Report reflects AOA input to enhance health care access and choice for Americans

Reflecting input from the AOA and an array of health care policy experts, a new, agenda-setting federal report, detailing urgently needed reforms to the nation's health care system, has embraced optometry's essential and expanding physician role.

“Restrictive state practice laws that are based on an antiquated perception of education and skills are holding patient care hostage, and it is only when these laws are fixed that patients will gain the choices and the access they need and deserve.”

The report was prepared by the Department of Health and Human Services, in collaboration with the Departments of the Treasury and Labor, the Federal Trade Commission and several White House offices. Released Dec. 3, the report comments on how state and federal laws, regulations, guidance and policy impact choice and competition in health care markets and delineates what steps the states and federal government should take to deliver optimal care to Americans.

"We know the United States health care system too often fails to deliver the value it should," the authors write. "This report identifies barriers on the federal and state levels to market competition that stifle innovation, lead to higher prices, and do not incentivize improvements in quality."

The report specifically addresses recommendations made by the AOA, in response to a 2017 request for information, which ultimately would increase patient access to care. Of particular interest to doctors of optometry, the report says:

• Doctors of optometry can provide the same services as other physician groups.
• "States should consider changes to their scope of practice statutes to allow all health care providers to practice to the top of their license, utilizing their full skill set."

The AOA calls the aforementioned recommendations a victory for patient access to safe care-central to health care decision-making. The AOA also urges states to take action in support of the recommendations to further patient care and allow doctors of optometry to practice at the fullest scope of their training, education and experience.

"The AOA spoke out loud and clear, and now we have a powerful statement of support from Washington, D.C., for the nation's doctors of optometry and for the objectives of our Future Practice Initiative," says AOA President Samuel D. Pierce, O.D., on the report's release to the public.

Dr. Pierce adds, "Restrictive state practice laws that are based on an antiquated perception of education and skills are holding patient care hostage, and it is only when these laws are fixed that patients will gain the choices and the access they need and deserve. With doctor education, technologies and treatments advancing at a more rapid pace than ever, it's absolutely time for the federal government to mobilize fully in support of the doctor-patient relationship at the heart of healthy patient outcomes."

Up to 16 million Americans struggle with undiagnosed or untreated vision impairments. Eye diseases, vision loss and eye disorders account for an estimated $139 billion economic impact. As America's primary eye health care providers, doctors of optometry are uniquely positioned to address this challenge, provided they are not hindered by antiquated and unfounded restrictions.

Report's recommendations

The report, requested by President Donald J. Trump, makes several recommendations to foster choice and competition in health care, including addressing:

• Health care workforce and labor markets: The report argues that more competition among clinicians and fewer government regulations can lower the costs of health care. It proposes eliminating policies that stifle competition, broadening providers' scope of practice and addressing physician supply shortages. It also recommends streamlining government funding for graduate medical education.
• Health care provider markets: Promote choice and competition in the states by repealing or scaling back certificate-of-need laws and supporting the development of flexible, value-based payment models and risk-based incentives for providers.
• Health care insurance markets: Change regulations that limit coverage choices, giving states more flexibility to develop policies that reflect diverse consumer preferences. It recommends scaling back government mandates, eliminating barriers to competition, and allowing consumers to purchase health insurance that meets their needs.
• Consumer-driven health care: Empower consumers by expanding their access to health spending accounts, implementing reference pricing where appropriate, and developing price and quality transparency initiatives so that they can make well-informed, health care decisions about their care.

"Health care bills are too complex, choices are too restrained, and insurance premiums and out-of-pocket costs are climbing faster than wages and tax revenue," the report says.

Early AOA advocacy

In a Jan. 25, 2018, letter, Christopher J. Quinn, O.D., AOA president at the time, responded to a request for information ahead of the report's release and offered input on the state of competition and choice in health care.

Dr. Quinn raised concerns about "discriminatory plan coverage and design, benefit limits, and enrollee cost-sharing, which the AOA argued limits patient access to certain providers though they would be within the bounds of their training and statutes." It also offered input on the need for patient choice of physicians, eliminating burdensome Medicare enrollment policies and issues with the Medicare Part D formulary.

Among the AOA's comments:

• Working to preserve, promote and defend the pro-patient, pro-competitive provisions of Public Health Service Act, Section 2706, which "aims to end certain health plan practices that have made it policy to summarily deny participation to a range of licensed and certified health care providers merely because those providers took a different educational path to clinical expertise, quality and licensure."
• Eliminating requirements by some insurance providers that doctors participate in "restrictive insurance plans or networks that force doctors to accept discounts on noncovered services; require doctors to participate in a vision plan as a condition for participation in a medical plan and restrict a doctor's choice of a lab. These types of plan abuses lead to higher overall costs and limit patient access to the doctors of their choice."
• Reducing the complexity and number of entities involved in enrolling in CMS programs and consider requiring Medicare Advantage plans to use a centralized and more streamlined the Medicare credentialing process.