Red tape hampers vision project

The research goal is to learn whether vision therapy for the elderly yields long-run savings

A Medicare research program, started in April to help treat the growing number of older North Carolinians with low vision, comes with such cumbersome regulations that the state has so far chosen not to take part.

The program was designed to help older people overcome vision problems through therapy, rehabilitation and training, but many state residents won't be able to take advantage of it. Debbie Jackson, director of the state Division of Services for the Blind, said the program's limits on services and requirements for oversight make it difficult to take part in.

"We've looked at and haven't seen a real good way that it would benefit our consumers," Jackson said. "We want to figure out a way to make it work, but it's not coming together quite yet."

People who qualify for treatment under the program can get help in learning how to use special magnifying equipment, training on how to navigate around an apartment or city street, or rehabilitation that helps some people regain the ability to read.

But there are lots of strings attached to the $10 million, five-year program. People here and in five other parts of the country have to have fee-for-service Medicare Part B insurance -- a policy in addition to basic Medicare, but not a managed care version -- and vision that can't be completely corrected by surgery, glasses or contacts.

Also, an ophthalmologist, optometrist, or occupational therapist in private practice has to come up with a specific plan of care for each patient so that Medicare can pay professionals for services.

That's a difficult hurdle, because some areas of the state have few medical professionals. With current programs, therapists or others who work with blind people across the state aren't required to have a doctor come up with a new plan for service and oversee it, Jackson said.

"We have an eye report and it's documented that the person has vision loss," she said.

"Anecdotally, I've heard about a number of kinds of barriers that people that have been encountering," said Jim Coan, project officer for the Medicare vision-rehabilitation project in the six U.S. regions where it's offered. "What we have to do is try to get people to understand that this is not pure Medicare -- it's a research project."

New Hampshire Sen. John E. Sununu announced the program in February as a way to determine whether these services can save money for Medicare.

At the conclusion of the program, researchers will look at patients' health histories to see if older people with low vision who get therapy through the program have fewer expensive accidents and conditions. Older people with low vision are prone to falls, often resulting in fractures that cost billions annually to treat.

Another complaint from some providers has been the limitation on hours of therapy or other service allowed under the plan. Patients are allowed nine hours during one 90-day period of the project. But some patients may need 25 hours to learn new skills.

"Nobody's happy about that," Coan said. "That is strictly a financial restriction."