Assessing the need for on-site eye care professionals in community health centers.

Poor vision health severely impacts school and work performance, quality of life, and life expectancy, and results in billions of dollars in medical expenditures each year. While eye and vision problems are often associated with age, low income and racial and ethnic minorities also have elevated risk of eye problems. Federally-funded community health centers, which are mandated to provide comprehensive primary care in underserved communities, are often the only option to improve vision health for low-income residents. With respect to certain chronic conditions, health centers are able to provide high quality care that meets or exceeds national benchmarks despite limited financial resources, a shortage of primary care providers, and greater health care demands. What is not well known, is the extent to which health centers are able to provide on-site professional vision care. Our analysis found that seven out of 10 health centers do not staff on-site eye care professionals to provide comprehensive eye exams. Rather, many health centers rely on referral arrangements with local optometrists and ophthalmologists for such services. Major barriers to providing on-site comprehensive eye care services include the inability to afford necessary space/equipment and the perceived lack of reimbursement or inadequate reimbursement from Medicaid, Medicare and private insurers. Health centers indicated also that they also need assistance in developing a business plan, designing space, and developing an inventory of eye care equipment. While the lack of health insurance coverage, differences in Medicaid coverage and benefits across states, and inadequate reimbursements are likely to limit capacity and access to vision care professionals, another challenge may be patient's general lack of understanding about the need for routine eye exams. Therefore, strategies to improve access to vision care must go beyond developing financial incentives and restoring eye care professionals for eligible placements in underserved communities, to include education about the importance of routine eye care exams.