (with pushups) to all fourth years, and 40% of them fail out. The schools brag about their higher standards and how tough OD school is, then collects another batch of tuition. More schools proceed to open, VSP still pays $40.

Basically, and you certainly know this: scope and reimbursement is driven by money. If we can do the what appears to be the same thing cheaper, ---> or if expensive lawsuits strike major employers <---, changes happen. Otherwise, not.

That's pretty much 99% of what results are driven by. All else is decorative.

 

[Michael W Ohlson]

Direct question here: how will "higher standards" benefit ODs? How's this going to go down? Thought experiment:

1. We double our CE requirements and have every OD take full proctored NBEOs every 3 years. In addition, 6 minutes of self-flagellation must be logged for each patient encounter that did not involve the instillation of tropicamide.

2. After 5 years of penance, we bring a diary of our accomplishments and flagellations to the Plan Administrators of Amazon, Boeing, GE, etc and request that they cover amniotic membranes without prior authorization because we are more trained now.

3. The Plan Administrators deny the request. We increase to 9 minutes of self flagellation and full proctored NBEOs every 2 years. In addition, all CE must be done in North Carolina in person under Lloyd Pate's direct supervision, where he will administer a 100-question pop neuro-ophthalmology quiz. There will also be a short physical fitness exam of 15 push-ups, a mile under 9 minutes, and a juggling test with each hand so that we can verify each OD can put in punctal plugs ambidextrously in under 30 seconds per plug, no insertion tool allowed. There is also a video BIO test where 90% fundus views must be maintained for 60 continuous seconds per eye while the ora serrata is in view at all times.

4. A log of these accomplishments is presented to Congress and John Hymes emails the director of OPM, requesting that the FEDVIP plan be eliminated and integrated into the regular FEP medical plan. Success?!?!?

5. Several new ODs schools continue to open. After collecting three years of tuition, ASCO administers the enhanced NBEO (with pushups) to all fourth years, and 40% of them fail out. The schools brag about its higher standards and how tough OD school is, then collects another batch of tuition. More schools proceed to open, VSP still pays $40.

Basically, and you certainly know this: scope and reimbursement is driven by money. If we can do the what appears to be the same thing cheaper, or if expensive lawsuits strike major employers, changes happen. Otherwise, not.

That's pretty much 99% of what results are driven by. All else is decorative.

Higher standards are for patients. However, ODs, the profession, benefit in knowledge and performance. The overall responsibility is here; the positives for optometry occur over time. Regardless, the world isn’t going to stay the same.

1. Doubling CE and repeating a test for minimal competence q 3 y would be silly. Never wrote it.

2. Again, I’ve suggested nothing of the sort. I like applying amniotic membranes, however. If you‘re having access problems, your state association is crucial. Again, there are no promises. One way to not reimburse is to exclude. I’m not supporting that.

3. Again, I’d never support these ideas.

4. I’m sorry I’ve triggered you at this point. Breathe. ODs do avoid performing DFE. It’s all over social media, a public, permanent documentation of same. Shrewd.

5. ASCO doesn’t administer NBEO; they’d be very upset about a low pass rate. VCPs won’t raise reimbursement when ODs accept the status quo. More colleges will open, yes. No one knows any better as far as I can tell.

Scope enhancements are generally politics, yes. Where optometry misses the point is in the collective cynicism; this sorta comes along when you’re… us. But, it’s not correct or professional. The political reality doesn’t negate the other facts/responsibilities. Tough world. It’s an omission.

Reimbursement is, of course, very, very low. This hits my hospital, too. It’s fundamentally broken unless you’re lucky/fortunate/in the right spot. But, some ODs will race to the bottom. It would be difficult to sue over much of this when providers sign the contracts and that’s up to the providers.

We’re left with the same needs. State and national advocacy. Membership. Higher standards for a competitive, demanding future.

 

[Weihan Wang OD]

Higher standards are for patients. However, ODs, the profession, benefit in knowledge and performance. Regardless, the world isn’t going to stay the same.

This is pretty nebulous.

1. Doubling CE and repeating a test for minimal competence q 3 y would be silly. Never wrote it.

2. Again, I’ve suggested nothing of the sort. I like applying amniotic membranes, however. If you‘re having access problems, your state association is crucial. Again, there are no promises. One way to not reimburse is to exclude. I’m not supporting that.

3. Again, I’d never support these ideas.

4. I’m sorry I’ve triggered you at this point. Breathe. ODs do avoid performing DFE. It’s all over social media, a public, permanent documentation of same. Shrewd.

Not triggered.

My point seems to have blasted right over your head, which is that to ODs in the trenches, to 90% of the dues paying membership..... any push for more homework and paying money to an association that pisses away $18 million in member dues per year on travel and executive compensation, coming from folks that used to be the head of ASCO..... is not going to go over well. It might be valid, even, but it will not ever appeal to most ODs, and will only serve to divide. Hopefully you can take what I've wrote as some feedback for what regular, dial-spinning ODs at Walmart think of your commentary. Not everyone who reads these forums responds to posts.

Finally:

I like applying amniotic membranes, however. If you‘re having access problems, your state association is crucial.

Absolutely, totally, no. An ERISA appeal with the threat of civil penalties is how that is done.

 

[Michael W Ohlson]

The above item cites

This is pretty nebulous.


Not triggered.

My point seems to have blasted right over your head, which is that to ODs in the trenches, to 90% of the dues paying membership..... any push for more homework and paying money to an association that pisses away $18 million in member dues per year on travel and executive compensation, coming from folks that used to be the head of ASCO..... is not going to go over well. It might be valid, even, but it will not ever appeal to most ODs, and will only serve to divide.

I'm sitting here with a group of other ODs today, reading your posts and you probably have a hard time imaging the level of eye rolling that is going on. Hopefully you can take what I've wrote as some feedback for what regular, dial-spinning ODs at Walmart think of your commentary. Not everyone who reads these forums responds to posts.

Finally:

Absolutely, totally, no. An ERISA appeal with the threat of civil penalties is how that is done.

I wish us well in keeping identical standards for academia, licensure, and CE as we push forward into the 21st century. Very realistic. It will turn out well. I suggested none of the items you wrote. You’ve taken standards to mean that you’ll have to pass a test or get a certificate.

Listing ludicrous CE and inappropriate testing might indicate triggered.

No one can make you study, learn, or pay dues to a membership-based org.

You lost me on the ASCO thing. I have not idea what you’re writing.

I don’t mind the eye-rolling. Don’t care. I don’t require feedback as I’m not in charge or elected.

If it would be such an easy lawsuit and win, why hasn’t it been done? It sounds simple. So, why?

 

[Weihan Wang OD]

You lost me on the ASCO thing. I have not idea what you’re writing.

I don’t mind the eye-rolling. Don’t care. I don’t require feedback as I’m not in charge or elected.

If it would be such an easy lawsuit and win, why hasn’t it been done? It sounds simple. So, why?

https://www.linkedin.com/in/michael-w-ohlson-1b429551

Certified Enucleator, Director of NBEO, and Past President of ARBO (whoops, wrong abbreviation. ARBO, not ASCO. my mistake). All alphabet soup to me. I apologize if I did not write your correct title(s).

Like I said, just a common dial-spinner here, seeing someone with those credentials advocating for more homework / tests / CE / certified CE / whatever.... and more payments to a top-heavy, ineffective professional association. You're posting on a public part of a public forum, you'll get some feedback.

Nothing personal. All opinion.

 

[Paul Farkas]

Theoretical talk is useful but most suggestions seem to go nowhere.

Rather than talk about improving optometric C/E, CEwire put a major effort in time and money and came up with a program that can be used at minimum cost to ODs and a fair compensation for quality programs and speakers,

CEwire2022 came up with...

1. Low cost per credit hour, paid for by participants not vested corporate interests.

2. National and international recognized OD, MD and PhD presenters

3. A three weekend opportunity to take all 60 credit hours with the speaker standing by to answer questions

4. A designated room where course participants can meet with one another and the speaker, available to answer additional questions

5. All courses will be on demand 24/7 through July 1, 2022 for participant review to guarantee full understanding of the material. The on demand courses have a quiz attached, for those who wish to take it for state board credit, where allowed.

What is missing and essential is proof that the participants are listening and understand the material before a state board credit is issued. To accomplish this, participants must pass a 10 question multiple choice quiz with 70% correct answer. This is automated and to accomplish with optometry colleges standing by to certify.

All that is needed are state boards to get off their backside and move into the 21st century to approve the program.

CEwire2022 should be the test of success of this approach, provided the system does not implode with up to 3K ODs from cooperating states and provinces taking the 60 hours offered simultaneously.

Stay tuned...

 

[Michael W Ohlson]

https://www.linkedin.com/in/michael-w-ohlson-1b429551

Certified Enucleator, Director of NBEO, and Past President of ARBO (whoops, wrong abbreviation. ARBO, not ASCO. my mistake). All alphabet soup to me. I apologize if I did not write your correct title(s).

Like I said, just a common dial-spinner here, seeing someone with those credentials advocating for more homework / tests / CE / certified CE / whatever.... and more payments to a top-heavy, ineffective professional association. You're posting on a public part of a public forum, you'll get some feedback.

Nothing personal. All opinion.

Well, see, you’ve made a sad assumption. You don’t know me, never met me, and assumed incorrect ideas. On you. Completely.

Definitely will need more homework to stay up to speed in this century. Not my fault. I’ve worked to increase innovation in CE. Nothing magic about hrs, seat time, live, etc. You’re simply wrong. I also worked at increasing ease in mobility for ODs. You’re not… right.

Tests: didn’t say that.

CE: CE accreditation is to improve the CE providers. This increases knowledge, performance, and pt outcomes. Optometry lags here. If you want federal intervention, risk to CMS reimbursement, paying for commercials, and/or bad CE at higher cost, that’s on you. If you have no idea what I’m writing, that’s on you.

Certified CE: no clue.

AOA: I’ve not taken their side on a few issues. They seemed upset. You offer no better alternatives and no answer to my question as to the easy lawsuit.

Feedback: Just an OD. Rural. Volunteered a lot. Paid for it… nope. Didn’t take the ARBO per diems as the group lacked money at the time.

Opinion: Everyone has one.

If your friends keep rolling their eyes, they’ll stick like that.

 

[Weihan Wang OD]

AOA: I’ve not taken their side on a few issues. They seemed upset. You offer no better alternatives and no answer to my question as to the easy lawsuit.

What easy lawsuit?

 

[Michael W Ohlson]

What easy lawsuit?

End of #19: If it would be such an easy lawsuit and win, why hasn’t it been done? It sounds simple. So, why?

 

[Weihan Wang OD]

End of #19: If it would be such an easy lawsuit and win, why hasn’t it been done? It sounds simple. So, why?

I didn't mention a lawsuit. Are you talking about the ERISA appeal?

 

[Michael W Ohlson]

I didn't mention a lawsuit. Are you talking about the ERISA appeal?

Ah. On me. You wrote: Absolutely, totally, no. An ERISA appeal with the threat of civil penalties is how that is done.

I saw civil penalties and heard “attorney.”

So, this is what’s occurring?

 

[Weihan Wang OD]

Well, see, you’ve made a sad assumption. You don’t know me, never met me, and assumed incorrect ideas. On you. Completely.

This is a public forum. When you post repeatedly advocating for essentially more homework (in whatever form that takes), and more dues.... what am I to assume? This is what a regular OD sees when he reads your posts.

CE: CE accreditation is to improve the CE providers. This increases knowledge, performance, and pt outcomes. Optometry lags here. If you want federal intervention, risk to CMS reimbursement, paying for commercials, and/or bad CE at higher cost, that’s on you. If you have no idea what I’m writing, that’s on you.

No, more CE red tape does not provably equal better patient outcomes, or at least that is blatant speculation. Do you have a single study that links CE quality / amount to improved patient outcomes in any medical specialty. It might be true, but it is highly speculative.

Feedback: Just an OD. Rural. Volunteered a lot. Paid for it… nope. Didn’t take the ARBO per diems as the group lacked money at the time.

Great, but you are an rural OD with a CV that I have to hit page-down five times to get through, one of the items of which is "Director of NBEO". That's not representative of the guy spinning dials at Walmart.

Opinion: Everyone has one.

If your friends keep rolling their eyes, they’ll stick like that.

Fortunately or unfortunately, they are the constituency and the future of the AOA, and helps nobody if they are alienated.

 

[Weihan Wang OD]

Ah. On me. You wrote: Absolutely, totally, no. An ERISA appeal with the threat of civil penalties is how that is done.

That's what the billers of every (other) medical specialty does when they run into a denial, including the billing department at your hospital, and that has been going on for years. If the insurer / plan administrators violate too many rules, they get sued.

Example: https://classactionsreporter.com/wp-content/uploads/boeing_erisa_complaint.pdf

One of the lead attorneys on that is married to the dry eye ophthalmologist right on the front of ODwire. This is a small, local case in my area that applies to a small, niche mental health treatment practice. Not rare, and this is the actual mechanism of how coverage gets expanded. Boeing paid $900,000 on that and starting covering it. Statements by the relevant state association would have absolutely no teeth. Lawsuits is how things get done incrementally.

 

[Michael W Ohlson]

This is a public forum. When you post repeatedly advocating for essentially more homework (in whatever form that takes), and more dues.... what am I to assume? This is what a regular OD sees when he reads your posts.


No, more CE red tape does not equal better patient outcomes, or at least that is blatant speculation. Do you have a single study that links CE quality / amount to improved patient outcomes in any medical specialty. It might be true, but it is highly speculative.


Great, but you are an rural OD with a CV that I have to hit page-down five times to get through, one of the items of which is "Director of NBEO". That's not representative of the guy spinning dials at Walmart.


Fortunately or unfortunately, they are the constituency and the future of the AOA, and helps nobody if they are alienated.

I’m not sure how you’re not knowing something is in any way my fault or problem. A “regular OD” has the identical responsibilities as whoever represents something more (?) if that exists. I don’t think it does. Held to identical standards. No difference.

Accredited CE: You’re completely lost. Entire medical journals are devoted to CME/CE and accreditation. This is not new; you just don’t know about it. Decades old.

I don’t “represent“ ODs in any office or setting. That‘s advocacy. I‘m sorry that I worked hard... I guess… sorry… no, I’m not.

Again, being alienated by the realities of a regulated profession, the increased accountability across society, the responsibilities of being a doctor, the trends in health care, the person that cites those facts… can’t help.

 

[Weihan Wang OD]

CE: CE accreditation is to improve the CE providers. This increases knowledge, performance, and pt outcomes. Optometry lags here. If you want federal intervention, risk to CMS reimbursement, paying for commercials, and/or bad CE at higher cost, that’s on you. If you have no idea what I’m writing, that’s on you.

Accredited CE: You’re completely lost. Entire medical journals are devoted to CME/CE and accreditation. This is not new; you just don’t know about it. Decades old.

Please link a single study of moderate or larger size in Internal Medicine that causatively connects CE "accreditation" to improved patient outcomes compared to "unaccredited" CE.

How about a single instance of CMS issuing an information letter or memo that states, to an entire profession, that if X certification standards are not met, reimbursements will be cut by X?

How about a single instance of any regulated profession that, due to bad CE, had its scope of practice decreased?

You sound like you know what you're talking about. How about a single example of the above?

 

[Michael W Ohlson]

That's what the billers of every (other) medical specialty does when they run into a denial, including the billing department at your hospital, and that has been going on for years. If the insurer / plan administrators violate too many rules, they get sued.

Example: https://classactionsreporter.com/wp-content/uploads/boeing_erisa_complaint.pdf

One of the lead attorneys on that is married to the dry eye ophthalmologist right on the front of ODwire. This is a small, local case in my area that applies to a small, niche mental health treatment practice. Not rare, and this is the actual mechanism of how coverage gets expanded. Boeing paid $900,000 on that and starting covering it. Statements by the relevant state association would have absolutely no teeth. Lawsuits is how things get done incrementally.

Yes, I’m well aware of ERISA.

I think the state association ODs care, volunteer, and work pretty hard. While I’m fine with suing when required (and given the number of ERISA appeal websites, it’s not unusual), I’m not on board with this somehow being a reason to avoid advocacy membership. It makes more sense to support the state association than not. I think we’ve covered it.

 

[Michael W Ohlson]

Please link a single study of moderate or larger size in Internal Medicine that causatively connects CE "accreditation" to improved patient outcomes compared to "unaccredited" CE.

How about a single instance of CMS issuing an information letter or memo that states, to an entire profession, that if X certification standards are not met, reimbursements will be cut by X?

How about a single instance of any regulated profession that, due to bad CE, had its scope of practice decreased?

You sound like you know what you're talking about. How about a single example of the above?

First, I don’t work for you.

If you have an interest in CME/CE accreditation, look here: https://accme.org/

And, here: https://journals.lww.com/jcehp/pages/default.aspx

If you have interest in standards for commercial support of CME, read this first: https://www.finance.senate.gov/imo/media/doc/prb042507a.pdf

Have fun.

Actually, I have year after year of articles, attained expert speakers for ARBO, etc. You’ll have to read on your own.

I’m unaware of a scope decrease. I suppose it’s possible, but I doubt CE would be the impetus. CE is used as a political football at times, though.

 

[Weihan Wang OD]

First, I don’t work for you.

If you have an interest in CME/CE accreditation, look here: https://accme.org/

And, here: https://journals.lww.com/jcehp/pages/default.aspx

If you have interest in standards for commercial support of CME, read this first: https://www.finance.senate.gov/imo/media/doc/prb042507a.pdf

Have fun.

Actually, I have year after year of articles, attained expert speakers for ARBO, etc. You’ll have to read on your own.

I’m unaware of a scope decrease. I suppose it’s possible, but I doubt CE would be the impetus. CE is used as a political football at times, though.

Great. Not a single article linking CE content to patient outcomes as you've claimed above.

I looked in https://www.finance.senate.gov/imo/media/doc/prb042507a.pdf. In 114 pages of fine print, the document contains the word "patient" zero times and "patients" seven times. The word "outcome" appears 0 times. None of the paragraphs or sentences containing those words reference objective criteria that links CE funding source, quality, content, etc. to patient outcomes... not even remotely.

But seems like this thread has played out. Good convo.

 

[Michael W Ohlson]

Great. Not a single article linking CE content to patient outcomes as you've claimed above.

I looked in https://www.finance.senate.gov/imo/media/doc/prb042507a.pdf. In 114 pages of fine print, the document contains the word "patient" zero times and "patients" seven times. None of the paragraphs or sentences containing those words reference objective criteria that links the funding source, quality, content, etc. to patient outcomes... not even remotely.

But seems like this thread has played out. Good convo.

Well, not quite. If you look at ACCME and JCEHP, you’ll see “patient outcomes” as crucial. You’ll need to read. You’ll find Donald Moore, PhD, to be an expert and easy to read. He’s a nice man. You’ll find accredited CME/CE to be effective at a community level at times. Not always; at times.

The SFC Report of 2007 was not about pt outcome or CE accreditation. It involves the demand for enforced standards for commercial support of CME. You asked for evidence of a profession being threatened; I provided the SFC.

 

[Michael W Ohlson]

For those interested in CE and physician learning, here is one proposal from 2009. Somewhere back in the ‘90s, medicine began questioning the value of some CME.

There is not one answer; there are many questions, many answers, and some concepts that have merit. Technology has assisted in this. I had a few moments and found some articles, but I’m using them for a new project and tech. Plus, there’s no way to have a useful conversation when people use differing terms/jargon.

This is a nice introduction to the area for the few having interest:

https://www.sacme.org/Resources/Documents/Virtual Journal Club/Moore_evaluation_article.pdf

 

[Michael W Ohlson]

Great. Not a single article linking CE content to patient outcomes as you've claimed above.

Having had a nice evening, I’ll come back to this. Since the above statement indicates disbelief with a hint of attitude, I’ve pulled a fairly simple reference from a decent set of authors. The concepts of physician learning theory and standards (SII) are hallmarks of CME accreditation. Systemic reviews can attain a decent level of evidence. When combined with the links to the SFC Report of 2007, the ACCME website loaded with accreditation information, the site for a journal devoted to improving CE, and the link to a Moore article, one can get a sense of where things have gone across health care over many years. Not knowing is just not knowing.

It won’t improve VCP reimbursement, no. That’s not the purpose.

https://pdfs.journals.lww.com/jcehp/2015/35020/The_Impact_of_CME_on_Physician_Performance_and.8.pdf?token=method|ExpireAbsolute;source|Journals;ttl|1643617241161;payload|mY8D3u1TCCsNvP5E421JYK6N6XICDamxByyYpaNzk7FKjTaa1Yz22MivkHZqjGP4kdS2v0J76WGAnHACH69s21Csk0OpQi3YbjEMdSoz2UhVybFqQxA7lKwSUlA502zQZr96TQRwhVlocEp/sJ586aVbcBFlltKNKo+tbuMfL73hiPqJliudqs17cHeLcLbV/CqjlP3IO0jGHlHQtJWcICDdAyGJMnpi6RlbEJaRheGeh5z5uvqz3FLHgPKVXJzdsvmI1HkvV33hNY39tQPM6czGr/pJWqzQJjshOpayQHg=;hash|3vMs6gtun4iIKs1h9KXB0A==

 

[Weihan Wang OD]

https://pdfs.journals.lww.com/jcehp/2015/35020/The_Impact_of_CME_on_Physician_Performance_and.8.pdf?token=method|ExpireAbsolute;source|Journals;ttl|1643617241161;payload|mY8D3u1TCCsNvP5E421JYK6N6XICDamxByyYpaNzk7FKjTaa1Yz22MivkHZqjGP4kdS2v0J76WGAnHACH69s21Csk0OpQi3YbjEMdSoz2UhVybFqQxA7lKwSUlA502zQZr96TQRwhVlocEp/sJ586aVbcBFlltKNKo+tbuMfL73hiPqJliudqs17cHeLcLbV/CqjlP3IO0jGHlHQtJWcICDdAyGJMnpi6RlbEJaRheGeh5z5uvqz3FLHgPKVXJzdsvmI1HkvV33hNY39tQPM6czGr/pJWqzQJjshOpayQHg=;hash|3vMs6gtun4iIKs1h9KXB0A==

Thanks for posting that; I am happy to see at least a little bit persistence in proving your point instead of the usual forum content of deteriorating to personal attacks, politics, and COVID related tangents.

That being said, I have finished reading the item you posted in its entirety as well as all the referenced material and was not at all surprised to discover the almost nonexistent nexus between CME and patient outcomes, and a total lack of support for "accredited" CE being better than "non accredited" CE as you have been pushing.

The item posted is a synthesis of 8 systematic reviews in the CME literature existing between 2003 and 2015 (date of publication) where some link between CME attributes (interactivity, duration, etc) and "physician performance and patient outcomes" was measured. In other words, the posted item is a summary-of-summaries of various individual studies that includes all or most of the studies done on that matter in that span of time. Some of the studies underlying the systematic reviews go back into the 1990s, so this is fairly comprehensive.

It should be mentioned that this summary was written by Ronald Cervero, a career teacher-of-teachers on the subject of how to teach teachers, and Julie Gaines, who holds a Master's degree in library science.

Let's get into a deep dive into the eight systematic reviews underlying the synthesis:

Study 1: https://pubmed.ncbi.nlm.nih.gov/24522680/
Conclusion: Online PBL is a useful method of delivering continuing medical education. There is limited evidence that PBL in continuing education would enhance physicians' performance or improve health outcomes.
>>> Not starting off strong here.

Study 2: https://pubmed.ncbi.nlm.nih.gov/16110718/
Results: Interactive techniques (audit/feedback, academic detailing/outreach, and reminders) are the most effective at simultaneously changing physician care and patient outcomes. --- Didactic presentations and distributing printed information only have little or no beneficial effect in changing physician practice.
>>> This systematic review is actually composed of even more systematic reviews and meta-analyses. Aside from categorically discounting all conventional didactic CE, this summary-of-summaries-of-summaries concludes that "academic detailing" and “reminders” would be nice. That means Michael flies to your office, like a pharma rep, to audit your gonioscopy once in a while, and you will also receive a weekly text reminding you to remind patients about warm compresses.

Study 3: https://pubmed.ncbi.nlm.nih.gov/19265075/#:~:text=The amount or frequency of,effective in changing physician performance.
Results: The review found 105 studies, which evaluated the impact of CME on short- and long-term physician practice performance. Nearly 60% met objectives relative to changing clinical performance in prescribing; screening; counseling about smoking cessation, diet, and sexual practices; guideline adherence; and other topics
>>> Stated differently, about 57% of fully accredited CME succeeded in causing MDs to remember to tell their patients to wear a condom and not smoke. There is no conclusion about patient outcomes.

Study 4: https://pubmed.ncbi.nlm.nih.gov/19370580/
Results: ---- the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention ---
>>> A 6% increase in MD behaviors like reminding people to not smoke when comparing CE with no CE at all. Instead of ODs remembering to tell patients about warm compresses 37% of the time (with CE) instead of 31% of the time (without CE), perhaps those taking “accredited” CE will remind patients 38% of the time.

Study 5: https://pubmed.ncbi.nlm.nih.gov/19265077/
Conclusions: The AHRQ Evidence Report provides no conclusions about the ways that internal or external factors influence CME effectiveness in changing physician behavior.
>>> Self explanatory: "no conclusions".

Study 6: https://pubmed.ncbi.nlm.nih.gov/17385735/
Discussion: The meta-analysis suggests that the effect size of CME on physician knowledge is a medium one; however, the effect size is small for physician performance and patient outcome.
>>> It's not possible to tell what kind of "effects" are being studied here. Again this concludes that the total effect of CME is "small" for patient outcomes; there is no conclusion about "accreditation" other than that longer, interactive CEs is better than shorter, passive ones. All states mandate CE type and duration already.

Study 7: https://pubmed.ncbi.nlm.nih.gov/17764217/
Results: Of the 68,000 citations identified by literature searching, 136 articles and 9 systematic reviews ultimately met our eligibility criteria. The overall quality of the literature was low and consequently firm conclusions were not possible.
>>> Self explanatory. At least we have honesty.

Study 8: https://pubmed.ncbi.nlm.nih.gov/19265076/
Conclusions: Further research is required to identify the qualities essential for measuring causal linkages thought to exist among CME, physician behavior, and clinical outcomes.
>>> That's research speak for "we didn't find jack squat but we need another grant".

You posted a comprehensive literature review of everything pertaining to CME-to-outcomes between 2003 - 2015 for all of medical CME. A couple of low quality studies indicate that CE vs no CE may cause MDs to remind patients about STDs at about a 6% increased rate. One study shows that all didactic CE is worthless but things like having OD professors show up at your office to test your BIO skills may be helpful. Other studies conclude that the literature quality studying the relation between CME and patient outcomes is low, and that no conclusions can be drawn. No study showed a linkage between third-party approval of CE (accreditation) and patient care outcomes.

Based on all that, which you posted... you believe that if we don't "accredit" our CE, patient outcomes will be impacted, so much so that we will have the Feds cutting Medicare reimbursement to optometrists --

If you want federal intervention, risk to CMS reimbursement

-- and you wonder why nobody takes it seriously?

 

[Michael W Ohlson]

Thanks for posting that; I am happy to see at least a little bit persistence in proving your point instead of the usual forum content of deteriorating to personal attacks, politics, and COVID related tangents.

That being said, I have finished reading the item you posted in its entirety as well as all the referenced material and was not at all surprised to discover the almost nonexistent nexus between CME and patient outcomes, and a total lack of support for "accredited" CE being better than "non accredited" CE as you have been pushing.

The item posted is a synthesis of 8 systematic reviews in the CME literature existing between 2003 and 2015 (date of publication) where some link between CME attributes (interactivity, duration, etc) and "physician performance and patient outcomes" was measured. In other words, the posted item is a summary-of-summaries of various individual studies that includes all or most of the studies done on that matter in that span of time. Some of the studies underlying the systematic reviews go back into the 1990s, so this is fairly comprehensive.

It should be mentioned that this summary was written by Ronald Cervero, a career teacher-of-teachers on the subject of how to teach teachers, and Julie Gaines, who holds a Master's degree in library science.

Let's get into a deep dive into the eight systematic reviews underlying the synthesis:

Study 1: https://pubmed.ncbi.nlm.nih.gov/24522680/
Conclusion: Online PBL is a useful method of delivering continuing medical education. There is limited evidence that PBL in continuing education would enhance physicians' performance or improve health outcomes.
>>> Not starting off strong here.

Study 2: https://pubmed.ncbi.nlm.nih.gov/16110718/
Results: Interactive techniques (audit/feedback, academic detailing/outreach, and reminders) are the most effective at simultaneously changing physician care and patient outcomes. --- Didactic presentations and distributing printed information only have little or no beneficial effect in changing physician practice.
>>> This systematic review is actually composed of even more systematic reviews and meta-analyses. Aside from categorically discounting all conventional didactic CE, this summary-of-summaries-of-summaries concludes that "academic detailing" and “reminders” would be nice. That means Michael flies to your office, like a pharma rep, to audit your gonioscopy once in a while, and you will also receive a weekly text reminding you to remind patients about warm compresses.

Study 3: https://pubmed.ncbi.nlm.nih.gov/19265075/#:~:text=The amount or frequency of,effective in changing physician performance.
Results: The review found 105 studies, which evaluated the impact of CME on short- and long-term physician practice performance. Nearly 60% met objectives relative to changing clinical performance in prescribing; screening; counseling about smoking cessation, diet, and sexual practices; guideline adherence; and other topics
>>> Stated differently, about 57% of fully accredited CME succeeded in causing MDs to remember to tell their patients to wear a condom and not smoke. There is no conclusion about patient outcomes.

Study 4: https://pubmed.ncbi.nlm.nih.gov/19370580/
Results: ---- the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention ---
>>> A 6% increase in MD behaviors like reminding people to not smoke when comparing CE with no CE at all. Instead of ODs remembering to tell patients about warm compresses 37% of the time (with CE) instead of 31% of the time (without CE), perhaps those taking “accredited” CE will remind patients 38% of the time.

Study 5: https://pubmed.ncbi.nlm.nih.gov/19265077/
Conclusions: The AHRQ Evidence Report provides no conclusions about the ways that internal or external factors influence CME effectiveness in changing physician behavior.
>>> Self explanatory: "no conclusions".

Study 6: https://pubmed.ncbi.nlm.nih.gov/17385735/
Discussion: The meta-analysis suggests that the effect size of CME on physician knowledge is a medium one; however, the effect size is small for physician performance and patient outcome.
>>> It's not possible to tell what kind of "effects" are being studied here. Again this concludes that the total effect of CME is "small" for patient outcomes; there is no conclusion about "accreditation" other than that longer, interactive CEs is better than shorter, passive ones. All states mandate CE type and duration already.

Study 7: https://pubmed.ncbi.nlm.nih.gov/17764217/
Results: Of the 68,000 citations identified by literature searching, 136 articles and 9 systematic reviews ultimately met our eligibility criteria. The overall quality of the literature was low and consequently firm conclusions were not possible.
>>> Self explanatory. At least we have honesty.

Study 8: https://pubmed.ncbi.nlm.nih.gov/19265076/
Conclusions: Further research is required to identify the qualities essential for measuring causal linkages thought to exist among CME, physician behavior, and clinical outcomes.
>>> That's research speak for "we didn't find jack squat but we need another grant".

You posted a comprehensive literature review of everything pertaining to CME-to-outcomes between 2003 - 2015 for all of medical CME. A couple of low quality studies indicate that CE vs no CE may cause MDs to remind patients about STDs at about a 6% increased rate. One study shows that all didactic CE is worthless but things like having OD professors show up at your office to test your BIO skills may be helpful. Other studies conclude that the literature quality studying the relation between CME and patient outcomes is low, and that no conclusions can be drawn. No study showed a linkage between third-party approval of CE (accreditation) and patient care outcomes.

Based on all that, which you posted... you believe that if we don't "accredit" our CE, patient outcomes will be impacted, so much so that we will have the Feds cutting Medicare reimbursement to optometrists --

-- and you wonder why nobody takes it seriously?

It doesn’t really matter if I’m persistent. The die on this is cast. What occurs, the reaction, is up to optometry. That doesn’t provide optimism at this juncture. The last years haven’t provided evidence of a unified, strong health care mission. Half-assing, capture, suggested guidelines rather than enforced standards, shortcuts, improper terminology or failure to understand… not good. Given what occurred with SCS (now AII) and BC, those outcomes are possible in optometry. Can’t fix that; one has to hope that younger, smarter, better ODs will step up.

I’ve provided a link to ACCME, a website containing a wealth of information on accreditation and the interprofessional efforts. Readers will find the concept to be well-accepted and significant across medicine, pharmacy, nursing, etc. It’s not small, new, or going away. The JCEHP website demos same. Done deal. Not going away.

The SFC Report of 2007 did not mean the sky was falling, but it shifted the field. This is relevant to CE providers, industry, and to those receiving federal reimbursement. As CE is the currency for relicensure, ineffectiveness and commercial bias become public welfare issues at a state gov’t’ level. It’s most likely better to address things proactively than to not know or care. Not going away.

The systemic review from 2015 seemed like a nice intro and it’s an article I’m not using on a current project. One finds no shortage of new data. The Moore article is a brief intro to a few of the concepts/directions. There’s far more. Not going away.

Repeating, the drive of accredited CME/CE (CME will drop the ‘M’ over time so as to be inclusive) isn’t stopping because of optometry. Not knowing isn’t somehow a plus.

Your negative take on physician learning and improvement isn’t new or surprising. In fact, there’s resistance for a few reasons, most of which are pretty sad. A couple of bits are realistic dilemmas. Most of the work done in advocacy and regulatory optometry represents volunteer effort. We’re small and relatively underfunded. We’re close to twenty years behind at this point. No less than fifteen years behind, certainly. In addition, a group cynicism or habitual negativity has become prevalent. But, the responsibilities remain the same. The trends are real. Mere opinions don’t alter those. You don’t really know more about this than the authors/professionals. I don’t.

Whatever occurs, I’ll be fine. No one can force a HCP to learn or to care, frankly.

 

[Michael W Ohlson]

I’ve asked no or few questions on this thread. I’m curious:

Is CE to stay the same? Seat time. Fifty minute time periods. Passive lecture. Topic chosen based upon available industry support or convenience for the planner. Physician learning isn’t a thing. This is the plan, then? Entire structures are wrong, nothing is changing, and we’ll slip under the rug. Forever. Shrewd.

State associations: don’t join. That’s the plan. Sound reasoning.

Scope: definitely politics. So, nothing else matters. Nothing. This is the plan. That’ll work out well. For a few. Maybe. Depends upon the jurisdiction and setting.

Optometry: A future of monocular refraction and imaging for a screening, both of which can be done by non-ODs, while creating more colleges placing new ODs $200K in debt. Good plan.

I think it’s all kinda related. It’s not a conspiracy as those take thought and coordination.

Oh, well. Fourth outreach pt is dilating. Good coffee. I’m behind on EMR. I loathe EMR; the best rates a D+. VCPs will continue to reimburse poorly. The hospital has identical issues as private practice, just more of them. And, since you mentioned it, there’s a pandemic. Really, CE accreditation is an odd hobby. Fell into it. I’ll be retired before optometry is capable of pulling it off properly and it might not happen at all. That is correct.

 

[Ken Elder]

I don't have strong feelings about accredited vs not accredited.

I have always felt though that the biggest problem with most optometric CE is that it's not helpful for the average optometrist.

I find that it's either much too basic.....like....I don't need to hear another 90 minute lecture on the "latest therapies for allergic conjunctivitis."

-OR-

It's so incredibly over the top where you have a scenario where a doctor who works at a tertiary referral center presents a two hour lecture on obscure retinal dystrophies they saw in their clinic after the patient saw seven optometrists and four ophthalmologists until finally the patient ended up at the tertiary referral center where they were diagnosed with a condition that occurs with an incidence of one in seven million but only in Easter European Ashkenazi Jews.

Neither of those is helpful.

I don't need another lecture on diabetic retinopathy. But a lecture on diabetes would be great.
I don't need another lecture on hypertensive retinopathy. But a lecture on hypertension would be great.
I don't need another lecture on Grave's disease. But a lecture on thyroid dysfunction would be great.