Doctors of optometry in Texas and Nevada build bulwark against vision plan abuses
Confounding the odds and strong opposition, doctors of optometry in Texas and Nevada overcame both last week to win important legislation against anticompetitive practices by vision plans.
They earned it.
In Nevada, S.B. 134 was signed by Gov. Joe Lombardo on June 12. On the way to passage, on two key votes, there was nary a nay vote on the bill.
“We’re excited that the governor signed the bill,” Spencer Quinton, O.D., president of the Nevada Optometric Association (NOA), says. “It’s not an earth-shattering scope bill, but it’s a big deal for doctors and patients because it will help ease some of the anticompetitive practices of the vision plans. This may give them pause.”
Texas Gov. Greg Abbott signed H.B. 1696, “Relating to the relationship between managed care plans and optometrists and therapeutic optometrists,” on June 16. It will go into effect Sept.1.
"Over 1,300 Texas doctors of optometry personally indicated their support of the bill to the governor, so we know our colleagues are happy that what seemed like an unwinnable fight for groundbreaking legislation was actually won,” Jennifer Deakins, O.D., president of the Texas Optometric Association (TOA), says. “It just takes gumption to stand up for what is right and understand that if you keep your legislative focus on your patients, you will prevail.”
Dr. Deakins adds, “We hope that vision plans look at what happened here in Texas and then take a long look in the mirror, and then decide to cooperate with our profession in a manner that respects patients and optometrists. After all, they don't exist without us."
A win in Nevada
Under the new legislation in Nevada, insurers can’t enter into a contract with a provider of vision care that (1) authorizes the insurer to set or limit the amount that the vision care provider may charge for vision care that is not reimbursed and (2) requires the provider of vision care to use a specific laboratory.
“This bill reduces the out-of-pocket costs to patients for new materials, since doctors can negotiate for better prices, and get them better discounts than was mandated by vision plans for extra sunglasses or glasses/contact lens dual purchases,” Jonathan Mather, O.D., legislative chair of the NOA, says. “It should improve speed and quality of delivery of glasses and other services to patients and maintain a free and open market to help keep vision care costs down.”
Additionally, the bill contained a new provision calling for providers to disclose in writing to insured individuals if the provider has any ownership or other financial interest in a supplier of ophthalmic devices or materials that the doctor might recommend. This provision was not supported by the NOA.
A win in Texas
In Texas, the TOA proposed and put forth a comprehensive list of statutes. Among other things, the new law will:
- Stop vision plans from differential identification and tiering of in-network doctors of optometry based on discounts on noncovered services, amounts spent on products or brands or sources of products utilized by doctors of optometry.
- Stop vision plans from steering patients toward any particular in-network optometrists, any retail location owned by plans, or any internet site or virtual provider owned by or affiliated with any of the plans.
- Require vision plans to disclose complete in-network and out-of-network plan benefits to patients and doctors of optometry by electronic means.
- Stop improper chargebacks to doctor reimbursements when the plan is not supplying the materials (cost of goods) to a patient.
- Stop plans from calling services and products "covered" when zero reimbursement of the service or product comes from the plan to the doctor of optometry.
- Halting plans from using or offering reimbursement rates that are different from another doctor of optometry based on the optometrist’s particular practice and business decisions, such as what lab they choose to use or what products they choose for a patient.
- Stop plans from requiring unneeded and unrelated patient information to file a claim or receive reimbursement, such as prescription information, medical diagnoses, facial measurements and facial photographs.
- Halting vision plans from using extrapolation as a method to complete an audit.
The new Texas law will address and put an end to the controlling tactics of vision plans who “steer” patients to their vision plan “co-systems,” Dr. Deakins says.
“If you are a doctor of optometry looking at what vision plan companies have been doing in the last few years, you might think to yourself, ‘should I give in to this financial scheme at the expense of my expertise as a doctor and oath to my patients?’
“‘Or should I just understand that slowly but surely my patients will be redirected to another office by the vision plan ... so should I just sell my practice now before it's too late?’" Dr. Deakins adds. “This bill will help independent optometry offices in Texas remain viable in business. The additional good news is that the law's provisions apply to medical plans, because we see some of the same tactics of ‘steering and tiering’ occurring in the medical plan space as well."
The new law is also beneficial for patients.
"Patients in Texas will continue to be helped by the local, independent doctors of optometry in their communities, and true competition at the level of service is what keeps health care costs lower for consumers,” says Tommy Lucas, O.D., director of advocacy for TOA.
Dr. Lucas continues: “Vision plans play a part in that access to care equation, but when they begin to use business tactics that threaten the existence of optometry practices and destroy the sacrosanct nature of the unbiased doctor-patient relationship, that is where the line must be drawn."
Keys to victory
Passage in either state wasn’t assured, considering the resources arrayed against both AOA affiliates—opponent the National Association of Vision Care Plans, for instance, says on its website that its members cover about 66% (more than 218 million people) of all Americans with their plans.
Opposition was met with a strategic and agile game plan by the affiliates: long-cultivated relationships with lawmakers were leveraged; members connected with elected officials, by phone and texts, asking them to support their bills; and experienced legislative teams planned and reacted quickly to situations that arose.
In Nevada, doctors of optometry contended with misinformation spread to some local labor unions: that costs to patients would increase if the bill passed. The NOA worked with union leaders to allay their concerns—prices wouldn’t necessarily go up, but competition would maintain patient choice and that is good for patients, Dr. Quinton says.
Further, NOA advocates had laid the groundwork two years earlier.
“We already had a foot in the door. That earlier bill increased transparency by requiring vision care plans acknowledge ownership of labs, for instance,” says Dr. Quinton, who also credited NOA lobbyists for the affiliate’s success. “It also put vision care plans under the purview of the state insurance commissioner. They previously operated in a gray area.”
Tricky might best describe navigating Nevada’s bill through its legislative gauntlet. Although the bill had bipartisan support, Nevada has a Republican governor and Democrat-controlled legislature.
“That struggle meant we had a few very late nights when bill deadlines came up, as leadership put our bill on the very end of the agenda simply because the sponsor was of another party,” Dr. Mather says. “This is the nature of our current political system, and the saving grace is that things still get done. With the right relationships, I think optometry can celebrate this win in Nevada and hopefully it pushes the national legislature to move forward on similar issues.”
Facing behemoth corporations
In Texas, Dr. Lucas began serving as TOA legislative committee chair in 2012 and then joined the TOA staff as director of advocacy in 2017. Dr. Deakins took over leadership of the committee, and the pair of optometrists have been a staple at the Texas capital now for seven consecutive legislative sessions.
Additionally, the TOA legislative committee is comprised of several previous TOA legislative leaders with decades of experience who continue to guide and mentor the new generation of leadership. All that experience comes in handy in the heat of the battle over bills.
"Passing legislation is never easy,” Dr. Lucas says. “The system is designed to kill bills, so passing anything at all is always a small miracle, even without opposition. With organized and sophisticated opposition, the pathway to success is even harder. Many doctors of optometry are experienced with fighting for scope-of-practice legislation, but insurance-based legislation takes on a different flavor.
“Instead of a difference of opinion with the state medical society, you are facing off with behemoth corporations with virtually unlimited resources,” he says. “In our case, the insurance industry, vision plan companies, and vision plan industry groups spent over a million dollars on influential lobbyists to attempt to defeat this TOA-supported legislation. To overcome this, you need your grassroots relationships, preparation by your association leadership and a solid game plan by your legislative team.”
Dr. Deakins agrees.
"As in any legislative endeavor, the conversation must begin with genuine grassroots relationships to all of your state's elected officials,” she says. “When you have a very strong grassroots organization, you get unanimous floor votes in the House and Senate, as we did in Texas on this legislation. Also, PAC dollars absolutely matter—your state political action committee must have the resources to support and elect candidates that support optometry's role in their communities and in the health care system at-large."
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