Promoting the Pediatric Benefit

It’s up to you to make the Pediatric Eye Health Benefit a Success. Here’s how.


  affordable care act

Promoting the Pediatric Benefit

It’s up to you to make the Pediatric Eye Health Benefit a Success. Here’s how.


The Pediatric Eye Health Essential Benefit, or the requirement for plans to provide coverage for an annual comprehensive eye exam with treatment and follow-up care from birth through age 18 in 48 states and in Washington, D.C., provides a significant opportunity for both young patients and optometrists, if, that is, optometrists can successfully promote the Benefit.

Unfortunately, there is no public service campaign for the benefit, explains Stephen Montaquila, O.D., the AOA’s Chair of the Third Party Center Executive Committee, who also practices in Warwick, RI. “For many, the success of the Benefit will hinge on word of mouth.”

Here, OM talks with Dr. Montaquila about the Benefit and what optometrists can do to promote it and successfully examine these young patients.

OM: The AOA recently held a forum on the first 100 days of the ACA Pediatric Eye Health Benefit. Are any stats yet available on how many children have seen an optometrist as a result of the Benefit?

SM: Nothing has been developed or printed yet. I think it’s probably too soon to have that kind of data, since the drop-dead deadline for the Affordable Care Act sign-up was March 31. I think it’s probably going to take at least a year before the AOA will know of any impact this has had on patient flow.

OM: How, specifically, can O.D.s promote the Pediatric Eye Health Benefit to grow their practices?

SM: There are a few ways. One is educating patients who have children you have never examined. In my practice, when patients are in the exam chair and talk about their kids, I’ll start talking with them about the link between vision and learning and how a comprehensive eye exam goes above and beyond vision screenings, in terms of its ability to detect refractive and/or ocular issues. If they respond that they don’t think their child has eye exam coverage, I bring up the Pediatric Eye Health Essential Benefit. This education may not only prompt eye exam appointments for their children, but word-of-mouth referrals as well.

The second way optometrists can grow their practices with the Benefit is to personally call a child patient’s pediatrician about the exam findings. This plants the seed in the pediatrician’s mind to refer more of their patients to this optometrist. Communication goes quite a long way to establish a referral-based relationship. Along those same lines, I recommend sending a letter that details the Pediatric Eye Health Essential Benefit, the refractive and ocular conditions vision screenings can miss, the services the optometrist can provide and a CV to all pediatricians in that optometrist’s area of practice.

Third, I suggest marketing the Benefit in your office by displaying a document that outlines the Benefit and the various refractive and ocular conditions that can be missed by a pediatric and/or school screening. The AOA has compelling statistics that optometrists can use in their marketing materials to grab a parent’s attention. For example: “It is estimated that nearly 25% of school-age children have vision problems. Vision screenings are not diagnostic.”

OM: What can optometrists do to prepare themselves and their practices for this patient population?

SM: I recommend starting with the AOA’s “Optometric Clinical Practice Guideline: Pediatric Eye and Vision Examination,” which can be found at In addition, on June 27, Optometry’s Meeting, which is in Philadelphia, has a specific course called “Executing a Thorough Pediatric Eye Exam as an Essential Health Benefit,” which will be taught by Kathleen F. Elliott, O.D. of the practice His Vision For Children in Tulsa, Okla. I suggest attending that course. Also, I recommend contacting colleagues who work with a large percentage of pediatric patients for their advice on how, specifically, to successfully obtain the needed tools to make testing and examining these children easier.

From my experience with young children, for instance, I’ve found that you have to make the testing relevant to them. If it isn’t, you won’t be able to maintain their attention, and there goes the examination. So, I ask what their favorite toy is and try to do the exam with that toy in mind the entire time. In our office, we have always had a large container of Lego blocks of all shapes and sizes.

Dr. Montaquila says the key to successful pediatric eye exams is to make them relatable to the young patient.

Almost every child who comes into the office stops to make something while they wait for their examination to begin. We even encourage them to bring their creation with them into the examination room. It seems to be a great way to ease their anxiety.

Promoting the Benefit

Educate patients who have kids you have never examined.

Reach out to pediatricans in your practice area.

Market it in your practice via a visible education form.

OM: Could you provide an example scenario in which you have used a toy to perform testing?

SM: So, as I said before, we have Legos in the office. Sometimes, we’ll give children the Legos, so they can start to actually build something, and then you can do their exam while their busy. Then again, sometimes you just have to speak with the child’s parent to find out what they will be comfortable with and go from there. If parents express concern when booking the appointment, we have our receptionist ask the parent to bring along the child’s favorite toy. We also have the parents take part in the examination: When we need to gain the child’s attention, we will ask the parent to help. Remember, they know their child best, and we use this knowledge to help us during the examination.

OM: Is there anything else about the Pediatric Eye Health Essential Benefit that you feel is important to mention?

SM: The Benefit is a huge patient access opportunity. From what I’ve read, the Benefit has enabled millions of more children to have access to eye care. This means we can intervene early and throughout their lives, especially during critical times in their learning and development. But, we, as O.D.s, must promote the Benefit if we want this underserved population to take advantage of it. Seeing patients early creates life-long patients. The Benefit is a win-win for everyone. OM