Why optometry is poised for health care’s new era
The American health care system is in a historic period of change.
New Year's Day 2014 was a "red-letter day" on which major provisions of the Affordable Care Act (ACA) took effect. The system is also feeling the impact of many other health care laws, and nongovernmental forces such as economics, technology and clinical advances continue to reshape the practice of health care.
The only certainty is that change is upon us—and optometry is ready.
"No one in the White House, any federal or state agency, Congress, think tanks, academia, industry, or the provider community can claim to know the full impact these changes will together have," said Roger L. Jordan, O.D., chair of the AOA Federal Relations Committee. "The only certainty is that change is upon us—and optometry is ready, thanks to important legislative, regulatory, and third party advocacy victories by the AOA Advocacy Group and ongoing AOA membership benefit programs."
The ACA in action
Four unprecedented eye and vision care provisions are included in the ACA reforms, Dr. Jordan said:
- Recognizing—in law—children's vision as an essential (required) benefit in health plans.
- Defining the pediatric optometric care benefit as an annual comprehensive eye exam, with treatment and materials (a definition confirmed in the regulations of 48 states and the District of Columbia).
- Requiring the pediatric benefit be embedded in new health plan coverage—not as an optional "stand-alone" benefit.
- Barring, for the first time under federal law, discrimination against optometrists by health plans, including self-funded Federal Employee Retirement Income Security Act (ERISA)-regulated employer health plans.
"The pediatric vision benefit and the Harkin Amendment prohibition on provider discrimination represent hard-won victories, addressing longstanding issues that have faced optometrists and their patients for decades," Dr. Jordan said. "Going forward, the AOA will continue working to reinforce the value of these new provisions to policymakers while fending off increasing attacks on these wins by anti-optometry forces."
Beyond the ACA
The ACA will be just one source of opportunities and challenges in the coming year. Optometrists are likely to see the following trends emerge in 2014:
- Payment reform: Public and private health plans are expected to transition from traditional fee-for-service payment to consumer-directed health plans and value-based reimbursement systems, such as pay-for-reporting, pay-for-performance, bundling and Accountable Care Organizations (ACO).
- Collaborative care: Medicare is fostering a nationwide system of ACOs to help ensure patients receive high-quality outcomes in a cost-effective manner—without needless duplication of services. Private, state and local health plans across the nation have begun to establish medical homes as the first step in clinical integration and an anchor of the more robust ACO model. Many commercial ACOs are in place or under development.
- Interconnectivity: Both collaborative care and reformed payment systems will require electronic patient recordkeeping with secure interconnectivity. Beyond such basic EHR functions as patient record exchange and e-prescribing, practitioners will increasingly be expected to make use of diagnostic decision support, adverse drug interaction warnings and public health reporting systems.
- Patient involvement: Although government plans are on hold for all Americans to have personal health records, patients increasingly will have direct access to their health information. Patients will be encouraged to be active partners in care planning and development of healthy lifestyles. Health care practitioners will be increasingly called on to work with patients to address issues from smoking and obesity to proper contact lens wear. They also will be required to interact with patients through electronic communications, including social media.
In addition, technological and biomedical advancements are improving instrumentation, pharmaceuticals and lens technologies. New products and services—such as genetic eye care, neuro-optometric services and nanopharmaceuticals—are emerging.
The AOA will continue to make sure members are ready for all of these changes—and any more that arise in health care's new era, Dr. Jordan said.