Results from a survey of eyecare professionals (ECPs) polled during the American Optometric Association (AOA)’s virtual town hall meeting earlier this month offer new insight into attendees’ concerns regarding state and national efforts to rebalance the power between doctors and vision plans.
Let’s start with this town hall.
A total of 700+ members of the eyecare community attended the webinar titled AOA Profession Wide Townhall on Reimbursement and Coverage Fairness to engage in conversation and listen to responses to commonly asked questions regarding vision plans in the United States.
What types of topics were discussed?
Led by AOA President Ronald L. Benner, OD, and the AOA’s Board of Trustees, new feedback from ECPs was collected that included concerns on the following topics:
- Devaluation of care
- Plan-imposed barriers
- Sneak marketing tactics and harmful contracting
- Sales and marketplace strategies employed by the industry
Now about this survey … give me the details.
Participants were polled on “an array of anti-patient, anti-doctor and anti-competitive abuses by the vision plan industry” that they view as a potential threat to their practices and U.S. eye care as a whole.
The AOA plans to use this feedback to support 2024 advocacy planning.
… and the results?
Per the AOA, vision plan policies were a major issue of concern among participants, with:
- 93% reporting they believe vision plan policies create a barrier to delivering quality care
- 94% reporting they believe vision plan policies do not support doctor-patient relationships
For “[vision] plan-imposed burdens” clinical practices face, ECPs reported the following:
- Valuation of care (55%)
- Linking vision plan participation to medical plan participation (27%)
- Lacking lab choice (9%)
- Exclusion from certain networks (7%)
What else were they polled on?
Another major topic: legislation.
By “large survey margins,” the AOA stated, “participating doctors also expressed strong backing for AOA and affiliate efforts throughout 2023 to push for legislation in Washington, D.C., and state capitals to investigate and outlaw plan abuses.”
So what’s the latest from a legal standpoint?
The AOA updated participants on vision plan reform-specific state legislation that was successful in 2023, which included:
- Texas
- House Bill (H.B.) 1696
- Relates to the relationship between managed vision care plans and optometrists (ODs) and therapeutic ODs.
- Effective Sept. 1, 2023
- House Bill (H.B.) 1696
- Nevada
- Senate Bill (S.B.) 134
- Prohibits an insurer from entering into a contract with a vision care provider that contains certain contingent measures
- Requires a vision care provider to make certain disclosures to an insured patient, among other related matters.
- Effective Oct. 1, 2023
- Senate Bill (S.B.) 134
- Georgia
- S.B. 27
- Closes loophole allowing vision care organizations (such as VSP Vision Care) to require that ECPs offer discounts on noncovered services
- Effective July 1, 2023
- S.B. 27
- Illinois
- S.B. 764 (Vision Care Plan Regulation Act)
- Prohibits vision care plans from requiring providers to set fees for services that are not covered under a plan
- Requires that any fees for covered services should be reasonably and clearly outlined.
- Prohibits misrepresentation of vision care benefits + vision care organizations restricting an ECP’s choice of suppliers.
- Effective Aug. 4, 2023
- S.B. 764 (Vision Care Plan Regulation Act)
To note, both Georgia and Illinois legislation targets protecting OD discounts and interference in the doctor-patient relationship.
What other legislation should we know about?
- Nebraska: LB 216 (introduced Jan. 10, 2023)
- Connecticut: Raised SB-899 (introduced Jan. 25, 2023)
- California: AB-765 (introduced Feb. 13, 2023)
- Massachusetts: Bill H.3606 (introduced March 9, 2023)
- Texas: HB 2324 (introduced March 9, 2023)
- Wisconsin: SB143 (introduced March 23, 2023)
- North Carolina: H576 (filed April 5, 2023)
- New Jersey: A-5445 (introduced May 15, 2023)
- New Jersey: S3841 (introduced May 15, 2023)
Now, how about ongoing advocacy efforts?
Also discussed were multiple state and federal advocacy initiatives involving the AOA—see here for details on all seven—including an update on a bipartisan bill: the Dental and Optometric Care (DOC) Access Act.
Tell me about this bill.
Reintroduced in March 2023 by Reps. Earl L. “Buddy” Carter (R-GA), Yvette Clarke (D-NY), and Pete Sessions (R-TX), H.R.1385 seeks to provide fairness in contracts between healthcare providers and vision and dental insurers, with the goal of increasing quality of care and eradicating anti-competitive practices.
Any updates on this at the townhall?
Rep. Carter spoke regarding recent movement on the legislation. Per the AOA, he is advocating for “a crackdown on vision plans/vision benefit managers (VBMs) by seeking”:
- A direct ban on forced discounts on non-covered services
- Safeguards for doctor choice of optical lab
- Reform of the contracting process
How has the AOA gotten involved?
The AOA, the Dental Optometric Association (DOA), and national patient advocacy groups are working together to gain the support of U.S. House members and U.S. senators as official congressional co-sponsors. To note, S. 1424, a companion bill to the DOC Access Act, is currently being sponsored by Sens. Joe Manchin, (D-WV), and Kevin Cramer (R-ND).
So what’s on the agenda for advocacy this year?
According to the AOA, the following:
- Preventing the National Association of Vision Care Plans from influencing state/federal legislation
- Directly resolving doctor complaints against plan-imposed barriers to patient care
- Launching the Health and Vision Plan action Report (see here for details).
- Forming alliances with national advocacy groups to eliminate vision plan abuses
- Working with affiliates to update state laws and increase legal enforcement
*Disclaimer: The information provided in this article does not and is not intended to constitute legal advice; instead, all information, content, materials available herein are for general information purposes only.