Bipartisan, AOA-backed legislation aimed at curbing abusive health and vision plan policies has gained impressive momentum on Capitol Hill, though a leading industry opponent continues efforts to derail its progress while wrongly asserting that they—and not the AOA—represent optometry's interests.
In an attempt to sway doctors' opinions against the Dental and Optometric Care Access Act (DOC Access Act, also known as H.R. 3323), and like-minded state legislation, VSP assembled a questionable narrative of the bill's repercussions ahead of its annual VSP Global Premier Program meeting, SHiFT 16, this October.
Namely, VSP falsely contends that the DOC Access Act and similar state actions would altogether stifle vision plans—suggesting it could collapse the entire system—in turn, hurting optometry.
Additionally, VSP acknowledged that several recent network policies of its own proved flawed and unfair, but still deceptively promoted VSP participation as a solution to falling medical reimbursements. So, too, VSP continued its quixotic quest to become the voice of the profession in Washington, D.C., and state capitals, even urging a stand against AOA and state association efforts to pass legislation to target plan abuses.
This meeting between VSP and VSP's State Professional Representatives (SPRs), a liaison network between VSP and panel doctors, did little to win over attendees, especially as the company declined to provide a copy of the DOC Access Act and failed to make a case against the bill, says Clifford Holt, O.D., Kansas Optometric Association president-elect and a VSP SPR in attendance.
It was Dr. Holt's opinion that SPRs actually seemed more keen and supportive of the DOC Access Act and similar state legislation once the language was fully explained. Although, he notes, the SPRs desired more information.
"We've been on a 10-year race to the bottom with vision plans," Dr. Holt says. "Patients and doctors are the groups that have been made to suffer in this race, and these types of bills are simply trying to bring sense back into the equation."
The AOA maintains that VSP assertions are patently false, and correspond to a failed effort in August 2016 to solicit skewed survey results among doctors of optometry that would've attempted to discredit the legislation. Then, AOA warned how these slanted results might be used to support efforts to defeat the DOC Access Act, considering that VSP is a leading member of the National Association of Vision Care Plans (NAVCP)— the group aggressively opposing the legislation.
These surveys used charged wording and showed an implicit bias, prompting AOA's Chief of Surveys and Data Analytics, Jennifer Spangler, M.B.A., M.P.H., to comment, "Opinion surveys, such as this one, tend to simplify choices in a way that could be misleading, and many of the questions are leading. Results of such an inappropriately conducted survey would be prejudiced."
Countering vision, health plan abuses
To ensure doctors and patients reap the full benefits of states' patient access laws and other efforts aimed at reforming health and vision plan abuses, federal action is necessary to complement—not supersede—state law. That's why the AOA and the American Dental Association (ADA) strongly support the DOC Access Act, outlawing unfair policies enacted by plans regulated on a federal level, such as ERISA. As of Nov. 21, the DOC Access Act had 65 co-sponsors on Capitol Hill, in addition to its lead sponsor Rep. Buddy Carter (R - GA) who introduced the measure just last year.
Already, more than 40 states have laws prohibiting some vision and/or dental plan abuses that the DOC Access Act seeks to eliminate at a federal level, such as:
- Restrictions on medical plan participation.
- Limits on doctors' choice of labs.
- Mandates on noncovered services and materials.
"Major changes in health care will be an immediate priority for Congress in 2017, and it's notable that a key bill we are supporting has gained a solid base of support," said Andrea P. Thau, O.D., AOA president. "Through our grassroots advocacy efforts and strategic partnership with the ADA, members of Congress have been eagerly learning about the DOC Access Act and how it would improve care and benefit our patients."
Despite VSP's assertions to the contrary, an Avalon Health Economics study presented on Capitol Hill in April 2016 showed that these unfair provisions deemed essential by vision plans only benefit the plans themselves, as opposed to the patients they claim to help. Study authors described how the plans' "monopsony"-like behavior actually leads to higher overall costs for patients across the board.
"Things took a leap (in the meeting) when VSP said it's very possible that vision plans would go away if the DOC Access Act passes," Dr. Holt says. "Perhaps vision plans would have to modify their business strategy a bit, but there's nothing that would make them obsolete. If anything, this would just bring patients and doctors back to a more equitable footing with vision plans." Similar to its lobbying tactics in opposition to the DOC Access Act, VSP and other plans connected to the NAVCP have issued dire predictions about the impact of AOA and state association-backed legislation—doomsday forecasts that time and again have proved false.
The AOA remains committed to removing unnecessary barriers that disrupt doctors' ability to provide seamless, quality patient care, and continues to emphasize the importance of legislation that puts patients and their doctors back in control of important health care decisions.
Mirroring some of the AOA’s longstanding agitation over vision plans’ abuses, the Sept. 26 lawsuit by Total Vision LLC (and Total Vision, P.C.) alleges unfair competition, monopolization, tying and intentional interference with prospective business relations. Total Vision LLC supports 59 independent practices in California.
The AOA and affiliates in Illinois and Georgia score wins against vision plan abuses in a year in which doctors of optometry are making inroads across the country. When all else failed, including talks with the plans and appeals to one state’s insurance commissioner, affiliates did the hard work of helping push through bills in their legislatures that address the abuses.