PECAA’s Integrated Eye Care Initiative strives to make Members aware of significant changes in the health care industry and health care reform that could affect independent optometry. In this article, we sit down with Dr. Jim Grue, Director of the Integrated Eye Care Initiative, as he’s been following what’s happening in Washington and the change in policy that is currently occurring in our country that will impact your practice.

Question: Most optometrists are not aware of something called the 21st Century Cures Act. What is it?

The 21st Century Cures Act is a large piece of legislation that was passed in the final months of the Obama Administration. The reason most providers have not heard about the act is that it is still in the process of being interpreted and the proposal on how to implement it is being worked on now. The public comment period on the proposed implementation just ended a few weeks ago.

Question: Why will the 21st Century Cures Act affect optometrists and ophthalmologists?

Up until this point everything put in place through the Affordable Care Act had been voluntary for providers. Although Meaningful Use paid providers to adopt electronic health records that included the tools necessary to deliver patient-centered, outcome based care, many providers, even though they took the incentive money associated with Meaningful Use, were not using the tools that were built into their EHRs to actually deliver outcome-driven care.

The slow rate of adoption by providers is what prompted the passage of the 21st Century Cures Act.  It basically changes many aspects of healthcare reform from being voluntary to being mandatory.

Question: Why should providers care about the 21st Century Cures Act?

The most important thing for every provider to understand is that we are all voting now on how aggressively the 21st Century Cures Act will be implemented, even if it is unknowingly and passively.

The act is designed to make sure that every provider is communicating electronically with other healthcare providers. It is also designed to make sure that every provider is measuring clinical outcomes through a registry and using that information to put in place a process to continuously improve their delivery of care.

Every provider (eye care or any other medical provider) who isn’t doing those two things is casting their vote for ONC to implement the 21st Century Cures Act in an aggressive manner. ONC is watching select areas of medicine to determine the percentage of providers that will “voluntarily” do these two things. They are watching the PECAA IECI as the indication for eyecare. If we can show them that eye care providers will voluntarily implement these two initiatives, then they won’t have to implement the mandatory requirements possible with an aggressive implementation of the 21st Century Cures Act.

Under the proposed implementation, if a patient tells you they want their information sent somewhere, you would be obligated to send all of their clinical data, all of their financial data, and all of the administrative information you have on that patient. The act puts in place financial penalities for you and your EHR if you are unable or unwilling to do this.

The act is prompting companies outside healthcare to enter this space. These companies will drive outcome based results, quality review of exams and serve as a  single source for the patient to obtain all of their health information.

If this stuff sounds like science fiction, understand, your current certified EHR already has most of the fundamental capability to do these things, and the things that aren’t there can easily be mandated in the next level of EHR certification.

Just a couple of examples of what your actions are voting for. An aggressive implementation of the 21st Century Cures Act will allow any online competitor that is selling glasses or contact lenses the technical ability, with the patient’s permission, to go into your EHR and extract the final spectacle and CL Rx without your knowledge. If your EHR, or you, block that from occurring, or are unable to provide electronic access, you and your EHR would be subject to significant financial penalties per occurrence.

Question: What should eye care providers be doing now? What is in our control versus what’s not?

The choice is to voluntarily use the Direct Messaging that is built into your EHR already, and sign up for a registry now, or wait and see what happens. If you are passively voting for the wait-and-see approach, make sure to spend time to understand exactly what you are waiting for, as the above items are only a small list of the ways an aggressive implementation of the 21st Century Cures Act will affect practices.

If you choose to start utilizing Direct Messaging and make the move to measure clinical outcomes, then let your IECI Team know so that we can accurately represent how many of our Members are voluntarily doing these things to the key decision makers in Washington, DC. Once you get setup to transfer one message through Direct Messaging, the IECI Team will add you to our list of optometrists who are doing this and it will help our case as we meet and provide demonstrations to key decision makers in DC next month.

I’d like to emphasize that we are here to support PECAA Members in a way that no other alliance group in the country has chosen to do. We have many resources on the website to help you understand what Direct Messaging is, whether your EHR has implemented it, and to what degree it has been made user friendly. We also have a document on the website titled, “The What, Why and How of Direct Messaging” and it provides all the information you need to get this technology activated and to test it outside a clinical setting.

Most importantly, the technology we are referencing is extremely practical and beneficial for practices. We are supporting many providers around the country to use it to add efficiency in working with other providers, enhance relationships with other practices and to build a referral network.

Question: Can you expand on those thoughts and tell us more about how this can benefit Member practices?

For instance, you can be sending and receiving diabetic reports with primary care practices in your community. You can be receiving information about new and existing patients, including height, weight, labs, validated A1c scores and patient demographics which can save time in creating a new patient account and/or updating this information in your EHR. All of this information can be “absorbed” or “consumed” by the EHR automatically and save you 10-15 minutes in data entry for that patient, plus you have an added level of confidence that the information is accurate since it is validated and from another medical provider (you are not relying solely on the patient to provide this information).

You’ll have the latest information about the patient so you can engage with the patient in a much more knowledgeable and impactful way – in a way that aligns with the messaging that patient is receiving from their other care providers. In fact, having this added level of information and alignment in
messaging with the other providers on a patient’s care team can even (and should) foster new referrals to your practice from these providers who are made aware of your approach.

All of this sets practices up for success to be able to make the transition to measuring clinical outcomes which is the biggest potential way you can impact the quality of care you are providing, the referrals coming to your practice and even your ability to influence payers. This is the biggest area of focus for the Integrated Eye Care Initiative Team and how we are supporting the members of PECAA.

Interested in Learning More About PECAA’s Integrated Eye Care Initiative?

PECAA’s Integrated Eye Care Initiative is included in a standard PECAA Membership and comes at no additional cost to Members. Enjoy an arsenal of resources helping providers understand health care reform, how it will affect them (on both a local and national level), and enjoy access to PECAA’s IECI Advisors that will help you navigate and implement changes in your practice that will help shape the future of the eye care industry.

We would welcome the opportunity to speak with you directly to answer any questions you may have about the IECI Program or PECAA Membership. Please fill out an inquiry form here and a representative will be in touch with you soon. Or, simply e-mail PECAA at or by calling 503.670.9200.

Download Our Ultimate Checklist for Running a Successful Optometry Practice

This checklist will help audit key areas of your practice and guide you toward sustainable, long-term success and growth.

Please complete the following form to download the ultimate checklist for running a successful optometry practice