Accommodating patients with a hearing disability

What your obligations are and are not

Sooner or later, a practice will face a communication challenge when a patient with a hearing impairment schedules an appointment. The protocol on how to deal with this type of disability in an examination has led to some confusion in the past.

First and foremost, an optometric office, regardless of the title ‘private practice,’ is a public accommodation. As a public accommodation, steps to ensure the practice and services are accessible to individuals with disabilities should be taken. Individuals with disabilities, as defined by the September 2008 amended Americans with Disabilities Act (ADA), are those with a physical or mental impairment that substantially limits one of more major life activities of such individual; a record of such an impairment; or being regarded as having such impairment.

Patients with a hearing impairment may request a sign language interpreter, but an optometrist is not required to hire one unless both parties have agreed on it. Other means of communication are an option, like having a family member of the patient or a certified employee interpret, writing a conversation with the patient on a note pad, or using various tools like a computer or phone to communicate. Auxiliary aids or services should be agreed upon prior to the scheduled appointment.

An optometrist is permitted to deny the use of an interpreter if there is proof that the cost or service of the interpreter would be an undue burden. An undue burden is a significant difficulty or expense for the practice. Factors in deciding the inclusion of an interpreter are: cost against financial status of the practice, the need for enhanced communication and the availability of the service desired. If an interpreter is needed, the optometric office is responsible for covering the cost. The patient holds no obligation to incur the fee. Passing this cost along to the patient would be a violation of the ADA, as would refusing to see the patient based on the needs of their disability or referring the person to another physician solely because the patient wants an interpreter.

The person with disability is entitled to only reasonable accommodation and cannot demand an interpreter if other alternative services are available. If no satisfactory services can be found, the practitioner is required to provide an interpreter. The downside to this justification is that ‘satisfactory’ differs for each person, but this means an interpreter is not always necessary. If a reasonable alternative is found, and would otherwise be acceptable, the patient cannot refuse the accommodation.

If hiring an interpreter, the best way to find one would be through a licensed audiologist. Using one of these professionals can ensure premium service and occasionally a discount.

Under the ADA, an optometrist is responsible to accommodate every disabled patient wanting to use the practice’s services, but are not obligated to accommodate with only an interpreter. Exploring all options is beneficial to the practice and the patient, who may assume the only option is an interpreter. Discussing all available auxiliary aids and services with patients helps to reduce financial cost in the long run. A person may not be denied an appointment or referred away from the practice based on their disability or desire to have accommodations made.

Optometry's Meeting®

AOA and POA members surged to Philadelphia in full-force for AOA's annual Optometry's Meeting®. The Pennsylvania Optometric Association had the honor of hosting the meeting. Below are some photos highlighting POA's involvement in the event.

Dr. Boltz, president of POA, waits to proudly represent Pennsylvania in the flag procession.

Dr. Boltz addresses attendees at the Opening General Session of Optometry's Meeting in Philadelphia.

Roberta Beers, CPOT accepts the 2014 Paraoptometric of the Year Award presented by AOA President Dr. Mitchell Munson.

Former figure skater Scott Hamilton entertains and enlightens the audience after the awards ceremony.

Dr. James Spangler discusses the Kids Welcome Here® program with attendees in the Exhibit Hall.

Dr. Boltz, Dr. Lori Gray and Dr. Robert Owens (dressed as John McAllister) pose with Benjamin Franklin, the special guest invited to POA's member reception.

Have some photos from Optometry's Meeting® that you want to share? 
Email Kelsey@poaeyes.org and you might see your photo on this blog or our Facebook page!

Please only submit photos belonging to you.

Vision Expo East

For members heading to New York for Vision Expo East from March 27-30, don't forget about the benefits you receive as a POA member:

• Free exhibit hall pass – a $75 value 
• Complementary lunch in Club Vision on Friday, Saturday and Sunday 
• Exclusive discounts off CE 
• Dedicated desk in the registration area
• Discounts on Broadway shows and famous attractions

Also, don't miss Dr. Greg Caldwell's POA-sponsored CE on Friday, March 28: Oral Pharmaceutical Agents for the Treatment of Anterior Segment Pathologies (OD Course #21B1; 8:30 - 10:30 AM) and Thyroid Dysfunction and the Eye (OD Course #23B1; 11:00 AM - noon). POA members receive an exclusive discount on Dr. Caldwell's course as well.

See the flyer in the March/April Keystoner for more information.

Regulatory Reminder

DEA numbers cannot be preprinted on prescriptions

POA recently received a letter from the Pennsylvania Pharmacists Association (PPA) regarding invalid prescriptions that contain preprinted DEA numbers on their face. The letter reiterated the language of the Controlled Substances, Drugs, Devices and Cosmetics Act that prohibits the preprinting of DEA numbers on prescription forms. PA Controlled Substance Requirement 25.53(e) states:

“The Federal Drug Enforcement Administration registration number cannot be preprinted on the prescription form.”

Since preprinting DEA numbers on prescription forms is prohibited in Pennsylvania, DEA numbers must be added at the time the prescription is written.

PPA has reminded its membership about this issue and has asked professional health associations to remind their memberships of the requirements of the law.

POA’s blog, The POAeyes Post, contains a June 21, 2013 post dedicated to prescription requirements in Pennsylvania, which can be viewed at http://www.poaeyes.blogspot.com/2013/06/prescription-requirements-in.html. In addition to the DEA number issue, it includes detailed information on spectacle, contact lens, pharmaceutical and Medicaid prescription requirements.

PPA has advised that if a pharmacist receives a prescription with a preprinted DEA number, the prescription is considered invalid and the prescription should not be filled. Instead, the pharmacist should request that the patient obtain a new prescription or contact the prescriber directly, both options causing a delay that could harm the patient.

PPA has been informed that auditing entities are denying claims and recouping 100% of the claim or refills for prescriptions that have a preprinted DEA number. 

The Intangible Benefits of Membership: The most important benefits we may take for granted

Anthony S. Diecidue, O.D., M.S.
POA Past President

Of course, it’s the intangibles that made membership in the POA and AOA a must for me. My time on the POA Board of Directors and as President of the POA afforded me insight into our profession; insight that revealed a whole other side to our chosen profession, a side that is vulnerable to attacks from ophthalmology, opticianry and third-party payers.

Once I understood what it means to be a legislated profession – i.e., a profession that can be changed by the passing of a bill by people who know little about what we do and who can be influenced by others – I really saw the need for organizations like the POA and AOA. Without them advocating for us, we would likely have a profession that bears little resemblance to our current one, or worse, no profession at all. Our professional associations come to our defense every day, supporting our initiatives and our ability to practice in a way that best serves the public.

In addition to that, our POA provides us with many tangible things like group discounts, services and help when we need it. Many of the programs offered to POA members not only drive patients into our offices, but also educate the public about who we are and what we do. They open doors that would normally be closed to us as a profession.

The POA and AOA both provide world-class educational opportunities for us at discounted fees. They both negotiate with third-party payers to ensure we are not left out or paid any less than any other providers. In a nutshell, they fight for us at every level, enabling us to practice at our highest educational level. Without them, we would be relegated to simple refrationists with no hope of ever expanding our ability to serve the public.

All of this and much more is why I have been a member for over 25 years.

Dollars and Cents of POA Membership

By Donna Buraczewski, O.D.

POA Immediate Past President

Have you ever considered dropping your membership because of the amount of dues or heard colleagues say they cannot afford the price of membership? Then this post -- the first of several analyzing the benefits of membership and why all optometrists in Pennsylvania should be members -- is for you.

I have been a member of the POA for 30 years. I recently received a memento letter opener with the POA logo as a recognition award. If I was a “number person," I could tell you exactly how much that membership has “cost” me. But really, it's more important to know how much more the membership has earned me. 

Let’s start by looking at history. When I graduated in 1983, optometrists were not reimbursed for medical services by Medicare and most other third party payers. Thanks to the efforts of the POA and AOA, we are now reimbursed for those services.

So when I began my solo private practice in 1986, I was able to bill Medicare and be reimbursed for my services. But how many medical services could I provide since I was not allowed to prescribe therapeutic agents? In 1996, the POA passed legislation so Pennsylvania optometrists could not only detect eye diseases, but also treat them.  Again due to the efforts of my fellow members, these privileges were expanded in  2002.

Now how much did you bill in Medicare services last year? What percentage of your income was from the treatment of eye diseases, including glaucoma? Last week alone, I billed 39% of my gross revenue to medical third party payers. 

How many of you have received incentive payments from CMS for EHR implementation? Did you know that optometry was not initially included for reimbursement? The AOA stepped in and changed that, and optometrists have now received a substantial amount in payments. Depending how many Medicare services you provide, each optometrist had the opportunity to receive $44,000 in incentive payments. That more than covers my 30 years of dues.

Do you receive income from the Pennsylvania Medicaid system? Due to the efforts of the POA, optometrists and other providers in Pennsylvania are paid equally for the same services. Many optometrists also received reimbursements for past services.

How many children do you examine in your office? The AOA was instrumental in having pediatric eye care as an Essential Benefit of the Health Care Reform policy. Remember that when you examine a child in your office.

We sometimes forget that these privileges were not handed to us because some other policy maker thought it was a good idea. POA and AOA advocated on our behalf to be included in these elements of the health care system; individual doctors could not have achieved inclusion on our own. Furthermore, never forget that that these privileges could be removed at any time at the whim of another profession, payer or regulator. The only thing preventing a reversal is your AOA and POA.

Would the POA and AOA accomplish these successes even if I or you weren’t members? Maybe, but this type of constant vigilance and proactive advocacy require significant human resources, and a small pool of optometrists -- no matter how dedicated -- could not afford it on their own.

And imagine how much more we could accomplish if all optometrists in the state were members. Share this information with non-members and encourage them to become members today.

And THANK YOU for your membership.

ACA Resources for Optometrists

Need help navigating implementation of the ACA? Following are tools and resources to help Pennsylvania optometrists.

Guidance on employee health insurance marketplace notice requirements: federal government's FAQs or the Department of Labor's Technical Release 2013-02

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Tools and resources on the Health Insurance Marketplace enrollment process and coverage options in Pennsylvania

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Help for Pennsylvania small employers navigating the Health Insurance Marketplace

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Information on the Small Business Health Options Program (SHOP) and tax credits


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Access to Pennsylvania's Health Insurance Marketplace

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Information on new opportunities for optometrists to participate in insurance plans and treat new patients

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AOA Third Party Center resources and FAQs that explain the new marketplaces and assess participation in plans