Issue: July 2012
June 26, 2012
3 min read

VSP, AOA air views on health care reform at public meeting

The groups disagree on the participation of stand-alone vision pans in the state insurance exchanges.

Issue: July 2012
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At a VSP-organized forum in St. Louis, representatives from the American Optometric Association and VSP Global presented the groups’ well-known views on stand-alone vision plans in the federal and state health insurance exchanges, the pediatric vision benefit and the Harkin Amendment.

The event was not billed as a debate, but an open forum through which the two groups could present their opinions. The live audience was made up of more than 100 attendees, the majority of which were AOA members and VSP providers, as well as several hundred viewers via Internet simulcast.

The AOA and VSP have publicly disagreed on how stand-alone vision plans not affiliated with a health plan will directly participate in the state health insurance exchanges. VSP believes inclusion of the stand-alone plans is vital to patient access, while the AOA has argued that stand-alone plans must be integrated with qualified health plans in the exchanges.

“There’s a common misconception that establishment of state insurance exchanges will take patients away from our practices,” Robert L. Jarrell III, OD, FAAO, chair of the AOA State Government Relations Center executive committee, said at the forum. “This is simply not true. Establishment of state exchanges will provide health insurance for over 30 million Americans who were previously uninsured. The exchanges will have no effect on the coverage of 270 million Americans who are covered by their current plans, stand-alone vision plans included.”

“With all of health care moving toward integration, we must question why we would remain fragmented from the rest of the health care delivery team,” Stephen Montaquila, OD, FAAO, chair of the AOA Third Party Center executive committee, said. “As my team and I have worked to educate third-party stakeholders on the profession of optometry, we have found that the current model that segregates vision care from the rest of medical care has served to isolate and define optometry primarily as a refractive profession.”

Dan Mannen, OD, VSP past chair and current director of VSP Global, said, “Until we have absolute assurance that all optometrists will be able to participate in all medical plans just like our medical colleagues, we absolutely have to protect our current access to patients and fight for medical equality.

“We have over 100 million patients coming to our practices unencumbered by health plans, by way of standalone vision plans,” he continued, “57 million by VSP alone.”

VSP also pointed out that patients are twice as likely to get an eye exam when their vision care is provided through a stand-alone vision plan vs. one bundled with a medical plan.

“As the health care system resets itself, and patients start enrolling in exchanges, we’ll see a migration of patients from one set of plans to another set of plans,” Tim Jankowski, OD, immediate past chair of VSP Global board of directors, said. “We need to be able to maintain our access to patients and continue to provide a regular flow of patients into private practices.”

Dr. Mannen added: “Experts predict that a significant amount of employer groups will move into these low-cost health care exchanges. We should all be concerned about access.”

The AOA panel asserted that the pediatric vision benefit will bring even more patients to optometry.

“Thanks to the efforts of the AOA, insurance exchanges will provide children’s vision care as a mandated essential benefit to 10 million kids who previously had little or no access to eye care,” Dr. Jarrell said.

VSP President and Chief Executive Officer Rob Lynch said the pediatric vision care benefit has yet to be defined. “Is it a screening or an exam?” he said. “We agree with the AOA that it should be an exam. The National Association of Vision Care Plans and VSP have been lobbying for it.”

Another component of health care reform important to optometry is the Harkin Amendment. Roger Jordan, OD, FAAO, chair of the AOA Federal Relations Committee, referred to its passage as one of the AOA’s greatest feats. This amendment prevents health insurers from discriminating against a provider acting within his or her scope of practice, he said.

“This also opened up [patients covered by] ERISA [Employee Retirement Income Security Act],” he said, “which we had been locked out of for years.”

Dr. Jordan said the amendment should bring parity in reimbursement among MDs and ODs, “except when it relates to quality or performance issues.”

Dr. Mannen views the Harkin Amendment with caution. “We should understand that the Harkin Amendment is not an any-willing-provider statute, does not offer protection to be sure all ODs can participate nor does it guarantee pay equal to our medical colleagues,” he said. “The Harkin Amendment is open to interpretation. There are some exceptions that can affect ODs.”

He also noted that participation in a health care-owned vision plan will not guarantee membership on the medical panel. – by Nancy Hemphill, ELS

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