Constant presence: Alliance builds reputation for patient safety advocacy

A good reputation—and the respect and credibility that comes with it—can take some hard work and time to build. The Health Care Alliance for Patient Safety is putting in the work.

In March, the AOA announced it had awarded the alliance its Apollo Award, given to individuals and organizations for distinguished service to the visual welfare of the public.

“The Apollo is a unique award, which is why the AOA reserves it for those programs that truly distinguish themselves in upholding the visual welfare of the public,” AOA President Ronald L. Benner, O.D., says. “Thanks to the Health Care Alliance for Patient Safety—supported by patient-focused partners, Johnson and Johnson Vision, EssilorLuxottica, Alcon, CooperVision—the alliance has made strides in establishing itself as the steward for patients and is working to become a trusted resource at all levels, including both legislative and regulatory to elevate the importance of the doctor-patient relationship as the cornerstone of improved health and wellness.”

Says HCAPS Executive Director Ralph Kohl: “The award is validation that the alliance is doing the right thing. The American Optometric Association is not just a partner. It’s the leading vision safety organization in the world. To have their membership recognize the alliance for all the hard work we are putting in is definitely gratifying and validating, and it confirms to us that we are doing valuable work.

About HCAPS

The alliance’s mission is “to advocate for patient safety and to protect and defend the doctor-patient relationship—the essential foundation of personalized health care decision making.”

Its principles:

• Support and advocate for the center of every health care decision: the doctor-patient relationship and ensure the delivery of the highest-quality care and outcomes.
• Support and advocate for the safest, healthiest and most effective use of medical devices, while promoting the advancements in technology to create better patient health outcomes.
• Support and advocate for the inviolability of a patient's prescription, determined through consultation between patients and their doctors.
• Support and advocate for needed enforcement and/or needed strengthening of patient health and safety laws and regulations.
• Educate and inform policymakers, the media and the public about the importance of doctor-patient decision making and respond to dangerous, abusive or harmful practices that undermine quality care or risk harm.

The alliance has about 70 partners including the AOA, manufacturers, state optometric affiliates, and schools and colleges of optometry. That membership diversity gives the alliance—again—credibility to groups that encounter HCAPS.

“They share a common cause and strengthen our voice when we go to Capitol Hill and advocate,” Kohl says.

Shared goals

The alliance plays a key role in patients and doctor advocacy, say liaisons to HCAPS on the AOA Board of Trustees.

 “The alliance stands in the gap to protect the doctor-patient relationship and entities seeking to disrupt that relationship for the sake of profits. Patient safety is their No. 1 priority. The alliance promotes pro-patient legislation, while educating lawmakers and the public about the vital union that exists between doctors and their patients and how this is the core of health care in America,” says Steven T. Reed, O.D., AOA vice president.

AOA Trustee and liaison to HCAPS, Paul M. Barney, O.D., says the alliance can affect real legislative and policy change against those online retailers who prefer sales over patient safety.

“A lot of the public doesn’t understand the differences in contact lenses and the importance of having lenses that fit well—and the consequences if they don’t,” Dr. Barney says. “Contact lenses are very safe, but there is potential, if they don’t fit well, that you can have some serious consequences.”

The gaze of HCAPS has not wavered from its patient protection mission, says AOA Trustee and liaison Marrie S. Read, O.D., M.B.A.

“Their advocacy focuses on eye and vision care, children’s eye and vision care and access to care but the foundation is centered on the doctor-patient relationship,” Dr. Read says. “Although HCAPS is focused on patient safety and advocating for our patients and putting them at the center of their own health care, the overlap between the goals of HCAPS and the AOA are significant.”

HCAPS advocacy

Three to four times a week, Kohl is on Capitol Hill, educating and advocating with members of Congress or their staff.

“I meet directly with members of Congress but also with their staff and staff of key committees,” says Kohl, who brought nearly 20 years of federal advocacy experience to the table when he took the helm last year. “We talk about the alliance more broadly—who we are and why we came together and what our mission is— we also advocate for identified priorities focused on patient safety and the critical role of the doctor-patient relationship.

“We are also working on two separate report language requests to be included in the annual appropriations package,” he adds. “A big focus of the alliance is to have that constant presence on the Hill, a constant presence talking to lawmakers about who we are and our key priorities for the upcoming legislative session.”

Legislative priorities

For the alliance, success can be measured by its continued recognition and presence on the Hill and its ability to elevate its mission and priorities.

“During (Congress’) appropriations process, even if you are not looking for a specific ask as far as funding for a particular program, it does allow you to elevate our priorities with members of Congress and the administration through report language,” Kohl says.

The Congressional Research Service defines report language as “information provided in reports accompanying committee-reported legislation as well as joint explanatory statements, which are included in conference reports. Report language contains more detailed guidance to departments and agencies than is provided in related appropriations bills or legislative text in conference reports.

It adds, “For example, a report might direct an agency to conduct a cost-benefit analysis of an activity or encourage an agency to implement specified regulations expeditiously. Spending restrictions might include instructions for a department or agency not to use funds provided in the bill for specified programs, projects, or activities, or they might set spending ceilings for these activities…”

Kohl says report language can be a “good opportunity” to shine a light on a particular issue and set the stage for further discussions in Congress and identify potential Congressional champions.

“This year we have been pursuing multiple report language requests,” says Kohl, noting that one request involved making sure the Centers for Disease Control and Prevention (CDC) allocated adequate resources to address the myopia crisis.

All of the groundwork sets up the alliance for future opportunities.

“The robocall bill is a good example of the type of patient-focused legislation the alliance is focused on,” Kohl adds.

About the robocalls legislation

Another high priority for the alliance: The Contact Lens Prescription Verification Modernization Act.

The bill, H.R. 2748, the Contact Lens Prescription Modernization Act, would revise the requirements for the verification of prescriptions for the purchase of contact lenses. Specifically, online sellers of prescription contact lenses must provide consumers with a method to transmit a digital copy of their prescriptions to such sellers. Online sellers also must encrypt protected health information they send by email.

Additionally, the bill prohibits any seller of prescription contact lenses from using telephone calls with an artificial or prerecorded voice (i.e., robocalls) to verify a consumer's prescription. Introduced April 20, the bill has been referred to the House Committee on Energy and Commerce, is backed by the AOA and HCAPS and is a priority issue for optometry’s advocates heading to Washington, D.C., this month, for the AOA’s single-largest federal advocacy event, AOA on Capitol Hill.

“I would like to thank Reps. Burgess and Blunt Rochester for reintroducing this important legislation,” David Cockrell, O.D., HCAPS chair, said in April. “This is a major step to protect contact lens patients from potentially harmful practices currently utilized in the contact lens marketplace.”

The act would address patient safety concerns brought about by online retailers’ use of automated robocalls and manipulation of verification requirements outlined by the Contact Lens Rule and under the Fairness to Contact Lens Consumers Act (FCLCA). The legislation would establish a paper trail by requiring retailers to use direct communication, such as email, live phone calls or fax, to confirm prescription accuracy. Further, the bill requires retailers to offer a HIPAA-compliant method for allowing patients to upload an electronic copy of their prescription thereby deprioritizing the use of verification robocalls.

Flaws in current prescription verification

Popular with more than 45 million Americans, contact lenses are a safe and effective vision-correction option when worn and cared for properly. However, poor-fitting or improperly used contact lenses can result in serious eye and vision harm, which is why the U.S. Food and Drug Administration (FDA) regulates contact lenses as Class II and III medical devices requiring an eye doctor’s prescription and oversight.

Despite health and safety concerns, some online contact lens retailers not only permit consumers to purchase these medical devices using expired prescriptions but also sell altogether different brands or types of contact lenses than were prescribed by the patient’s doctor. Although these kinds of practices are outlawed by the FCLCA and Contact Lens Rule, retailers commonly take advantage of the law’s interpretation to subvert its intent.

While the FCLCA clearly allows telephone, fax or email for prescription verification, the FTC interpreted the law to also permit robocalls. However, these automated calls to eye care providers are often difficult to understand, do not include all the necessary information for confirmation, and create barriers for doctors’ real-time feedback about prescription corrections. In some cases, doctors are unable to immediately provide critical health and safety feedback if a request is being made for an incorrect device or for an individual who is not a patient of the doctor.

Some retailers also use robocalls to take advantage of the current “passive verification” provision of the FCLCA and Contact Lens Rule that doctors have only an eight-hour window to respond before a prescription is automatically verified. By exploiting such loopholes, retailers push products not prescribed by the patient’s eye doctor.

A report from the AOA Health Policy Institute found that among doctors of optometry who provide contact lens services:

• 89% received prescription verification calls for invalid prescriptions.
• 54% received prescription verification calls for an altogether wrong patient.
• 43% received prescription verification calls for someone who wasn’t their patient.

As many Americans choose to purchase their contact lenses through direct-to-consumer internet mass retailers, the AOA and HCAPS are speaking out against these unsafe practices.

“The bill would address the use of robocalls,” Kohl says, “which, we think, the data shows is leading to consumers getting the wrong prescriptions, which can be costly to their health eye.”

Get involved

The AOA urges the profession’s support of the Contact Lens Prescription Modernization Act to close loopholes in the verification system and restore commonsense health and safety considerations. Here’s how you can help:

• Join optometry’s advocates for AOA on Capitol Hill.
  A cornerstone of the AOA’s federal advocacy efforts, AOA on Capitol Hill is taking place in conjunction with Optometry’s Meeting, June 21-24, in Washington, D.C.This legislation and other key issues will be among the priorities championed by doctors of optometry and students across scores of meetings with members of Congress.
• Report illegal or unsafe contact lenses or business practices.
  Suspect an FCLCA or Contact Lens Rule violation? Use the link above to complete a form that helps the AOA better advocate for improved laws and regulations that better protect patients. Although the AOA is not a regulatory or enforcement agency, it can help build a case with these federal entities.
• Learn moreabout HCAPS and sign up for their news and policy updates newsletter.