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VISION OF HOPE
Iman Moore is a legacy patient at the Illinois Eye Institute on campus at Illinois College of Optometry. His first clinic appointment at the Illinois Eye Institute (IEI) was as a 6- or 7-year-old. His mother has been an active patient since she was seventeen. His grandmother, uncle, and other family members have all been treated there dating back to the 1960s, when it opened as the ICO Eye Clinic.
Iman Moore is now the Clinical Coordinator at IEI for Urgent Care and Referral Management and Co-Chair of the Diversity-Equity-Inclusion Committee of ICO. His pride in the work is palpable. Mr. Moore is in a unique
position to have experienced IEI both as a patient and now as an integral part of patient care. In his role, Moore sees first-hand how important the treatment that patients enrolled in the Vision of Hope program (VOH) is for them and the larger community, “IEI is unique. Most folks can go anywhere to get eye exams in 30-40 minutes. Here, our patients receive a thorough exam that takes two hours, including the education they need for eye health. It’s not just an exam, but an educational tool.”
That includes every VOH patient.
VOH was started in 2001 as an alliance of local agencies and healthcare providers funded with grants from the State of Illinois and the Washington Square Health Foundation. The original intent of the program was to link un/underinsured patients to primary eye care services at IEI. Twenty years into the program, its need has never been more urgent or necessary. The evidence is in the data:
VOH has provided over 20,000 patients with comprehensive eye exams
More than 15,000 patients have received eyeglasses or contact lenses
60% of VOH patients have required advanced ophthalmic care
5% of VOH patients have received surgical care for eye disease
70% of VOH patients also suffer from some type of systemic disease
VOH serves 1,000 patients annually
Over 90% of the IEI patient base consists of underrepresented minorities
“IEI is unique. Most folks can go anywhere to get eye exams in 30-40 minutes. Here, our patients receive a thorough exam that takes two hours, including the education they need for eye health. It’s not just an exam, but an educational tool.”
Clinical Coordinator for Urgent Care and
The ongoing cost for care provided to VOH patients is roughly $300,000 annually. Overall, that might not seem like a lot of money and something that the institution could adequately budget for or absorb. The reality is far more nuanced and complicated.
“It’s disheartening to live in the United States, one of the richest countries in the world, and see that there are people going without healthcare. The Affordable Care Act brought the number of people without insurance from double digits into single digits, which is great, but there are still tremendous gaps in Medicaid coverage,” says Leonard Messner, OD, Vice President for Strategy and Institutional Advancement and a practicing optometrist on the IEI Advanced Care team.
Medicaid reimbursement is typically low and only one reimbursement is allowed per patient encounter. That means if a Medicaid patient is seen at IEI for a clinic visit, only one of the tests, procedures or panels that is necessary for appropriate care and diagnosis can be submitted for reimbursement, regardless of the clinical necessity of them to the plan of care.
These gaps in funding are significant and leave Medicaid patients even more vulnerable. They are already at a disadvantage being un/underinsured and are significantly more at risk to be living with a systemic disease like diabetes or hypertension. “We see a disproportionate share of Medicaid patients. We run the tests,” says Dr. Messner, “and end up eating the costs for them. It’s the right thing to do for our patients, and we do it. I don’t see a bright light at the end of this tunnel. ”
Clinical Practice Manager
“I worked at a different eye clinic in the city for twenty-two years and I never saw the degree of pathology I see here at IEI. Right now, we have over one hundred people on the waiting list for cataracts! Clinical care is important here and I see what a difference good quality care provided with dignity makes.”
There are now twenty-eight different Federally Qualified Health Centers (FQHCs) that refer patients to IEI for care. Most of those patients are un/underinsured and qualify for treatment under VOH, but the numbers are overwhelming and the current capacity to serve them all is in jeopardy. IEI does not qualify for government funds or grants that provide the enhanced reimbursements that hospitals and FQHC’s receive.
“As a teaching program, these are the cases you want to see, but they don’t pay the bills,” says Dr. Messner, “We’ve been fortunate to have [Congressional] Representative Bobby Rush in our district and we've received support from foundations, but those funds do not cover the full cost of clinical services. We make a profound impact, and I can’t say strongly enough what an honor and privilege it is to serve our patients who are extraordinarily valued.”
That patient base includes the VOH patients with the most complicated care profiles living in extreme poverty in communities with historic disinvestment. These patients are now experiencing even greater need given the healthcare inequities that always existed, but have been made more obvious during the COVID pandemic. Dr. Messner uses this analogy, “It’s like someone has turned on a hose and never turned it off. I saw it at both ends of the barrel when I came to Chicago in the late 1980s. If you can handle our patient population, you can handle any patient. The need is there and continues to build. We need the resources to meet those needs.”
Maureen Dwyer is the Clinical Practice Manager at IEI and could not agree more. In her role in the clinical setting, she is tasked with linking VOH patients to referrals and other avenues of care, “My biggest frustration is telling people they need to go somewhere else for care. I work hard to figure out a way to get patients the care they need here, but it’s not always possible.”
She agrees with Dr. Messner that the VOH patients served at IEI are unique, “I worked at a different eye clinic in the city for twenty-two years, and I never saw the degree of pathology I see here at IEI. Right now, we have over one hundred people on the waiting list for cataract surgery! Clinical care is important here and I see what a difference good quality care provided with dignity makes.”
Ms. Dwyer puts her money where her mouth is. Each year, she donates some of her income to the VOH patients at IEI, “I’m not wealthy, but I will continue to give. Losing vision is terrifying, but when we catch a diagnosis early, we can prevent blindness. It’s gratifying to see the smiles on faces. People are so happy when their vision is restored and it’s contagious.”
Mr. Moore knows those same joys and frustrations Ms. Dwyer describes, “I’ve been on both sides of the coin. If you’ve never been in the situations our patients are in and faced those challenges, it can be hard to understand. There is a lack of financial resources to cover co-pays and even getting time off from work is hard. I would ask our alumni to think back to the patients they saw as 3rd and 4th year students, beyond primary eye care. You provided help, person to person. You guided them. Remember those feelings you got, that twinkle in the eyes of patients who see better? Remember your white coat ceremony and the oath you took?”
That oath Mr. Moore refers to is the Optometric Oath, recognized by the American Optometric Association, and includes the following pledges recited by each 2nd and 4th year student at their White Coat Ceremonies and graduation:
I WILL provide professional care for the diverse populations who seek my services, with concern, with compassion and with due regard for their human rights and dignity.
I WILL work to expand access to quality care and improve health equity for all communities.
I WILL place the treatment of those who seek my care above personal gain and strive to see that none shall lack for proper care.
These patients have been invaluable to the training and education of ICO students since our beginnings. Help us honor the oath you took and help us ensure that Vision of Hope patients continue to receive dignified care at IEI. Let's continue our commitment to quality patient care, no matter their ability to pay.