The AOA is leading opposition to a new policy by VSP Vision Care to differentiate payments for certain lens products and anti-reflective coating set to take effect Sept. 1.
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, apparently driving 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 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, EyeMed 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 payment remains the same. Through that change, VSP forces the provider to encourage the use of their branded lenses, which makes VSP more money but there is no financial incentive for the patient to make that change. This pushes doctors of optometry to make decisions on patients' care based on reimbursement, not what is best for the patient, either financially or medically.
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 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 AOA 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.
The prior-authorization requirement ended July 1, 2022, for all patients—except Medicare Advantage in Georgia and Florida—a year after the AOA and other groups decried Aetna’s decision.
Medicare Advantage Organizations’ denials of prior authorization requests raise flags in HHS report and prompt AOA’s third-party advocacy outreach on behalf of optometry practices.
Direct third-party advocacy remains a critical component of the AOA and affiliates’ mission, helping support practice success by ensuring patients can freely access the broadening scope of eye health and vision care delivered by optometry. But advocacy requires a team effort, and optometry’s advocates have an opportunity this spring to help bring about the payer changes the profession needs.