Regulatory Issues

Senior Eye Associates is committed to delivering the highest quality eye care with efficiency and appropriate utilization within the regulatory framework.

Referrals and Surgery

Senior Eye Associates is concerned with the overuse of referrals and unnecessary surgery performed on residents of long term care facilities. Our primary care Optometrists are highly trained and qualified in ocular diagnosis and treatment. Routine cataract, glaucoma, and diabetic patients do not require further referral and can be monitored at the facility. Our optometrists refer patients to ophthalmology if the patient requires further diagnostic testing, treatment is required that is outside the optometrist’s scope of practice, and/or surgery is recommended.

Senior Eye Associates has a long standing protocol regarding potential surgical candidates. Not only must the resident desire the surgery, but their Power-of-Attorney for Healthcare, or closest family member, and Attending Physician agree to the procedure. After these steps have been taken and documented, arrangements are made for surgery. One must remember that cataract surgery is an elective procedure to improve a patient’s quality of life. Only when there is a potential benefit to the patient should surgery be undertaken. It is collectively the patient, POA, primary care physician, and ophthalmologist’s decision for or against surgery.

Authorizations for Examination

Beginning in 1997, all Medicare recipients residing in nursing homes require authorization for examination as indicated in the following Medicare regulation.

To authorize an eye examination in a Nursing Facility there must be:

An order by the Attending Physician or
A request by the patient, or their representative.

Senior Eye Associates strictly adheres to this Medicare regulation prior to examining any resident for the first time. NOTE: This does not apply to established patients of the practice.

For further information go to www.wpsmedicare.com/provider/pdfs/eyecare_notes.pdf.