1 THE NEW TPA/g CERTIFICATION PROCESS Mark W. Harris, O.D. Dorothy L. Hitchmoth, O.D. David J. Caban, O.D. PowerPoint adapted by BSK

2 RSA 327 OPTOMETRY CHANGES IN THE LAW THAT YOU MUST BE FAMILIAR WITH: CHANGES IN THE LAW THAT YOU MUST BE FAMILIAR WITH: –ANTI-VIRALS –GLAUCOMA TREATMENT  Primary Open-Angle Glaucoma (POAG)

3 ANTI-VIRALS ANTI-VIRALS –T–T–T–TOPICAL AND ORAL, AS APPROVED AND INCLUDED IN THE FORMULARY –O–O–O–OPHTHALMOLOGICAL CONSULT NO LONGER REQUIRED PRIOR TO Tx –R–R–R–REFERRAL IF NO IMPROVEMENT IN 10 DAYS

4 IT’S BETTER THAN IT WAS! EVERYONE SHOULD BE INVOLVED UP TO HIS/HER COMFORT LEVEL EVERYONE SHOULD BE INVOLVED UP TO HIS/HER COMFORT LEVEL WE NEED TO DEMONSTRATE OUR COMPETENCE WE NEED TO DEMONSTRATE OUR COMPETENCE NEW CHANGES MAKE IT EASIER TO REACH THE GOAL NEW CHANGES MAKE IT EASIER TO REACH THE GOAL

5 THE TPA/g CERTIFICATION PROCESS HAS BEEN SIMPLIFIED! Anyone willing to make the effort should be able to achieve independent treatment status. Anyone willing to make the effort should be able to achieve independent treatment status. Within a few years, most NH optometrists should be “tpa/g” certified. Within a few years, most NH optometrists should be “tpa/g” certified. No one will be forced to do it if they don’t want to. No one will be forced to do it if they don’t want to.

6 GLAUCOMA CERTIFICATION GLAUCOMA CERTIFICATION COURSE PLUS CO-MANAGEMENT STILL REQUIRED –F–F–F–FINE POINTS MUST BE WELL UNDERSTOOD –L–L–L–LAW ALLOWS FOR WAIVER OF BOTH COURSE AND CO-MANAGEMENT REQUIREMENTS –“–“–“–“GLAUCOMA” DEFINED AS POAG ONLY

7 FIRST STEP - GLAUCOMA PRESCRIPTIVE AUTHORITY OD COMPLETES 40 HOUR COURSE, PASSES EXAM. OD COMPLETES 40 HOUR COURSE, PASSES EXAM. BOARD AUTOMATICALLY WAIVES COURSE FOR GRADS AFTER 2002 or ODs WITH 12 MOS FEDERAL GLAUCOMA TX CREDENTIALS. (RSA 327:6-C I (a), (b), (c)) BOARD AUTOMATICALLY WAIVES COURSE FOR GRADS AFTER 2002 or ODs WITH 12 MOS FEDERAL GLAUCOMA TX CREDENTIALS. (RSA 327:6-C I (a), (b), (c)) JPFCC MAY WAIVE COURSE FOR ODs WITH RESIDENCY or 12 MONTHS PRACTICE IN ANOTHER GLC STATE (RSA 327:6-C III (a), (b)) JPFCC MAY WAIVE COURSE FOR ODs WITH RESIDENCY or 12 MONTHS PRACTICE IN ANOTHER GLC STATE (RSA 327:6-C III (a), (b)) OD NOW AUTHORIZED TO WRITE PRESCRIPTIONS FOR GLAUCOMA MEDS DURING CO-MANAGEMENT PERIOD OD NOW AUTHORIZED TO WRITE PRESCRIPTIONS FOR GLAUCOMA MEDS DURING CO-MANAGEMENT PERIOD COURSE NOT REQUIRED TO TREAT AACG ON EMERGENCY BASIS

8 THE CO-MANAGEMENT PROCESS PHASE 1 – CO-MANAGE 25 CASES (MINIMUM 20 NEW, 5 MAY BE PRE-EXISTING) FOR 18 MONTHS EACH CASE. CASES YOU STARTED UNDER THE PREVIOUS LAW WILL COUNT AS NEW OR PRE- EXISTING DEPENDING ON THEIR ORIGINAL CLASSIFICATION. CASES YOU STARTED UNDER THE PREVIOUS LAW WILL COUNT AS NEW OR PRE- EXISTING DEPENDING ON THEIR ORIGINAL CLASSIFICATION. IF YOU QUALIFY YOU CAN OBTAIN A WAIVER OR REDUCTION IN THE NUMBER OF CO- MANAGED CASES YOU MAY QUALIFY IF YOU FALL INTO ANY OF THE FOLLOWING CATEGORIES: YOU MAY QUALIFY IF YOU FALL INTO ANY OF THE FOLLOWING CATEGORIES: –BOARD AUTOMATICALLY WAIVES ALL CASES FOR GRADS AFTER 2002 or ODs WITH 12 MOS FEDERAL GLAUCOMA TX CREDENTIALS. (RSA 327:6-C I (a), (b), (c)) –JPFCC MAY WAIVE OR REDUCE NUMBER OF REQUIRED CASES FOR ODs WITH RESIDENCY or 12 MONTHS PRACTICE IN ANOTHER GLAUCOMA STATE (RSA 327:6-C III (a), (b))

9 REQUESTING WAIVER JPFCC WILL DETERMINE ELIGIBILITY FOR WAIVER BASED UPON DOCUMENTATION SUBMITTED JPFCC WILL DETERMINE ELIGIBILITY FOR WAIVER BASED UPON DOCUMENTATION SUBMITTED INCLUDE AS MUCH DOCUMENTATION AS YOU CAN WITH YOUR REQUEST! INCLUDE AS MUCH DOCUMENTATION AS YOU CAN WITH YOUR REQUEST! CV CV LETTERS OF RECOMMENDATION (LETTERS FROM OPHTHALMOLOGISTs CARRY A LOT OF WEIGHT) LETTERS OF RECOMMENDATION (LETTERS FROM OPHTHALMOLOGISTs CARRY A LOT OF WEIGHT) CERTIFICATES OF COMPLETION (RESIDENCY CERTIFICATE, ETC.) CERTIFICATES OF COMPLETION (RESIDENCY CERTIFICATE, ETC.) EVIDENCE OF GLAUCOMA CREDENTIALING COURSE IF YOU TOOK ONE EVIDENCE OF GLAUCOMA CREDENTIALING COURSE IF YOU TOOK ONE TMOD - DATE TAKEN AND SCORE ACHIEVED TMOD - DATE TAKEN AND SCORE ACHIEVED

10 TO WHOM DO I SEND A WAIVER REQUEST? Joint Pharmaceutical Formulary and Credentialing Committee David J. Caban, O.D., Secretary c/o Board of Registration in Optometry 2 Industrial Park Drive, Suite 8 2 Industrial Park Drive, Suite 8 Concord NH Concord NH 03301

11 NO WAIVER, WHAT DO YOU DO? YOU MUST PROVIDE EVIDENCE OF SUCCESSFUL COLLABORATIVE TREATMENT AND CO-MANAGEMENT OF 25 GLAUCOMA PATIENTS YOU MUST PROVIDE EVIDENCE OF SUCCESSFUL COLLABORATIVE TREATMENT AND CO-MANAGEMENT OF 25 GLAUCOMA PATIENTS –UP TO 5 MAY BE ESTABLISHED GLAUCOMA PATIENTS  A “NEW GLAUCOMA PATIENT” MEANS A PATIENT WHOM YOU ARE THE FIRST TO DIAGNOSE WITH POAG, OR  WHO HAS BEEN PREVIOUSLY DIAGNOSED WITH POAG BUT IS NEW TO YOUR PRACTICE E ACH PATIENT MUST BE FOLLOWED FOR A PERIOD OF NOT LESS THAN 18 MONTHS E ACH PATIENT MUST BE FOLLOWED FOR A PERIOD OF NOT LESS THAN 18 MONTHS EXCEED THE MINIMUM NUMBER OF PATIENTS - IN CASE YOU HAVE DROP OUTS EXCEED THE MINIMUM NUMBER OF PATIENTS - IN CASE YOU HAVE DROP OUTS ESTABLISH PROTOCOLS WITH YOUR CO-MANAGING OPHTHALMOLOGISTs ESTABLISH PROTOCOLS WITH YOUR CO-MANAGING OPHTHALMOLOGISTs –OD SHOULD WRITE THE Rx –SAMPLES USED AS APPROPRIATE

12 REFERRAL CRITERIA DURING INITIAL CO-MANAGEMENT, THE OD SHALL CONSULT WITH THE OPHTHALMOLOGIST WHEN ANY OF THE FOLLOWING OCCURS: DURING INITIAL CO-MANAGEMENT, THE OD SHALL CONSULT WITH THE OPHTHALMOLOGIST WHEN ANY OF THE FOLLOWING OCCURS: TARGET PRESSURE NOT ACHIEVED WITHIN 90 DAYS TARGET PRESSURE NOT ACHIEVED WITHIN 90 DAYS DOCUMENTED PROGRESSION OF OPTIC NERVE HEAD DAMAGE DOCUMENTED PROGRESSION OF OPTIC NERVE HEAD DAMAGE DOCUMENTED, REPEATED PROGRESSION OF VISUAL FIELD LOSS DOCUMENTED, REPEATED PROGRESSION OF VISUAL FIELD LOSS PATIENT DEVELOPS ANGLE CLOSURE OR OTHER SECONDARY GLC (e.g. pigmentary or pseudoexfoliative glc) PATIENT DEVELOPS ANGLE CLOSURE OR OTHER SECONDARY GLC (e.g. pigmentary or pseudoexfoliative glc)

13 ONCE I AM TPA/G CERTIFED AM I DONE? ONCE I AM TPA/G CERTIFED AM I DONE? UNFORTUNATELY, NO UNFORTUNATELY, NO –UPON CERTIFICATION TO TREAT GLAUCOMA (Phase II), FOR A PERIOD OF 24 MONTHS, OPTOMETRISTS SHALL CONSULT WITH AN OPHTHALMOLOGIST WITHIN 30 DAYS FOR CONFIRMATION OF DIAGNOSIS AND REVIEW OF TREATMENT PLAN

14 IS THAT IT? IS THAT IT? YOU WILL ALWAYS BE REQUIRED TO CONSULT WITH AN OPHTHALMOLOGIST IF THERE IS YOU WILL ALWAYS BE REQUIRED TO CONSULT WITH AN OPHTHALMOLOGIST IF THERE IS  DOCUMENTED PROGRESSION OF ONH DAMAGE, OR  DOCUMENTED, REPEATABLE PROGRESSION OF VF LOSS, UNDER MAXIMUM MEDICAL THERAPY,  or THE PATIENT DEVELOPS SECONDARY OR ANGLE CLOSURE GLAUCOMA –THIS REQUIREMENT CONTINUES INDEFINITELY –THIS IS WHAT WE WOULD DO ANYWAY!

15 QUESTIONS OR COMMENTS?