Health Care Reform: A Threat To Optometric Access?

By Daniel L. Mannen, OD, FAAO November 17, 2011

We cannot and should not allow access to diminish through stand-alone vision plans until we have ensured equal access and standing within health plans.


So here’s the deal. As it stands today, insurance exchanges, as mandated under health care reform, are set to open up in 2014 and ultimately be available to everyone in 2017. Why is that important? It is important because the largest channels for optometric access—stand-alone vision plans like VSP® Vision Care—are excluded from selling in the exchanges. Further, optometry is not included in the list of caregivers under health care reform.

To refresh everyone’s memory, stand-alone vision plans were poised to be included as direct participants in the exchanges until eleventh-hour lobbying by the American Optometric Association (AOA) ultimately kept them out. The result of this action is to potentially impair current optometric access to patients and to bet the farm on the hope that health plans will treat optometry fairly.

VSP has attempted, in good faith, to reason with AOA leadership regarding their decision to block stand-alone vision plans. The realities of discrimination, the potential economic hardship, and the fact that only half as many patients will be served if care is provided through health plans have been explained in thoughtful detail. AOA leadership maintains that their goals for the profession are true integration into healthcare and maintaining professional independence. We have repeatedly asked the AOA to describe specific plans for achieving these goals. None have been forthcoming. It seems that they are willing to trust the unknown (health plans with a legacy of discrimination), without protecting the known (open access via stand-alone vision plans).

The AOA simply refuses to acknowledge that VSP has not only supported the integrated medical model, but also proven in overwhelming numbers the ability to marry vision care with medical care in programs like VSP Eye Health Management®. The fact is that the majority of optometric care emanates from access via vision plans. To cut off our best access channel in the hope that health plans will magically welcome all of optometry with equal status and access simply denies history and defies logic. AOA leadership acknowledges discriminatory practices by health plans and, yet, believes that these same health plans are the answer to integrated care and the future of optometry. Yikes! By the way, in its current form, vision plans like Spectera, Comp Benefits, and Davis will be advantaged over stand-alone plans as they are owned by health plans and, therefore, included in the exchanges.

In recent comments to the U.S. Department of Health and Human Services, AOA President Dori Carlson, OD, states that, “In its wisdom, Congress decided to allow stand-alone dental plans to participate directly in the exchanges.” Then, where is the wisdom in opposing stand-alone vision plans and the important access to patients which they provide? In my mind, if the AOA leadership cannot articulate the exact steps by which they will accomplish true optometric integration and cannot describe how optometric access will be protected if stand-alone vision plans diminish, then their plan must be considered, at best, unrealistic and, at worst, downright harmful. And one more thing: AOA opposition to stand-alone vision was done in concert with the American Academy of Ophthalmology. What is that about?

Everyone in our profession wants optometry to achieve fully integrated, equally recognized provider status, which it absolutely deserves. However, the fact remains that the majority of medical patients are derived from vision plan patients and not through medical referral. In my practice, I am fortunate to be a panel provider for a number of medical panels and, therefore, have a substantial medical practice. However, after many years of participation, I still receive only a trickle of patients by way of medical referral. Medicine is accustomed to referring within the “medical community” despite the clinical capabilities in optometry. Just think about it. If it is all left up to health plans, and if health plans historically direct the majority of medical patients to their medical colleagues, just how does optometry achieve integration and equality?

I am 100% in favor of achieving professional recognition and parity. Optometry has demonstrated excellent clinical expertise and outcomes for many years. But the fact remains that we are faced with discrimination and restricted access on a daily basis. To somehow impair stand-alone vision plans before eliminating existing barriers within health plans is downright foolish. We should continue to work toward our rightful recognition, but we cannot damage our access to patients and our economic viability while we wait for this to occur. To hope that fairness will prevail and that peace and tranquility will abound is nothing but wishful thinking without a bonafide game plan.

To restate, we have two access channels for patients—stand-alone vision plans and health plans. Many more patients accrue to our practices today via stand-alone vision plans than via health plans. The vast majority of our medical patients derive from our vision plan patients and not from medical referral. To impair the greatest access channel to optometry in the hope that health plans will right their historic wrongs and immediately integrate us into the medical model, with no articulated plan for this to occur, is frightening and unacceptable.

As I see it, we need to demand that the AOA leadership help protect our existing access to patients while we continue to fight for equal recognition and integration into health care. The decision of AOA leadership to block participation in the exchanges by stand-alone vision plans and, therefore, potentially block access to millions of patients without any acknowledgment of the risk to optometric practice is simply not acceptable.

I recommend that you call your AOA leadership and/or state associations to demand a reversal in their position and that they support ongoing efforts for stand-alone vision plans to be included in the exchanges. You can also voice your concerns by posting a comment here, as well as e-mailing my blog to colleagues and suggesting it be published in your state and local professional publications.

Read more about this issue:

Leave a comment

Prev Post Next Post

Recent Posts




E-mail me