These are my top six legislative battles and how they have impacted our future as optometrists.
The future of optometry as a profession sometimes feels uncertain. Many challenges and threats exist including managed care plans and online retailers. Optometric societies across the country are actively pursuing legislation to secure our profession. If you aren’t currently plugged into the AOA and your state society, it is vital you get involved.
1. Texas legislature bill House Bill 3550/ Senate Bill 683 (2015):
What is it?
The bill prevents managed care companies from dictating to doctors which labs/materials they must use and requiring them to use a lab that the insurance company owns.
The basis for the law:2
- Requirement of optometrists by managed care plans to disclose confidential diagnoses in order to remain on the panel.
- Requirement of optometrists to use a lab the insurance company owns even when the job can be done with better quality materials, more quickly, and at a better cost.
The legislation specifically prohibits a managed care plan from attempting to control an optometrist’s “judgement, manner of practice […] employ an optometrist to provide a vision care product or service.”2
Why is this important?
THIS IS HUGE!!! This allows us to provide our patients with the best lenses and frames without insurance company involvement. It allows us to use our own timely, high quality labs at the best price. This is key for the future of optometry!
** This case will set precedent for the success of other states**
What can we learn/action steps to take?
- Write/Call your state board and ask them to take action in your state.
- Send money to your state PAC specifically stating you hope they will initiate this legislation in your state.
- Similar legislation set precedent in Georgia in 2013.
2. 1-800 Contacts vs. Contact Lens Manufacturers and UPP (Utah SB 169) (2015):
What is it?
Most optometrists are aware of the battle between contact lens companies and 1-800 Contacts over the Unilateral Pricing Policies instated in the recent time. 1-800 Contacts claims that these policies remove price competition, and not that legislation was introduced “to prevent optometrists from selling contact lenses, to allow retailers to substitute the brand on the prescription, or to take a brand off a prescription are false.”1 They claim the consumer’s price has increased due to UPP.
Why is this important?
- SB 169 is about much more than maintaining retail sales. Although important, the law degrades our scope of practice in prescribing contact lenses. We are all aware of the unlawful acts of online retailers, but the goal of the legislature is to eliminate doctor choice in type of lens fitting. This effectively eliminates our education as doctors for prescribing a certain brand or fit for a patient. In Utah, UPP was banned, but legislation has been introduced in other states.
What can we learn/action steps to take?
- Support those companies who are taking a stand for optometry by prescribing their products.
- Join the AOA and support the actions they are taking with your AOA dues and PAC money.
- If you live in any of the following states, support your state PAC in its lobbying effort against this bill: Arizona, California, Florida, Idaho, Illinois, Louisiana, Minnesota, Mississippi, New York, Oregon, Rhode Island, Tennessee, Utah and Washington.1
3. Wilson vs Spectera (2013):
What is it?
The Georgia Supreme Court affirmed that Spectera violated Georgia’s Patient Access to Eye Care Act when insurance companies required independent doctors to use Spectera’s lab network for contacts/glasses. The key to winning was timely filing of a suit as soon as Spectera announced that it was phasing out its Patriot Provider Agreement that allowed independents to use their own ophthalmic goods. It did not enforce this new contract with retail corporations.3
Why is this important?
- This sets precedent for potential wins in other states. This was the first attempt by an optometrist to challenge managed care plans.
What can we learn/action steps to take?
- Take action at the time the new contract occurs.
- The court’s decision was based on the Patient’s Access to Eye Care Act by the AOA which prevents discrimination between “classes of eye care providers.”
- Managed care plans must enforce their policies equally between corporate and private providers.
4. Acuity Labs vs. Davis Vision (2014):
What is it?
The private lab, Acuity Optical Laboratories filed an anti-trust lawsuit vs. Davis Vision based on its requirements of providers to use only their labs. The suit claims Davis will hinder competition by forcing competitive labs to close, and patients will see their health care costs increase as a result of Davis’ integration of managed care and ophthalmic goods.
Why is this important?
- This is another case with the potential to set precedent. If Acuity Labs is successful, vertical integration within the industry could suffer a major blow.
What can we learn/action steps to take?
- Lawsuits must be filed at the implementation of a new policy.
- Anti-trust violations are difficult to prove in court.
- Damages inflicted due to “anti-trust” are also difficult to prove.
5. Harkin Amendment (2014):
What is it?
The Harkin amendment is a part of the Affordable Care Act. The legislative provision was included to prevent anti-discrimination of optometrists by medical plans. The agency who implemented the provision issued “sub-regulatory guidance” which was misleading, inaccurate, and discriminatory towards optometrists and their patients. The AOA is working to clarify language at present time.5
Why is this important?
- We need access to medical patients as primary eye care providers.
- We need reimbursements as medical providers for seeing those patients.
What can we learn/action steps to take?
- Join/support the AOA.
6. Kentucky HB 465 (2015):
What is it?
Beginning September 15, 2015, optometric physicians will be able to contract with Cigna without participating with VSP. The law, signed on March 30, prohibits insurers from requiring a provider to participate with a vision insurance in order to be a provider on a medical plan. Additionally, it prohibits conditions for an optometrist that are not required for another provider.
Why is this important?
- This sets precedent for legislation in other states where the optometric physician is enrolled in VSP in order to be on the panel to provide medical care.
What can we learn/action steps to take?
- Support/contact state PACs to encourage similar legislation in your state.
How can you protect the future of your profession?
In summary, managed care plans are the biggest threat to optometry’s future. Managed care plans not only reduce fees for service, but have acquired retail entities. While organizations like the Union of American Eye Care Providers (AADO) have configured to represent eye care providers against vision care plans, the executive director, Craig S. Steinberg O.D., J.D believes the Department of Justice is taking a “wait-and-see approach” due to active legislation occurring in the states.4 We must get actively involved by paying our dues to the AOA and to our state societies. The Union of American Eye Care Providers needs several thousand optometrist’s support at $39 a month to continue their efforts.
What other major legislative battles are missing? Please comment and let our users know below!
References
1. “Contact Lens Pricing Battle Decided in Utah, Garners National Attention With Litigation and Proposed Bills.” Vision Monday 30 March 2015 <http://mobile.visionmonday.com/article/contact-lens-pricing-battle-decided-in-utah-garners-national-attention-with-litigation-and-proposed-legislation-1/>
2. 684 Texas Senate Bill. 13 May 2015.<http://www.capitol.state.tx.us/tlodocs/84R/billtext/pdf/SB00684F.pdf#navpanes=0>
3.”Georgia Supreme Court Affirms That Spectera Can’t Require Optometrists to Use Their Labs.” Vision Monday 18 December 2013 <http://www.visionmonday.com/latest-news/article/georgia-supreme-court-affirms-that-spectera-cant-require-optometrists-to-use-their-labs-1/>
4. Union of Eyecare Providers Homepage. 8 July. 2015. Union of Eyecare Providers. <https://www.theaado.org/files/Acuity%20vs%20Davis.pdf>
5.American Optometric Association Advocacy Page. 9 July. 2015. American Optometric Association. 13 September 2013 <http://www.aoa.org/news/advocacy/aoa-defends-ods-against-new-attack-on-harkin-law?sso=y>.
