Article Date: 10/1/2009

In The Debate Over Healthcare Reform, a Word of Caution
o.d. to o.d.

In The Debate Over Healthcare Reform, a Word of Caution

If vision care is integrated into a comprehensive medical plan, you may have to face some “Stark” realities.

BY WALTER D. WEST, O.D., F.A.A.O., Chief Optometric Editor

It seems that in representing its 36,000 members, the American Optometric Association (AOA) is urging Congress to integrate “comprehensive vision and eye health” into new health programs and policies contained within healthcare reform. The AOA says its first priority is patient access to comprehensive care.

According to the AOA, reform that contains “stand-alone” vision plans as a “preferred and specially recognized mechanism for delivering eye health care for America's children” doesn't protect patients, and may actually serve to bypass important consumer protections contained in healthcare reform legislation.

A comprehensive package

“We are at a point where we must increase the integration of comprehensive vision and eye-health services into covered medical services,” says AOA President Randy Brooks, O.D. “Vision benefits separately offered and priced from other required health benefits disassociates care from the medical model and adds unnecessary barriers to care coordination.”

He explains that “stand-alone vision plan companies aim to turn back the clock by continuing to segment vision care from eye health.”

As I read this position statement by the AOA, I thought of the “any willing provider” initiative that has languished about for a decade or so, and I recognized that this may be an opportunity to move that effort along as well as the awareness of the need for comprehensive vision and eye health care.

One thing I would caution the AOA lobbyists about is in the differentiation of eye health care, vision care and eyewear. While I agree that the stand-alone vision plans may very well confuse consumers and the government into believing that clear vision is all that's necessary, it's important to recognize that where the vision care goes, there most likely go the material sales — i.e., all the frames, lenses and contact lenses that represent a large investment and return for most optometric practices.

Where would vision care go?

My concern for the potential for this division of eye health care and vision care is that I don't see the government legislating an opportunity for eyecare practitioners to profit from retail sales. I've occasionally mentioned the exemption to the Stark Law under which optometrists are allowed to fill their own prescriptions. I think we must all, along with the AOA, cautiously approach any recommendations for structuring health-care reform in a manner that would encourage the repeal of optometry's Stark Law exemption and thus compromise the opportunity for optome-try to continue delivering comprehensive eye care, which includes eye health, vision as well as the provision of materials.

One last concern

My concern and caution in this, as in so many areas in which the AOA focuses, is to be absolutely sure this is in the best interest of the 36,000 optometrists the AOA represents as well as the public we seek to serve. It makes me wonder whether the AOA is occasionally so concerned about optometry being left out, that it looses sight of whether optometry really wants to be included.

By the way, is the AOA promoting the inclusion of optometry in healthcare reform, or the inclusion of certified optometrists? OM

Optometric Management, Issue: October 2009