You might look at the AOA's advocacy efforts in 2016 like a full-court press in basketball: defending against unscrupulous online contact lens retailers, safeguarding the doctor-patient relationship against vision plans, and relying on the referees—lawmakers and federal agencies—to make sure the game is called fairly.
"Our advocacy efforts have never been h2er," says AOA President Andrea P. Thau, O.D. "We are taking a proactive approach. We want to protect our patients' vision and assure doctors of optometry have access to their patients so they can provide care at the highest level."
And what propels this dogged pursuit? Protecting the doctor-patient relationship. For the AOA and its patients, there is no substitute for comprehensive eye examinations provided by doctors of optometry.
"We're pressing it because we see that doctor-patient relationship coming under attack," says Steven A. Loomis, O.D., AOA immediate past president. "Everything we do is aimed at maintaining that relationship, which we think is critical not only to patient eye care, but also to health care."
Here are some of the AOA's advocacy wins in 2016:
Defending against deceptive internet contact lens sellers
The AOA mobilized an all-star alliance—the Coalition for Patient Vision Care Safety that included contact lens makers and others—to convince members of Congress to initiate a bill that would crack down on unscrupulous internet lens retailers.
Introduced by Sens. Bill Cassidy, M.D., (R-La.) and John Boozman, O.D., (R-Ark.) in April, the bill—the Contact Lens Consumer Health Protection Act, S. 2777—would strengthen existing patient health safeguards contained in the Fairness to Contact Lens Consumers Act (FCLCA). In September, Reps. Pete Olson (R-Texas) and Kathy Castor (D-Fla.) introduced H.R. 6157, which complements S. 2777.
The existing FCLCA has been undermined by deceitful internet contact lens sellers by:
- Selling contact lenses without proper prescription verification.
- Overfilling orders.
- Filling orders with expired prescriptions.
- Substituting with non-prescribed lenses.
The AOA commended the Federal Trade Commission (FTC) for filing suit against 1-800 Contacts, alleging the company unlawfully used its market power to orchestrate and maintain anti-consumer agreements with rival online contact lens resellers. According to the suit, 1-800 Contacts signed agreements with 14 other online contact lens retailers to manipulate its way into prominent search engine advertising. The retailers allegedly agreed not to advertise against each other in search engines such as Google and Bing.
Only days earlier, the AOA-supported coalition had met with FTC Commissioner Maureen Ohlhausen to talk about the necessity of safeguarding patients' eye health and the risk of improper contact lens practices.
"This suit reveals anti-competitive sales tactics that 1-800 Contacts purportedly employs to suppress competition—tactics that harm patients by restraining competition in online advertising and restrict truthful internet advertising, resulting in some consumers paying higher retail prices for contact lenses," the AOA said in a statement.
Taking on vision plans
Teaming up with the 158,000-member American Dental Association, AOA threw its support behind the Dental and Optometric Care Access Act (DOC Access Act) (H.R. 3323) to thwart anticompetitive business practices by vision plans. Originally introduced by Reps. Buddy Carter (R-Ga.) and Dave Loebsack (D-Iowa) in 2015, the bill had 62 co-sponsors by mid-September. That's 52 more than last year.
Roger Jordan, O.D., vice chairman for policy on the AOA Advocacy Executive Committee, says, "H.R. 3323 will prohibit insurance companies and vision plans from interfering with the doctor-patient relationship. Many states already have this in effect with the help of the AOA State Government Relations Committee (SGRC), but we need to cover those plans not covered by states under the ERISA umbrella. This will make patient care better and give the doctor more leverage in how the office will interact with third-party vendors."
In a national Day of Action in March, doctors and students petitioned members of the U.S. House of Representatives to boost support for the DOC Access Act. They called on lawmakers to help level the playing field for patients and their doctors against vision and health plan abuses. A month later, 600 doctors and optometry students traveled to Washington, D.C., to visit Capitol Hill and federal agencies for the 2016 AOA Congressional Advocacy Conference.
And in June, Drs. Thau and Loomis wrote a letter to VSP Global board chairman Daniel Mannen, O.D. They called VSP's Premier Provider program "fundamentally misleading to patients, unfair to doctors, and at odds with the delivery of quality care" and expressed opposition to VSP's frame policy that required eye doctors to carry VSP-owned frame lines or face a cut in reimbursements.
On July 1, VSP announced that it was postponing implementation of the frame policy.
Putting doctors of optometry 'on equal footing'
In 2016, the AOA's Third Party Center (TPC) contested policies that would infringe upon a doctor's ability to provide quality care to patients, TPC chair Steven Eiss, O.D., says. "We're always working to have an environment where doctors of optometry are on an equal footing across the board."
For instance, AOA and its affiliates convinced Cigna to discontinue its requirement that doctors of optometry contract with VSP's Integrated Primary Eyecare Program rather than directly with the medical insurance network. Going forward, Cigna intends to reach out to providers directly.
Stephen Montaquila, O.D., is currently vice chairman for coverage on the AOA Advocacy Executive Committee, and served as chair of the AOA's TPC Executive Committee for the past six years. "Optometrists now have a choice and are allowed to participate in exactly the same way as others (ophthalmologists) who provide the same services," Dr. Montaquila says.
The AOA also beat back plans by the National Association of Vision Care Plans (NAVCP) to establish a new credentialing portal for doctors of optometry separate from the Council for Affordable Quality Healthcare and the rest of health care.
Another highlight: AOA outmaneuvered vision plans on new network adequacy requirements established by the National Association of Insurance Commissioners (NAIC). For two years, the AOA worked to ensure that model language contained in NAIC's requirements was inclusive so that patients could get access to the right care at the right time, including care provided by stand-alone vision plans for the first time.
The AOA also helped defeat efforts by vision plans to create an administrative loophole when administering benefits for health plans.
On the winning side
The AOA will fight when it must. There is no off-season for advocacy.
"Advocacy is not only important to protect our patients, but also to ensure that our profession can continue to grow and advance so we can meet the needs of our patients," Dr. Thau says.
Adds Dr. Loomis: "We have gone toe-to-toe with these groups because the opposition has become more aggressive and the threat is bigger."
The second of two Medicare sequester cuts took effect July 1 with up to 2.75% of Medicare physicians’ pay affected in 2022. Even more significant cuts are scheduled in 2023 without Congressional action.
AOA-led effort builds Congressional support for the DOC Access Act, delivering in-person briefings for members of Congress and strong backing from the American Dental Association and national pro-patient groups.
Already the subject of one complaint to the IRS, the National Association of Optometrists and Opticians (NAOO), a lobbying “front” for large optical retailers, was called out to legislators for deceptive tactics and seeking a self-serving overhaul of patient health and safety standards. The AOA follows up on winning activism of South Carolina doctors with a new push for a federal investigation of NAOO tax exempt status.