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Who Provides Vision Rehabilitation Services?

With Vision Rehabilitation Therapist Awareness Week #VRTWeek  fast approaching—the week of April 14, the topic of who provides vision rehabilitation services, and why, is a timely subject. According to the CDC, vision loss and blindness cost the U.S. $134.2 billion annually. The American Academy of Ophthalmology (AAO) reports, “Provision of, or referral to, vision rehabilitation is now the standard of care for all who experience vision loss.”

As a result of an aging population age-related vision loss is quickly creating an epidemic of vision loss expected to increase the burden of costs related to vision impairment, exponentially. In spite of this, the highest quality vision rehabilitation is often very difficult to find, referrals from eye doctors rarely happen, and insurance companies and Medicare routinely approve services from some of the least qualified providers of vision rehabilitation, and refuse to cover the most highly qualified vision rehabilitation specialists.

Currently the most highly trained and nationally certified vision rehabilitation professionals provide services primarily through a social services model. Certified Vision Rehabilitation Therapists (CVRT), and Certified Orientation and Mobility Specialists (COMS), acquire a Master’s level academic specialization in blindness and vision loss, followed by a national certification through the Academy for Certification of Vision Rehabilitation Education Professionals (ACVREP). Both CVRT and COMS are found at state and local agencies for the blind and visually impaired, and within the Veterans Administration healthcare systems. The profession of Vision Rehabilitation Therapist in the U.S. is over 150 years old, beginning as Home Teachers (most notably Anne Sullivan), and that of Orientation and Mobility is nearly 80 years old, and to date, neither is recognized by Medicare or third-party insurance. As a result, there are fewer than 1000 CVRTs and less than 2000 COMS nationally in the U.S. —too few to respond to the referrals, if made, for vision rehab services.

Medicare began reimbursing Occupational Therapists (OT) for vision rehabilitation services beginning in the early 1990s. The OT is a medical generalist, and without additional training or certification, has little academic training on vision rehabilitation. While the American Occupational Therapy Association (AOTA) provided a Specialty Certification in Low Vision (SCLV), at one time, for OTs who desired training in vision rehabilitation, it was discontinued. It is estimated that approximately 100 OTs nationally obtained this certification. Although the OT often has no specialized training or certification in vision rehab, they are nonetheless able to bill Medicare. As a result, the OT with a specialization in Pediatrics or Orthopedics, for example, can nonetheless, bill for vision rehab. Consequently, without a need for specialized training or certification to bill insurance, there is no incentive for a medical practice or agency to hire an OT with certification or encourage the acquisition of certification. While frequently far less trained, either academically or through specialized certification, the OT is often perceived as a greater financial asset to the medical practice or agency because of their ability to bill outside insurance. Unfortunately, without regulations requiring academic training or certification, the OT generalist may not be capable of providing the highest quality patient/client outcomes for vision rehabilitation. Ironically, because the more highly skilled CVRT and COMS work through state and local agencies, there is often no out-of-pocket fee or it is provided on a sliding scale to consumers, so the highest quality vision rehabilitation services cost far less to both consumers and the healthcare system.

Although the academic training for an Occupational Therapist does not include the same level of specialization in vision rehabilitation as the CVRT or COMs, the OT has many opportunities for certification, also through the ACVREP. The OT may also pursue a CVRT or COMS certification, as well as a certification as a Low Vision Therapist (CLVT) or CATIS (Certified Assistive Technology Instructional Specialist). While these certifications are available to OTs Medicare does not require this for billing and there is little incentive for the OT to acquire the certification.

The CDC reports that as the population ages, blindness and vision loss will double in the U.S. by 2050,  impacting more than 9 million people. It is safe to assume that without immediate changes in how we provide vision rehabilitation services, this will result in a significant increase in the personal and social cost of vision loss. It’s time to ask why the most highly trained vision rehabilitation professionals are unable to access Medicare and insurance reimbursement, and why appropriate national certification is not a requirement for both providing these services, and billing Medicare for them. Both measures will increase the number of skilled vision rehabilitation professionals in the field and reduce the overall personal and social cost of vision loss.


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