focus on low vision

Healthcare Reform and Vision Rehabilitation

by Cynthia Stuen, PhD

With healthcare reform on the horizon, several coalitions are working to make sure vision impairment and its rehabilitation be recognized.

Those broad-based coalitions, whose members total some 180 organizations, include:

■ VisionService Alliance—a membership organization of more than 80 not-for-profit vision rehabilitation organizations and schools. Lighthouse International is working closely with this group.

■ The Vision Advocacy Coalition—convened by Prevent Blindness America, it is comprised of the American Academy of Ophthalmology, the American Optometric Association, The Vision Council, and National Alliance for Eye and Vision Research.

■ The Legislative Working Group—this coalition includes, among others, the American Foundation for the Blind, American Council of the Blind, and National Industries for the Blind.

CONGRESSIONAL COMMUNICATIONS

In addition to creating a unified voice when it comes to healthcare reform, the groups have also been active in communicating with Congress. Among their activities:

■ Ensuring that the Congressional Vision Caucus is kept informed.

■ Targeting the tri-committees in the House of Representatives and then the Senate Finance, as well as H.E.L.P. (Health, Education, Labor, and Pensions) Committees.

The message to Congress has been one that seeks to incorporate all aspects of vision care—particularly low vision and other vision rehabilitation modalities—into the pending health reform bills.

THE MESSAGING

Here is part of the coalitions' reasoning.

■ INTERVENTION. It makes good sense to avert or prevent excess disability by providing a small amount of intervention for someone losing vision to macular degeneration, glaucoma, or diabetic retinopathy, for example, early on in the progression of the eye disorder. It can mean the difference between a lifetime of dependence versus independence.

■ BLINDNESS. Those with blindness or those who meet the “legal blindness” definition have a reimbursement mechanism for services available in each state.

■ LOW VISION. More than 90 percent of people identified as visually impaired are not totally blind but rather have low vision. Growing numbers of aging baby boomers are being diagnosed with low vision disorders, but because they do not meet the definition of legal blindness, they don't have access to critical services.

SECONDARY SAVINGS There's another, though often overlooked, reason for including coverage for the vision impaired. Increasing the independence and safety of people with visual impairments improves their quality of life. It also saves money by preventing other injuries that can result from loss of vision. In fact, visually impaired patients are at four times greater risk of having a hip fracture than sighted individuals of the same age. Preventing such falls or limiting health risks will significantly reduce long-term healthcare costs.

PROPOSED CHANGES

To address this gap, the coalitions have been advocating for inclusion of vision rehabilitation professionals as these changes can easily be incorporated into the healthcare reform legislation currently debated in the Senate.

■ LANGUAGE REQUEST. Senator John D. Rockefeller's staff reached out to Lighthouse International in November 2009 and requested specific language that could be considered for an amendment to the Senate Health Reform agenda.

■ SUMMARY RESPONSE. Following is a summary of the response and inclusion information: Vision rehabilitation professionals should be covered providers under healthcare reform. Vision rehabilitation is conducted by nationally certified professionals (including certified vision rehabilitation therapists, certified low vision therapists, and certified orientation and mobility specialists) and each instructs people with visual impairments on the best ways to utilize remaining sight and senses. Recommended inclusion area in Social Security Act, Title 18 (Medicare, Part B) Section 1861 [42 U.S.C. 135x]. Recommend adding as own section under (s)(2) (A)Vision Rehabilitation Services.

■ COSTS. Of course, legislators want to know the cost. After working with Kevin Frick, PhD, a health economist from Johns Hopkins Bloomberg School of Public Health, it was determined that the coalition estimated costs for coverage of the current certified vision rehabilitation workforce would be less than $25 million per year.

The time has come for vision rehabilitation to be on the radar screen and be fully recognized for its important contributions to maintaining quality of life and independence. EB

Dr. Stuen is senior vice president, evaluation and education, at Lighthouse International (cstuen@lighthouse.org).