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How does the new VSP policy impact you? AOA challenges VSP reimbursement policy change


Tell the AOA how these policies affect your practice or patients, or express other concerns about plan policies, by sending an email to: AOATPC@aoa.org for resources.

Doctors call a new VSP policy bullying, limiting and disrupting. And worse than that it breaks the community trust. These are some of the concerns doctors are sharing on the timing and impact they see from VSP's just announced plan to differentiate payments for certain lens products and anti-reflective coating. The changes, due to take effect on September 1st, are being challenged by the AOA. 

According to an AOA assessment, the VSP plan will unacceptably restrict choice and undermine doctor-patient decision-making. The timing is highly questionable as well, promising harmful reimbursement cuts for VSP network doctors at a time when practices across the country are struggling to reactivate and recover from the economic meltdown brought on by the coronavirus pandemic.  

The AOA is leading opposition to the new policy and is asking doctors to share their stories on how these policies are affecting practices and patients. Supported by insights from doctors, AOA will take every action to challenge this egregious policy.

"The AOA fights back every day against the anti-doctor and anti-patient policies of vision plans and, through our payer advocacy attorneys, we are right now looking at all options to address not only the change that VSP has announced but also similar damaging vision plan policies already in place," says Barbara L. Horn, O.D., AOA president. "Although there's no quick fix, we'll do everything possible to ensure that our doctors are heard loud and clear by VSP and any other plan seeking to control doctors and doctor-patient decision-making."

VSP's new policy has changed the reimbursement to the provider for the type of lens used, but the patient's payment remains the same. VSP's approach is designed to force doctors to use their branded lenses instead of what products might be best for the patient, medically or financially. There is no financial incentive for the patient to make that change. 

Public health experts encourage health plans to steer patients to high-quality, relatively low-cost products and services. But here, vertically integrated VSP is attempting to steer doctors to recommend certain products to patients not because of cost or quality but to improve VSP's performance and profits in the lenses market.  

"Elsewhere in health care, if a plan wants patients to use designated products, the patients are required to pay an increased cost share to remain with a non-designated product, and it becomes the patients' choice," says Steven Eiss, O.D., chair of the AOA Third Party Center Executive Committee. "This would be like going to the pharmacy for your branded heart medication that you have been successfully using and being told by the pharmacy to change to a different brand. Now the other brand is not going to save you any money and might not work as well, but the pharmacy will make more if you change. That type of behavior is just not going to fly."  

Changes evoke criticism of VSP  

VSP announced the changes June 1, explaining in its notice that it was updating its ophthalmic product formulary into two categories (preferred and non-preferred) for anti-reflective coating, progressive, and digital single vision lens products. These adjustments follow in the footsteps of similar changes VSP quietly made for photochromic lenses earlier this year.  

"These formulary updates may change your doctor service fees for all [VSP] plans," says the notice, which added that preferred brands would be unaffected but non-preferred brands will be reduced by about 50%.  

The changes in reimbursement have rankled doctors of optometry who say VSP is motivated by profit and not what's in the best interests of patients. VSP and Essilor have both messaged the doctors on the subject.

"Practices are going to have to make a decision to either encourage patients to make the product change to be able to cover costs or allow patients to stay with the lenses they currently use and the doctor take a loss on the products," Dr. Eiss says. "Again, this is not a decision a business should have to make in this manner."

The AOA has directly advised VSP's leaders of the profession's immediate concerns and will continue to press. In addition, also being targeted are policies of other vision plans that are interfering in the doctor-patient relationship.  

"This is a top priority for the AOA and our payer advocacy resources, and we will be pressing our position with the plans in every way possible," Dr. Eiss says.  

In the AOA's view, VSP's latest move follows a long line of profit-centric moves made by vision plan companies, which ultimately undermine patient care and choice. Due to this type of ongoing behavior by the vision plans, 23 states have enacted some form of statutory protection, which levels the playing field for patients and doctors of optometry from unscrupulous acts like this. Patient choice and clinical decisions should be made by those most prepared and impacted to do so, not by predetermined plans with only one goal in mind: profit.

An initial review indicates that some states' laws may prohibit such a restriction on choice in products. Additionally, the bi-partisan DOC Access Act (H.R. 3762), backed by 52 U.S. House members, the American Dental Association and the AOA, seeks to ensure that health care decision-making isn't controlled by plans or their anti-patient, anti-doctor policies, including through assured freedom of lab choice, sources and supplies. Vision plans vigorously oppose H.R. 3762 through their lobbying organization, the National Association of Vision Care Plans.

What can members do?  

Doctors are encouraged to reach out to their local VSP representatives and underscore their concerns regarding the flawed policy. In addition, doctors should reach out to the AOA to share how these policies affect their practice or patients, or express other concerns about plan policies, via email to AOATPC@aoa.org.

June 25, 2020

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