Excerpted from page 5 of the May/June 2023 edition of AOA Focus
Welcome to the new normal.
Somehow, I’m not sure that I’ve seen much change when it comes to the care we provide—at least not much that is positive. Nationally, we have all been subjected to unprecedented changes at all levels of life and practice.
I know how much more challenging providing care has become. I also recognize the importance of adapting to change; it is a necessity in health care. We mobilized, evolved and even expanded our care over the past 20 plus years as our scope, standards of care, and technology have evolved. We persevered through one of the greatest crises in modern history and today we lead the way in the delivery of eye care to our communities.
So why not celebrate? Think about what it costs your office to care for each patient. That cost has increased dramatically, even if you didn’t purchase technology or do a remodel. Our staff and commodities have greatly risen, especially in the past few years. Again, we should all be proud that we provide high-quality, high-value care. But the boat anchor holding us back has not changed (at least for the positive) over that same 20 years.
What concerns me—and the AOA—is what hasn’t changed over the years.
Health and vision plans are stuck in a 1990s pay scale. They have not adapted and grown with the care we deliver but found a pathway to increase their profits and, in turn, hold back optometry’s momentum. In short, they publicly reinforce the quality care we deliver while devaluing our profession by continuing to follow an outdated model for how doctors are compensated for the essential care we provide.
We need to adapt and define our value differently. The plans publicly share that vision is priceless and is directly related to valuable care that contributes to overall quality of life. The perceived true value of the vision care we deliver is to their company bottom line. At some point the vison plan market will hit a breaking point. There is only so much more that can be done when there are continuing diminishing returns.
The AOA understands this dynamic, and we are taking action each day to address the disparity and move toward an equitable system where the value of our care is recognized, not just verbally but through realistic and fair care coverage and valuation policies. We are committed to evolving the health and vision plans’ valuation of our essential and expanding role in health care.
This is a daily focus for the AOA Board of Trustees, our almost 275 volunteer doctors, affiliates and our staff. You can find out more information about what we are doing every day in the AOA’s Health and Vision Plan Action Report, featured in AOA’s First Look, as well as at aoa.org. Even better, join us in Washington, D.C., in fighting for the value of our care at Optometry’s Meeting® and AOA on Capitol Hill. We have a track record for driving change and we will continue that forward momentum.
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.
The AOA has long championed nondiscrimination against doctors of optometry. The survey of doctors of optometry and AOA affiliates gathered responses from 47 of the 50 states plus the District of Columbia.
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.