AOA: A force to reckon with

Excerpted from page 20 of the September 2023 edition of AOA Focus

Advocate for the profession and serve doctors of optometry in meeting the health and vision care needs of the public.

The AOA’s mission statement is the North Star of an organization over 49,000 members strong. What happens, top to bottom, is driven by a desire to faithfully deliver on this promise.

As myriad challenges confront our profession, from the coronavirus pandemic to economic uncertainties, federal regulations and payer obstacles, the AOA strives to navigate these headwinds always with an eye on that North Star. Because at the heart of everything the AOA does, it’s about keeping you, your practice and our profession first. See how the AOA Board of Trustees is working to serve you.

Reimbursement and coverage fairness

Just three years ago, the pandemic disrupted life as we know it. In staring down quite possibly the profession’s greatest challenge ever, the AOA and affiliates mobilized on behalf of optometry practices to build key inroads, deliver accurate information, secure $2.3 billion in federal crisis relief aid, and reinforce and expand optometry’s scope of practice. Yet, while the AOA and affiliates were busy doing what is best for doctors and their patients, health and vision plans had different priorities.

Despite optometry’s colossal care pivot, plans proceeded to implement policies that had the effect of restricting patient choice and undermining the doctor-patient relationship. Reimbursements, years stagnant, remained so despite emerging circumstances that saw supply lines dry up and inflation reach decade-highs. Plans offhandedly dismissed hard-earned scope gains and erected arbitrary hurdles to furnishing that care.

Questions of provider discrimination reared an ugly head yet again. Plans, many already vertically integrated, worked to use their market dominance to tighten their control over providers. Far from valuing the care optometry provides, plans enacted policies that devalued the profession, doctors’ knowledge and skills, and their essential role in safeguarding Americans’ eye health.

Enough is enough.

In bolstering the AOA and affiliates’ always-on third party advocacy, the AOA’s leadership doubled down in directly worded statements to plan executives throughout 2022: “We are concerned that current valuations do not fully reflect the economic situation that currently exists ... valuation of care must consider the economic factors that are currently at play.”

In some cases, plans had no response. In others, plans pushed back. But the AOA committed to terms of engagement with plans, and as AOA President Ronald L. Benner, O.D., puts it, these tough discussions require all the clinical, coding, practice operations and policy “firepower” we can muster.

“The AOA is working for every member to assure that all payers recognize and value the high-quality care we provide in today’s economic environment. Via direct leader-to-leader dialogue with those who seek to devalue our care, we are looking to hold vision plans accountable for their outdated model. Only the AOA and our affiliates are pointing out the harm and economic damage they are inflicting on doctors and patients. We plan 10,000 meetings with congressional members in D.C. to expose their self-serving polices, vertically self-enriching integration and lack of economic support for their network doctors. Bad players may win at times, but truth and light will expose them. The AOA is providing that truth and light,” says Dr. Benner.

Today, plan advocacy features prominently among the AOA’s priorities. To be certain, it was always there. But members deserve to know more, and to that end, the AOA introduced its Health and Vision Plan Action Report. This daily facet of AOA members’ First Look emails—as well as a dedicated portion of the website—offers a live-running tally of member-reported plan abuses, as well as how the AOA and affiliates responded and the result generated by that outreach.

“We have taken our vision plan concerns directly to the top by engaging the CEOs of the largest plans in direct dialogue,” says Robert C. Layman, O.D., AOA immediate past president. “While solutions have not been immediate, the conversations between our board and their leadership teams have certainly helped them understand the difficulty of our situation. We explained the complex administrative burden involved in serving the patients they cover, and the increased costs associated with COVID-19, inflation and current workforce challenges. We plan to continue to press these issues until there is a meaningful resolution proposed. Your board is determined to devote high energy toward these priority issues.”

With more support than ever, the DOC Access Act was reintroduced on March 7 in the U.S. House (H.R. 1385) by Reps. Buddy Carter, R-Ga., and Yvette Clarke, D-N.Y., and on May 3 in the U.S. Senate (S. 1424) by Sens. Joe Manchin, D-W.Va., and Kevin Cramer, R-N.D. As far as priority legislation goes, the DOC Access Act has remained a fixture of advocates’ federal agenda since 2015. Part of the multi-armed strategy to combat plan abuses at the federal level, the AOA and American Dental Association (ADA)-backed DOC Access Act complements state-level vision and dental plans enacted in 45 states.

“Practices are finding it increasingly difficult to succeed in today’s market due to low vision plan reimbursement. As a result, we have launched a series of top-to-top meetings with two of the largest plans, educating them on the challenges that doctors face each day as they attempt to reconcile low payment and quality of care. We plan to continue this direct dialogue on the valuation of care, searching for solutions that serve the best interest of our members and the patients they serve. In addition, we will continue to promote our Dental and Optometric Care (DOC) Access bill aimed at curbing other types of vision plan abuses such as mandated discounts on noncovered services and lack of lab choice. We’ll also continue to support our affiliates with vision plan legislation that will provide relief at the state level. We’re taking a multi-pronged approach to this, recognizing that it’s one of our members’ top concerns,” says Steven T. Reed, O.D., AOA president-elect.

“Yes, it is obvious to all of us that optometry provides the services necessary for a stronger, more robust health care system. However, to achieve our rightful role as the country’s primary eye care/health care provider, we must advocate this message in Washington, D.C., and every capital across the nation,” adds Tad R. Kosanovich, O.D., AOA trustee. “It has been my observation over the past decade that our legislative challenges have strengthened the relationship of the AOA and the affiliates, the most obvious example being the DOC Access Act. Despite dozens of states passing legislation to rein in vision plan abuses, it is ignored by the payers. Passing the DOC Access Act will provide a better environment for both optometrists and dentists, as well as their patients.”

As the cornerstone issue that optometry’s advocates took to members of Congress during June’s AOA on Capitol Hill, in conjunction with Optometry’s Meeting®, the legislation continues to see mounting support in Congress—and elsewhere. The DOC Access Act is expected to be a larger focus for lawmakers due to a growing chorus of patient advocacy groups joining the fray. Last year, the bill found support from both the Hispanic Leadership Fund and the Southern Christian Leadership Global Policy Initiative, and this year, the Patients Rising advocacy organization also joined the call to put a stop to increasingly harmful vision benefit manager abuses. Beyond the DOC Access Act, the AOA’s federal advocacy continues to speak directly to the Centers for Medicare & Medicaid Services (CMS) against Medicare Advantage plans’ misleading advertising practices that sow patient confusion and frustration over such coverage, as well as the Department of Labor as it drafts long-sought provider nondiscrimination regulations. But these aren’t the only irons in the fire.

Essential and expanding role in health care

Concurrently, the AOA and the Association of Armed Forces and Federal Optometric Services (AFOS) continue to fight for federal service doctors of optometry in the delivery of care to America’s veterans. Two years after overturning the U.S. Department of Veterans Affairs (VA) 15-year “laser ban” that had prevented doctors of optometry from providing laser eye care services, the VA dismantled another access-to-care barrier by removing a ban on community eye care doctors providing injections, lasers or eye surgery to veteran patients.

“The work that the AOA and affiliates have done with the VA community and advocating for community care providers to practice at the highest level of their state scope has been tremendous, certainly for communities such as mine,” says Paul M. Barney, O.D., AOA trustee. “Here in Alaska, we have one VA facility in Anchorage that serves the entire state, so we rely heavily on community care providers. Kodiak Island, Nome, these are areas where optometry provides this level of laser care, so that allows VA patients—and also Alaska Medicaid patients, as well as private pay—to get their care in those communities without having to find their way to the sole facility in our state. We’ve already seen what a huge impact this has for our rural patients, especially, and reducing associated health care costs.”

Such achievements come as affiliates continue their momentum in statehouses nationwide, advocating for scope of practice advancements that fully realize the education and training that doctors of optometry receive, and the vast patient care benefits provided to their communities. The efforts have tendrils dating back to the AOA’s Future Practice Initiative, launched in 2018 to create an operational partnership with affiliates and identify advocacy synergies further honed by 2022’s and 2023’s AOA State Government Relations Center (SGRC) Regional Advocacy Meetings. To date, nearly a dozen states validate optometry’s scope of practice advances to include in-office optometric surgical procedures and injections.

“The AOA and its affiliates have been working for the past several decades on many fronts to usher in our new, contemporary practice of optometry. As a result of our combined efforts, many states, the U.S. Congress, and an array of federal agencies have updated laws, regulations, and policies to recognize optometry’s essential and expanding role. In light of these wins, some medical groups continue to push tired anti-optometry language in troubling ‘not-a-doctor’ legislative efforts. The AOA stands with our affiliates in rooting out and opposing such tactics. We are committed to keeping our doctor-patient relationships unencumbered from these political abuses,” says Terri A. Gossard, O.D., M.S., AOA trustee.

Primary eye health and vision care nationwide is supported by sound clinical research and bolstered by the AOA’s evidence-based guideline development process. Recently having released a second edition of the AOA’s Comprehensive Adult Eye and Vision Examination, the Evidence-Based Optometry Committee provides the profession with guidelines that leverage the best-available research and evidence to inform contemporary patient care.

In much the same way, the AOA’s forward-looking focus on contemporary care influenced its approach to telemedicine in optometry. In late 2022, the AOA board updated and approved its Position Statement Regarding Telemedicine in Optometry to reflect lessons learned and ensure the preservation of access to high-value, high-quality eye health and vision care. This North Star statement guides the AOA’s advocacy toward legislative and regulatory proposals while ensuring not only an appropriate use of telemedicine but also fair and equitable reimbursement for such services, as well as health equity in telemedicine.

“As technology changes, new disease processes are identified, and novel treatments improve patient outcomes, optometry’s role in health care will continue to evolve and expand. The AOA Board and volunteers work tirelessly to ensure our membership has the most up-to-date, evidence-based information in this ever-changing environment,” says Marrie S. Read, O.D., M.B.A., AOA trustee. “I have witnessed firsthand the hours of meticulous review of research and literature to ensure our membership has guidelines it can trust to assist them in improving patient outcomes. Moreover, these guidelines are not a ‘one and done.’ New guidelines are developed, and current ones are updated and revised with the newest validated information to ensure these guidelines are evolving with the profession. Telemedicine/telehealth is another example of the iterative process our policies undergo. With advances in technology coupled with the real-life experiences during the pandemic, the AOA embraced these inevitable changes while ensuring the preservation of the doctor-patient relationship by establishing it as our criterion standard by which all other health care delivery mechanisms and advancements are compared.”

Unsurprisingly, optometry’s momentum in statehouses has drawn opposition in the form of a retreading of a years-old tactic. This year’s legislative cycle saw the introduction of legislation that would prohibit anyone not holding an M.D. license from referring to themselves or publicly advertising themselves as a physician. The bills, proposed in seven states, are reminiscent of the American Medical Association’s (AMA’s) attempt to build support for similar legislation 10 years prior that imploded on a national stage due to optometry’s grassroots effort.

Given this knee-jerk reaction to scope advancements, the AOA believes a resurfacing of the AMA’s public-facing “truth in advertising” campaign, which was successfully rebuffed years ago, may make a reappearance. The AOA continues to build awareness at the federal level for the leading role that optometry takes as the nation’s largest eye care profession in delivering two-thirds of all primary eye care in the U.S.

Informing the public

Building that awareness doesn’t end at the chamber doors, however. Increasingly, the AOA’s 24/7/365 media advocacy serves a watchdog role in keeping optometry’s detractors in check when it comes to public awareness. From scathing opinion pieces that require timely rejoinders in local newspapers to fact-checking national news outlets, the AOA’s media advocacy keeps the record straight.

In January, an NBC “Today” show segment devoted to debunking eye myths perpetuated its own when an ophthalmologist minimized optometry’s vast contributions to primary eye health and vision care. In reducing doctors of optometry as simply glasses and contact lens prescribers, the comments served to sow public confusion at a particularly poignant time for health care misinformation. In response, the AOA admonished the show’s producers over the mischaracterization and rallied the support of countless AOA members who shared their feedback over the diminishing characterization.

Only weeks prior, the AOA had responded to an opinion column in South Carolina that decried the VA’s community care decision as a reduction in the standard of care, citing much-maligned “evidence” of repeated procedures. While the piece served to paint the VA’s decision as radical, the reality is that the decision means the VA is less an outlier than before among other federal and private coverage providers.

In yet another case, the AOA immediately responded to a mischaracterization of optometry’s role in an article published by Delta Dental that aimed to differentiate between an ophthalmologist and optometrist. Through coordinated outreach from the AOA, Wisconsin Optometric Association and the Illinois Optometric Association, Delta Dental amended its erroneous definition of optometrist.

The AOA’s two-pronged approach to media advocacy also includes the proactive messaging about the importance of in-person, comprehensive eye care provided by doctors of optometry as part of the Eye Deserve More public awareness campaign. This hyper-targeted campaign employs a multi-channel approach to reach Americans, directing them to the AOA’s doctor locator where they can find an AOA member for their primary eye care needs.

In 2022 alone, the Eye Deserve More campaign generated:

• More than 205,000 clicks to the AOA’s doctor locator and Eye Deserve More web page.
• More than 93,000 engagements across celebrity partner platforms, such as Olympic surfer Caroline Marks, NBA player Tacko Fall, actor/singer Jordan Fisher and professional gamer Aruuu.
• More than 26.4 million impressions across social and digital ads.

“Because I have been deeply engaged in the AOA’s communication strategies for many years, I know the importance of ensuring the public understands that doctors of optometry provide the vast majority of the primary eye and vision care,” says Teri K. Geist, O.D., AOA secretary-treasurer. “By telling compelling patient stories and the incredible care that we provide our patients every day, we are able to strengthen our messaging through our Eye Deserve More campaign. We will fight for our AOA members through strong advocacy messaging and remain committed to highlight the importance of the doctor-patient relationship.”

Currently delivering a message about screen time and eye health—and therefore targeting an audience comprised of the more than 227 million Americans who play video games—Eye Deserve More speaks directly to gamers, fewer than 46% of whom visit an eye care provider for a comprehensive eye exam every year.

“The pandemic has sent our day to day into the digital space more than ever before. Eye Deserve More is now focused on screen time, specifically targeting gamers. AOA members have asked for a PR program that translates to the public understanding the importance of yearly in-person, comprehensive examinations. Eye Deserve More is meeting the public where they are in games, social media or however they consume their digital information. Our goal is to help raise awareness that in order to be healthy online, you must go offline to a doctor of optometry. We are educating the public that eye care is health care. Because of our targeted approach, our member doctors may not be the individuals seeing our advertisements. With all the platforms available, we have the capability to prioritize getting the information to those who need to know our messaging,” says Belinda R. Starkey, O.D., AOA trustee.

The power of membership

Yet all that said, the AOA can deliver for members because of its members. As an inclusive community of doctors committed to the profession’s advancement and collective defense, members—and their tireless support—make it possible for the AOA to be recognized as a small-but-mighty force, consistently ranked among Washington’s top advocacy organizations. Representing over 49,000 members, the AOA takes its direction from an all-doctor led board of trustees and a 300-strong cadre of volunteers spanning 53 affiliates, all focused on delivering for practices and the profession.

“True to the saying, ‘a rising tide lifts all boats,’ AOA members have a strong history of assisting each other to ensure we are all successful. We accomplish that through the talents and dedication of our members at the local and national levels. At the local level, there are many examples of our members sharing best practices with one another and even lending a helping hand in times of need or tragedy. In our affiliates, members fight tirelessly every day to protect and advance our scope to provide the highest quality and accessible care to patients in our communities. As a volunteer-led organization,

AOA relies on the large network of committee volunteers to provide valuable member benefits. Doctor and staff education, clinical guidelines, billing and coding resources, federal advocacy efforts, and public awareness campaigns are just a few areas where volunteers make a difference in member success. We know that our profession is more powerful when we work alongside one another—we are truly stronger together,” says Curtis A. Ono, O.D., AOA trustee.

While advocacy remains paramount, the AOA delivers a wealth of member benefits and resources oriented toward helping optometry practices succeed. From a panoply of AOAExcel® business solutions to staff training modules, webinars and professional development within the AOA EyeLearn Professional Development Hub, as well as member access to the annual Optometry’s Meeting, the AOA offers a complete portfolio to help members. And all that for less than the cost of a daily trip to Starbucks.

“The board is always focused on the needs of our profession, and on elements that support our thriving practices. We know there are needs that are constant and require persistent attention and protection. But we also constantly keep our finger on the pulse of change within the profession and in outside influences. Because these changes are emerging rapidly, we rely heavily on the work of our volunteers to help guide the direction and priorities of the AOA. Our association is so fortunate to have so many dedicated volunteers! We are admired by other professional associations, well known for our positive presence in Washington D.C., and we are battle ready for whatever it takes to advance optometry,” says Jacquie M. Bowen, O.D., AOA vice president.

But truly, the proof is in the pudding—AOA members earn 13% more, on average, than nonmembers. Leveraging the power of connection, membership is what keeps the profession moving forward.