Following several weeks of ongoing debate around all aspects of the issue, the California Optometric Association House of Delegates passed a resolution on Feb. 11 stating their support for the inclusion of stand-alone vision plans in the state insurance exchanges being established as a result of health care reform.
“The California Optometric Association supports stand-alone vision plans having the ability to participate in the exchanges,” said Movses D’Janbatian, OD, COA president. “Stand-alone plans provide access for patients to continue seeing their optometrist for eyecare and can be a valuable channel to make sure optometrists are fully integrated as the primary providers for patients’ vision and medical eyecare. We will continue to work with these plans to ensure doctors don’t lose their patients.” The provision was sponsored by three San Francisco Bay Area optometric societies—the Santa Clara County Optometric Society, the San Francisco County Optometric Society and the San Mateo County Optometric Society. California lawmakers will be finalizing key elements of the state’s insurance exchanges in the coming months.
“Speaking as a 35-year member of the California Optometric Association, I am pleased the COA and COA House of Delegates have overwhelmingly reaffirmed the critical role that stand-alone plans have in providing access to patients for optometry as the healthcare landscape continues to change,” said Tim Jankowski, OD, FAAO, chairman of the VSP Board of Directors. “VSP and the COA are committed to working together to develop programs that support full medical integration for optometrists.”
“This is an important day for the state of optometry in California, and we are pleased that we’ve all come together with the California Optometric Association to support the doctors in this state,” Julian Roberts, executive director of the National Association of Vision Care Plans told ROB sister publication Vision Monday’s VMail. “Through our research, we know there is higher exam frequency with stand-alone vision plans than when bundled with a medical plan. The higher utilization provides more opportunities for detecting chronic conditions, which is a critical component to health-care reform. The California Optometric Association’s support for the inclusion of stand-alone vision plans in the exchanges is good for the overall wellness of Californians.”
The American Optometric Association, which has publicly advocated that vision coverage should not stand alone but should instead be provided as a part of qualified health plans, issued a statement by its president Dori M. Carlson, OD, which said, in part, “Our profession’s future stands to be severely compromised if we allow profit-driven private corporations to define our role in healthcare as simply providers of refractions, glasses and contact lenses. I understand the important role that vision plans have played in many of our practices over the past 20 years. However, many vision plans are continuing to resist the legislative, regulatory and marketplace changes that the AOA has been confronting head-on since the health care reform debate began. Since their resistance threatens our future, I’m urging companies that administer vision plans to work with us by taking the following steps to help optometry deliver improved eye health and vision care in the era of health care and payment reform: 1) vision plans must agree with the AOA that a comprehensive eye exam should be a benefit in every American’s health insurance plan, 2) vision plans must acknowledge that they can participate in state health insurance exchanges by contracting with qualified health plans, 3) vision plans must always utilize optometrists to provide to the full extent of their scope of practice and training, 4) vision plans must commit to supporting the same path and opportunities for participation in medical plan credentialing for ODs that exist for MDs, 5) vision plans must provide equal alignment between ODs and MDs for payment priority, assuring that reimbursement levels are defined by procedure code and not licensure.”
Prior to the vote, the AOA and other optometric organizations and leading optometrists shared opinions both for and against including stand-alone vision plans in state exchanges. In addition, the day before the vote, the Sacramento Bee ran an editorial titled “Vision Plans Should Be Included in Proposed Health Care Exchanges” by Thomas Fleischmann, OD, who is a member of both the American Optometric Association and the California Optometric Association.
As the Patient Protection and Affordable Care Act gradually approaches full implementation in 2014, every state will be required to establish insurance exchanges where companies and individuals can purchase health insurance that covers 10 Essential Health Benefits, pediatric vision care among them. The discussion about whether stand-alone vision plans will be permitted to provide this benefit independently of qualified health plans is expected to intensify throughout the country as each state establishes the parameters of its own insurance exchange.