Professional Practice for Optometry

Privacy is a patient right. Optometrists have an ethical and legal responsibility to safeguard patient information. Patient information includes such information as personal data, medical history, diagnosis, treatment, and financial situation.

Patient information should be shared only on a need-to-know basis with those who participate in the care of the patient. Unless disclosure is required by law, patient information should not be shared with anyone without the patient's written permission. Court orders, subpoenas and investigations by the Office of Professional Discipline are examples of disclosures that may be required even in the absence of the patient's consent.

Patient information, written or electronic, must be kept secure from loss, theft, or unauthorized access, use or disclosure. Confidential information should be kept out of plain view, and stored in a secure environment. Care should be taken not to talk about patients in public places, even if you are not using the patient's name.

Under section 29.1(b)(8) of the Regents Rules, it is unprofessional conduct to reveal personally identifiable facts, data or information obtained in a professional capacity without the prior consent of the patient or client, except as authorized or required by law. If you violate this confidentiality rule you may be subject to charges of unprofessional conduct.

Your decision to disclose patient information must be consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), if it applies. More information regarding HIPAA may be found on the United States Department of Health and Human Services Web site at www.hhs.gov/ocr/hipaa.

Health professionals are required to maintain records for each patient that accurately reflect the evaluation and treatment of the patient according to section 29.2(a)(3) of the Rules of the Board of Regents. All patient records must be retained for at least six years, with the exception of records for minor patients, which must be maintained for at least six years and for one year after the minor patient reaches the age of 21.

Accurate and complete patient records serve many purposes. For example, patient records can ensure consumer protection, guide professional treatment, and facilitate professional consultations. Patient records are required in matters pertaining to professional liability and professional discipline.

Practitioners and their patients should be aware that under some conditions other parties might have reason to have access to patient records. For example, in some cases, patient records may be needed by other professionals to provide requisite patient care. Your records, therefore, should be an accurate and legible account of the evaluation and treatment of the patient.

Under Section 18 of the Public Health Law, patients have the right of access to their records under most circumstances. If you deny access to records to a patient, you have an obligation to inform the patient of his/her right to appeal to the Office of Record Access of the Department of Health. Contact information is available on the New York State Department of Health Web site at www.health.state.ny.us/nysdoh/opmc/medright.htm.

If you dispose of records when there is no longer any obligation or need to maintain them, they should be properly destroyed to safeguard patient confidentiality.

Optometrists who retire or sell their practices must make provisions for records to be maintained and accessed, if requested. The obligation to maintain records is not changed by the retirement or sale of a practice by an optometrist.

Your records may be your principal defense to charges of professional misconduct. There is no statute of limitations for charges of professional misconduct.

Optometrists should also make provisions for the maintenance and destruction, as appropriate, of their patients' records in the event of the optometrist's death. In some cases, if appropriate provisions are not in place, the optometrist's estate could be subject to a malpractice suit after his/her death.

The optometrist should adequately monitor the performance of all personnel, licensed or unlicensed, that he or she supervises. The optometrist is ultimately responsible for quality patient care and is accountable for all services provided by administrative and clinical individuals that the optometrist supervises.

Section 29.2(a)(1) of the Rules of the Board of Regents defines as a basis for unprofessional conduct, "abandoning or neglecting a patient or client under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care, or abandoning a professional employment by a group practice, hospital, clinic or other health care facility, without reasonable notice and under circumstances which seriously impair the delivery of professional care to patients or clients."

In the event of an emergency, optometrists may become unexpectedly ill or disabled rendering them unable to continue to provide services. Normally these cases would not be considered abandonment. However, appropriate planning for such events early in the professional relationship can ensure that patients receive the essential services they need when emergencies occur.

Optometrists who surrender or lose a license as a result of a professional disciplinary action should also ensure that patients are referred to other optometrists who can provide essential professional services.

Good practice often involves the need to consult with other professionals to provide for quality patient care. When legally required or when consultation is otherwise appropriate, you should obtain the patient's consent before consulting with other professionals.

It is also good practice, and in certain circumstances it may be necessary, for the patient to give informed consent permitting you to reveal any personally identifiable information to a consultant.

The Office of the Professions does not negotiate or resolve fee disputes. However, fee disputes can often lead to complaints of professional misconduct including claims unrelated to the actual fee dispute, such as claims of negligence or incompetence. Even when these complaints are determined to be unfounded, the optometrist will have had the inconvenience and expense sometimes associated with an investigation.

To avoid these complaints, optometrists should:

• Clarify the billing conditions, including insurance coverage if applicable, with the patient at the outset of the evaluation and treatment, and specify the financial arrangements in terms that the patient can understand.
• Explain to the patient all costs involved with their treatment, including co-payments and expenses that are not covered by insurance. It would be useful to have a written policy in place which is signed by patients to indicate their understanding of the costs involved for their evaluation and treatment and for the optometrist and the patient to develop an individualized payment agreement in advance of treatment when the patient must pay for non-covered expenses.

Insurance billing, though sometimes seemingly uncomplicated and straightforward, may easily lead to disputes and/or allegations of misconduct. To avoid this, billing statements, insurance claims, and treatment reports should be simple, clear, direct, and accurate representations of the services provided, the fees charged for each service, and the nature of the patient's evaluation and treatment.

• Discussing payment and insurance issues (including pre-certification) at the first meeting with the patient, or soon afterward, could help to ensure that the patient fully understands all financial arrangements and could also help to avoid any possible misunderstandings and subsequent disputes regarding issues such as co-payments or contract differences.
• It is good practice to have the patient's written authorization to release information necessary to process an insurance claim or to complete a treatment report for pre-certification; there may be circumstances in which authorization is required.
• Optometrists should be aware of precisely what they are stating when signing any insurance form or report. What information you are asked to provide and what you are asked to attest to often varies depending upon the insurance form or report. For example, a signature as provider on the insurance form may, in some instances, constitute a certification that the signatory directly provided the services him or herself.
• Attention to details and making certain that you have provided all of the required information when completing insurance forms and reports can help to avoid delays in payment and subsequent misunderstandings and disputes between you and the patient.
• When a patient cancels or does not appear for an appointment, it is usually considered fraudulent to bill an insurance company for that appointment unless the insurer has provided for cancellations within the contract.

The Education Law requires that every four years every optometrist practicing in New York State complete approved coursework or training appropriate to his/her practice in infection control and barrier precautions. Regular training is required to prevent the transmission of the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV) in the course of professional practice. Each optometrist must document compliance with this requirement at the time of your first registration and at each subsequent reregistration.

Optometrist should treat all patients with respect and with a professional demeanor. If a complaint is filed, it will be your responsibility to demonstrate that the patient has been treated in a professional manner and that appropriate boundaries have been maintained.

Optometrists should establish a working relationship with patients and when appropriate, with their legal guardian, involving them as active participants in treatment decisions.

Section 29.2(a)(2) of the Rules of the Board of Regents defines unprofessional conduct to include "willfully harassing, abusing or intimidating a patient either physically or verbally."

Sometimes problems may arise due to miscommunication and misperceptions between optometrists and patients/guardians. You should try to recognize the indicators of such problems and try to prevent or quickly defuse these situations.

The optometrist should keep careful records of what transpires in discussions with each patient and if appropriate, their legal representative.

All prescriptions for drugs and devices are required to contain the following information:

• Date the prescription is written
• Prescribers name, address and phone number
• Profession and registration number
• The patient's name, address, and age
• The name, strength and quantity of the prescribed drug or device
• The directions for use by the patient

Other than contact lens prescriptions, optometrists are required to provide a patient with a copy of his or her prescription, upon request. The prescription must include the name, address and signature of the prescriber and date of prescription.

The Federal "Fairness to Contact Lens Consumers Act" requires prescribers of contact lenses to provide the patient with a copy of their contact lens prescription upon the completion of the contact lens fitting, whether or not it is requested by the patient. The prescriber may not require that the patient sign a waiver or release before verifying or releasing prescriptions. For other requirements relating to contact lens prescriptions, visit the Federal Trade Commission's Web site at www.ftc.gov.

The laws, rules, and regulations pertaining to the practice of optometry in New York State can be found at Laws, Rules & Regulations for Optometry. If more detailed information is required, you may contact the New York State Board for Optometry by calling 518-474-3817 ext. 591 or e-mailing optombd@nysed.gov.