AOA redoubles plan advocacy; volunteers chart association’s path forward

Vision plans’ valuation of optometry’s critical eye health and vision care ranks chief among the priorities before optometry’s leaders as AOA volunteers convene to advance the profession.

“The highest priority will continue to be for the AOA to insist that health and vision plans recognize the value of modern, full scope, comprehensive eye exams and fully value doctors of optometry,” remarked AOA President Ronald L. Benner, O.D., during the AOA Leaders Summit in St. Louis, Missouri, Feb. 2-4.

In his first address from the AOA Board of Trustee’s top position since taking office on Feb. 1, Dr. Benner emphasized how optometry faced, arguably, its biggest challenge ever with the COVID-19 pandemic, pivoting on behalf of patients and gaining recognition as essential care providers, while vision plans chose a familiar approach: the status quo.

“Far from valuing us and the care we provide, [vision plan] policies devalue our profession, our knowledge, our skills, our training, our relationship with our patients and our essential role in safeguarding the health of tens of millions of Americans—and it’s against these giant forces we’re fighting back,” Dr. Benner added.

Continued vertical integration and acquisitions have created a scenario where plans’ market dominance perpetuates a “stranglehold” on practices, Dr. Benner said, with forced discounts on non-covered services, restrictions on lab choices, tactics that steer patients’ choices and hostile contracting processes. While vision plan advocacy has long been an important priority for the AOA, it’s vitally apparent that current vision plan practices do not fully reflect the expansion of the scope of comprehensive eye care over recent decades, as well as the economic situation that currently exists. Even among federal payers, evidence suggests reimbursements have not kept pace and fail to adequately cover the cost of care.

Before the nearly 300-strong corps of AOA volunteer doctors, paraoptometrics, students and affiliate leaders convened for the AOA Leaders Summit, Feb. 2-4, Dr. Benner committed the association’s rapt attention to countering the “hopelessness and helplessness” that many practices under plans’ pressure.

“This is not a new fight, but it has reached a stage where we must unite and resolve to do even more,” Dr. Benner announced.

Such is the case, the AOA outlined new and ongoing plans for combatting plans harmful and hurtful policies, including:

1. Reintroduction of the Dental and Optometric Care (DOC) Access Act.
   Championed by both the AOA and American Dental Association, the bipartisan DOC Access Act complements state-level vision and dental plan laws by disallowing detrimental policies by ERISA and other federally regulated vision, dental and health plans. The DOC Access Act would prohibit plans from limiting patients’ and doctors’ choice of labs, as well as price-fixing noncovered services and materials. Bolstered by a second Avalon Health Economics report that concluded such mandates result in higher costs, less convenience and worse health outcomes, advocates found support late in the 117^th Congress among a bipartisan coalition, including the Hispanic Leadership Fund and the Southern Christian Leadership Global Policy Initiative. The DOC Access Act remains a key priority for the AOA’s vision plan advocacy.
2. Direct, face-to-face dialogue w`ith vision plans.
   In addition to advocating and advancing the DOC Access Act, optometry’s advocates maintain periodic, face-to-face dialogues with leading vision plans to educate plans regarding the impact of their practices on doctors of optometry, the scope of care provided by optometrists in 2023 and the costs associated with providing that care, including the increase in practice costs due to COVID-19 or inflation. These conversations are bolstered by real-world data from doctors of optometry on their experiences with vision and health plans, such as a 2022 survey suggesting discriminatory practices among plans’ credentialing of optometrists versus ophthalmologists.
3. Transparent communication on plan advocacy.
   To promote better awareness of the AOA’s third-party advocacy, as well as to communicate relevant actions affecting optometry practices, the AOA will incorporate a periodic “Vision Plan Action Report” update within members’ First Look morning briefing email to share actionable third-party updates. This action report will include information about the plan, complaint, resolutions/actions and additional information for reporting abusive policies. Members will begin to see the action report within First Look in the coming weeks.

“These plans are viewed by our colleagues—for valid reasons—as a negative force working against our profession, our practices and our patients,” Dr. Benner said. “Like you, AOA Board members and I live it every day in our practices. Together with all of you as affiliate leaders, we seek to fight back and stand up for optometry’s present and future.”

CMS addresses ongoing issues with Medicare Advantage

In a different vein, the Centers for Medicare & Medicaid Services (CMS) issued a final rule last week to hold insurers accountable within Medicare Advantage (MA). By updating its Risk Adjustment Data Validation (RADV) Program, the CMS seeks to strengthen the MA program by ensuring accurate payments are made. This is crucial as the Health and Human Services (HHS) Office of the Inspector General studies have shown that medical records don’t always support the diagnoses reported by MA Organizations (MAOs), leading to billions of dollars in overpayments and increased costs to Medicare.

In fact, the CMS estimates that between 2023 and 2032, the agency will record $4.7 billion from insurers using its new audit methodology. Such is the case, the CMS will begin extrapolation of data with the 2018 RADV audit. While legal challenges are sure to arise, the rule indicates that the CMS is working to address concerns with MAOs. The AOA will work to ensure these new policies do not cause undue burdens on doctors and should doctors have concerns with documentation requests or requirements, they may report those to the AOA.

The AOA is also actively advocating for CMS to address detrimental policies and practices by MAOs. Among those, MAOs’ marketing efforts related to eye care often focus on available supplemental benefits without making clear that medical eye care is covered under traditional Medicare. Reflecting AOA advocacy, new CMS proposals call for MAOs’ transparency with beneficiaries, including new requirements for plan brokers to confirm for patients whether their doctor is in-network for the plan before the patient enrolls.

Still further, Dr. Benner noted, the AOA will continue working directly with members of Congress to ensure any future congressional action related to MA plans reflect optometry’s input.

Looking forward: Telehealth & technology

In the closing session of Leaders Summit, AOA volunteers received updates on developing technologies coming to the forefront that might affect optometry’s current and future delivery of primary eye health and vision care.

In late-2022, the AOA Board of Trustees updated and adopted its Position Statement Regarding Telemedicine in Optometry to reflect developments in artificial and augmented intelligence, as well as dialogue regarding preserving access to high-value, high-quality eye health and vision care.

Jeffrey Michaels, O.D., AOA State Government Relations Committee member, noted that much has changed since the AOA’s original policy statement, created in 2017. Patient experiences and expectations have greatly changed since the COVID-19 pandemic and technologies have constantly evolved. Such is the case, new lessons learned with the sudden pivot to telemedicine during that time proved that telemedicine didn’t necessarily level the playing field for access to eye care.

“There’s an ongoing need to continue providing some value in telemedicine in eye care, including triaging some emergencies and at-home monitoring of previously diagnosed conditions,” Dr. Michaels noted. “We recognize this technology is evolving quickly, and we’re going to continue evaluating remote technologies and work to protect our patients.”

Separately, a presentation by AOA Federal Relations Committee consultant Chris Wroten, O.D., emphasized emerging clinical and pharmaceutical developments within the eye care profession that could stand to dramatically impact optometry. While many of these developments remained in various stages of clinical trial, the message was clear: research is rapidly advancing treatment opportunities that doctors of optometry can readily employ in their practices in keeping with the trend in state scope of practice. Such developments include:

• Device-assisted drug delivery technologies
• Oral, topical medications for eye diseases
• Diagnostic contact lenses
• Myopia control

“We’ve got such a great opportunity to be sure to position optometry to take advantage of these and other technologies, devices and drugs that are coming for our patients’ benefit—I could not be more excited about the future,” Dr. Wroten said.

Quick committee take-aways

February’s AOA Leaders Summit provides the association’s volunteers and staff the opportunity to meet in committee workgroups and address priorities for the coming year. Among other updates and ongoing work, committees reported: 

• The AOA EyeLearn Professional Development Hub is available for doctors’, as well as paraoptometric staff, continuing education (CE) and professional development with many members already leveraging the platform since its redesign in 2022. Revamped to promote an enhanced user experience, AOA EyeLearn continues to prove a valuable resource, especially among practices utilizing the wealth of staff education and training opportunities within the platform. Enroll your paraoptometric staff as AOA associate members—at no cost to the AOA member doctor—to gain access to these resources.
• Progress is underway on updating the AOA’s evidence-based clinical practice guideline for glaucoma and the second edition of the AOA’s adult eye guideline is forthcoming to membership.

The AOA acknowledges and thanks its industry supporters for this event, including Johnson & Johnson Vision, EssilorLuxottica, Alcon, CooperVision, Allergan, Neurolens, Health Care Alliance for Patient Safety, Lumenis, Dry Eye Rescue and Ocular Therapeutix.