Talk of the townhall: Doctors view plan abuses as threat to doctor-patient relationship and quality care

January 11, 2024
Forum on reimbursement and coverage fairness advocacy produces fresh reports of plan-imposed barriers and support for mobilization for tough new laws, stronger enforcement and close government scrutiny of the vision plan industry.
Vision Plan Townhall on Zoom (Screenshot)

Doctors of optometry are reporting an array of anti-patient, anti-doctor and anti-competitive abuses by the vision plan industry that they view as a threat to practices and the delivery of quality eye health in America, according to survey and other feedback from hundreds of doctors who joined a Jan. 4 profession-wide townhall.

The virtual townhall was convened by Ronald L. Benner, O.D., AOA president, and the AOA Board of Trustees.

“Given the serious situation we’re facing, it’s essential to open the new year listening closely to colleagues and discussing the ways our AOA and affiliates are fighting back in the policy advocacy arena against plan policies designed to work against us, our practices and patients,” Dr. Benner said following the event.

“Coupled with a strong national legal enforcement team that meets often with affiliate leaders and individual members, we’ve committed our relentless advocacy network, our full grassroots capability, our AOA-PAC clout, our always-on communications platforms and our organizational strength to the job of securing policy change and needed relief for our doctors,” Dr. Benner added.

By large survey margins, participating doctors also expressed strong backing for AOA and affiliate efforts throughout 2023 to push for legislation in Washington, D.C., and state capitals to investigate and outlaw plan abuses. 

In what was the largest virtual forum held by the AOA since the pandemic period’s #AskAOA webinar series—with more than 700 participants logging on—the AOA Board of Trustees gathered new reports from doctors detailing concerns about devaluation of care, plan-imposed barriers, sneak marketing tactics and harmful contracting, and sales and marketplace strategies employed by the industry.

In addition to the survey and live results, participants received briefings on the status of each of the multiple active advocacy initiatives underway at the state and national levels, including successful 2023 enactment of vision plan reform legislation in TexasNevadaGeorgia and Illinois and the outlook for more in the year ahead.

Rep. Buddy Carter, R-Ga., a health policy leader in Congress, provided a real-time update on the bipartisan bill he is championing, the Dental and Optometric Care (DOC) Access Act. Congressman Carter is leading the charge for a crackdown on vision plans/ vision benefit managers (VBMs) by seeking a direct ban on forced discounts on non-covered services, safeguards for doctor choice of optical lab and reform of the contracting process. 

As Rep. Carter’s legislation also seeks to address urgent dental plan abuses, the American Dental Association (ADA) has joined forces with the AOA in urging both U.S House members and U.S. senators to join as official congressional co-sponsors, a key indicator of a bill’s level of support and whether it will be considered a priority. Sens. Joe Manchin, D-W.V., and Kevin Cramer, R-N.D., are now sponsoring a DOC Access companion bill in the Senate.

National patient advocacy groups, including Patients Rising, are taking note and have endorsed the legislation, calling on congressional leaders to prioritize the bill. 

Recognizing the immense resources of the vision plan industry, Rep. Carter detailed the pathway he sees toward enactment.    

“We’ve got to work together on this,” said Rep. Carter, who noted the added momentum gained from dozens of supportive members of Congress, the Senate activity, AOA, ADA and Patients Rising backing and the expanding efforts underway to educate and inform legislators. “We are stronger together than we are individually, and that's why it's extremely important that we support the American Optometric Association in the important work that it’s doing on Capitol Hill.”

Since the townhall was announced in late 2023, doctors have been joining the AOA- and affiliates-led mobilization to pursue national and state policy changes aimed at securing relief for optometry practices. In furtherance of the AOA and affiliate efforts, doctors have also been contacting the AOA to receive personalized policy advocacy action plans and to learn more about where their elected leaders stand on VBM reform and accountability.

And the survey says...

During the townhall, participants were polled about their concerns to help further focus 2024 advocacy planning. Key input:

  • 93% believe that vision plan policies create a barrier to delivering quality care
  • 94% believe that vision plan policies do not support the patient-doctor relationship
  • The most immediate reported plan-imposed burdens facing practices today
    • Valuation of care: 55%
    • Tying vision plan participation to medical plan participation: 27%
    • Lack of lab choice: 9%
    • Being excluded from certain networks: 7%

Optometry’s strategies for relief for practices

The AOA and affiliates have developed a multi-pronged approach to achieving reimbursement and coverage fairness, Dr. Benner said. During the past year, this approach has met with success—accomplishments that the AOA will build on with an ever-greater advocacy in 2024. The AOA is committed to exploring all possible options to bring relief to doctors and put them back into a position of authority.

The AOA’s approach includes:

  • Defeating a scheme by the vision plan industry’s lobbying group, the National Association of Vision Care Plans, to gain influence over state legislation and legislator
  • Taking direct action to resolve doctor complaints against plan-imposed barriers to patient care.In 2023, the AOA identified an error in Elevance’s claim system that was disallowing doctors of optometry from billing for dry eye testing. AOA advocated for doctors to be paid for the care they have provided, and the payer reprocessed the claims and appropriately paid doctors for their care.
  • Launching its Health and Vision Plan Action Report, a day-by-day advocacy tally focused on the work of resolving doctor complaints about plan abuses and errors.
  • Forging advocacy alliances with the ADA, Patients Rising and other groups supporting a crackdown on plan abuses.
  • Working together with affiliates to update state laws, including wins in 2023 in Texas, Nevada, Georgia and Illinois, as well as seeking stepped-up legal enforcement.

Dr. Benner added: “Every colleague can take action right now and help build support for our AOA and state affiliate priorities to fight back against plan abuses. Please reach out to the AOA legal and advocacy team at stopplanabuses@aoa.org or to me directly at president@aoa.org with questions, comments or an interest in joining our profession-wide mobilization to fight for our patients, our practices and our profession.”

All professional associations, including the AOA, are strictly prohibited from coordinating the contracting decisions on behalf of their members.

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