AOA leader: ‘No stone unturned on behalf of our members’

March 30, 2023
AOA Immediate Past President Robert C. Layman, O.D., discusses the biggest challenge he faced during his presidency: fighting the devaluation of care by vision plans. Learn how the AOA is prioritizing the issue and how members can engage.
Headshot of Robert Layman, D.O.

With leadership comes responsibility—the responsibility to seize strategic opportunities and tackle priority challenges.

In an interview, Robert C. Layman, O.D., AOA immediate past president, discusses the biggest challenge he faced during his presidency and how he and the AOA continue the battle.

What’s been the biggest challenge of your time as AOA president?

Although optometry’s essential and expanding role in health care is recognized more today than ever before, I see every day in my own practice how our profession is being devalued, disrespected and even undermined by vision plan policies, and I will continue to call that out.  

Just like colleagues across the country, I mobilized my practice to serve my community and my patients through the worst days of COVID-19 and, more recently, through an extended period of spiraling inflation and staffing disruptions. Our AOA and affiliates mobilized and reprioritized resources to do more than ever to support doctors and practices and win changes to outdated laws and regulations. Government agencies and even visionary industry leaders stepped forward to help us as well. But that’s not what we’ve seen from vision plans.

I’ve called on vision plans to recognize these extraordinary times and join the mobilization in support of optometry, optometric care and America’s health and vision. The CEOs and their layers of executives may not want to hear it, but they know I didn’t hold back during my time as president, and I won’t ever stop fighting for optometry.

This is a critical topic that each doctor faces. On a personal level, why do you view the devaluation of care by vision plans as a priority?

For too long, vision plans have devalued our care. The comprehensive eye exam I provide in my office today is significantly more sophisticated and costs about 65% more to deliver based on inflation than the one I conducted 20 years ago. Over the past several years, more and more research is demonstrating the value of the comprehensive eye exam … but my reimbursement during that same period? Stagnant. I am committed to providing the most advanced care to all of my patients, but in today’s environment it is increasingly difficult.

Some vision plans have expanded continually, acquiring and vertically integrating to advance their control while also claiming to be of, for and about optometry. They use market dominance to try to tighten a stranglehold with forced discounts on noncovered services, restrictions on lab choice, sneak marketing tactics aimed at our patients and what feels like a hostile contracting process.   

Far from valuing us and the care we provide, their 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.

It’s against this devaluation of care that we are fighting every day.

Since your presidency, what steps and actions have you led the organization in taking to address this issue?

This is a fight the AOA has been in for a long time. The AOA, affiliates and volunteers have been working at the national, state and individual level to identify vision plan abuses and determine solutions to overcome them. From getting resolution on an individual doctor’s issue with erroneous downcoding to state legislation and now with the recently introduced Dental and Optometric Care (DOC) Access Act, we are leaving no stone unturned on behalf of our members.

As we have been pursuing state and federal advocacy solutions, we also have pursued a direct, face-to-face, transparent dialogue with the CEOs of the leading vision plans on their inadequate valuation of the care we provide. We discussed valuations that don’t account for the expansion of the scope of the care we provide and the increase in in-practice costs arising from COVID-19 and these inflationary times. 

These are tough discussions, and they require all of the clinical, coding, practice operations and policy firepower we can muster. Fortunately, the AOA Board of Trustees and all of our volunteers have never been stronger as we share the No.1 concern our members express to us with their leadership.    

These plans are viewed by our colleagues—for valid reasons—as a negative force working against our profession, our practices and our patients. Like you, I live this every day in my practice. Together, we are seeking to fight back and stand up for optometry’s present and future.   

Will this continue to be a focus for the AOA?

We are in this for the long haul. Would we want a quick solution? Of course. But President Theodore Roosevelt said it better than I can: “Nothing in the world is worth having or worth doing unless it means effort, pain, difficulty …” We don’t deserve this burden, and our patients’ care shouldn’t be compromised because of it. But we won’t stop until we effect solutions.

One example of our resolve is the DOC Access Act, our bi-partisan U.S. Senate and House legislation aimed squarely at outlawing especially predatory abuses used by vision plans.     

Our powerful partnership in Washington, D.C., with the American Dental Association—an organization five times our size but one that has joined with our senator-by-senator/House member-by-House member lobbying campaign—is committed to passing this bill on Capitol Hill.

With more support than ever, DOC Access was reintroduced on March 7 in the U.S. House by Reps. Buddy Carter, R-Ga., and Yvette Clarke, D-N.Y. AOA priority legislation, the DOC Access Act has made steady progress through Congress since its original introduction in 2015. We anticipate the Senate companion legislation soon, and we are seeing further public support from patient advocacy groups calling on Congress to take action.

  • DOC Access is not only the AOA and ADA top legislative priority, it’s Exhibit A in how we are setting the policy agenda, taking on these plans and spotlighting the need for an end to a system that has become rigged against doctors and patients.    
  • To understand how effective this legislation would be, we only need to look at those who are opposing it and working every day to defeat the bill: the out-of-control, deep-pocketed vision and dental plans.   

What more can be done to take on this challenge?

Anyone who knows me understands I am a broken record on what can be done. We need all doctors of optometry to join our advocacy efforts and be a force as part of our AOA.

  1. Make sure you and your colleagues are as engaged as possible in your state and at the national level.
  2. Urge your federal legislators to join as co-sponsors of DOC Access today through the AOA Online Legislative Action Center or text “DOC” to 1.855.465.5124.
  3. See what advocating with your colleagues can do at this year’s combined Optometry’s Meeting® / AOA on Capitol Hill in Washington, D.C., June 21-24. The meeting will be bigger and bolder than ever before, giving every attendee an unprecedented opportunity to effect lasting change in our profession and make the AOA a stronger, more effective advocate for the quality care doctors of optometry provide their patients. Register now!
  4. Share your experiences—and issues—with us. You can send your challenges to stopvisionplanabuses@aoa.org and we will get back to you to determine the best action.

The AOA will continue to be hyper focused on this important subject. And we want to make sure all of our doctors are informed and know how they can engage. Next week, we will be kicking off the AOA Health and Vision Plan Action Report, a daily accounting of vision plan challenges and how the AOA is taking them on. Members will be able to find the tracker in the gray box of our daily First Look. Take a look on Monday!

We are committed to ensuring our system—and vision plans—value the important care you deliver every day.

*Federal anti-trust law directly prohibits any discussion of collective action or a coordinated approach to negotiations with plans. The AOA does not and cannot represent its members in their individual negotiations with any third party payer.

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