At the end of April, hundreds of optometrists and optometry students from across the country met in Washington, DC to advocate for optometry.

As you have heard and learned many times throughout school, optometry is a legislated profession. This means that if there is something new that we as optometrists want to do, we need to pass legislation in order to expand our scope of practice.

In addition to expanding the procedures we are allowed to do, we must also protect our profession from others who may want to take things away from us.

This year, there were several topics that we discussed with our congressmen and women on Capitol Hill. Here are the basics:

Dental and Optometric Care (DOC) Access Act HR 1606

• The DOC Access Act aims to combat anti-patient and anti-competitive practices in the vision and dental coverage markets while prioritizing the preservation and protection of the doctor-patient relationship.
• Unfortunately for patients and their doctors, competition in the vision plan market is severely lacking. Currently, a small number of national, vertically–integrated players monopolize markets in a large majority of communities. In fact, the two most dominant vision plans provide coverage to roughly two-thirds of Americans with supplemental vision coverage.
• Among the range of anti-patient, anti-doctor mandates, plans dictate what doctors must charge patients for services and materials not covered by the plan, force doctors to accept damaging terms of a supplemental vision plan in order to provide medical eye care to patients covered under the traditional health plan, and force doctors to use a specific lab (often owned by the plan) when providing needed care and treatment.
• For patients, harmful vision plan practices have led to confusion and frustration, as well as increasing overall costs and diminished access to needed care. Patients are increasingly finding that local doctors may no longer accept their vision plan due to harmful plan practices. Patients with these restrictive plans also likely face additional financial burdens, including higher out-of-pocket costs, as plans increasingly leverage these types of provisions to increase the marketability and profitability of their products at the expense of doctors and patients.
• Doctors’ frustration stems not only from anti-patient and anti-consumer requirements, but also because it is nearly impossible for independent doctors to negotiate plan-provider agreements with large corporate entities which dominate most markets and have all of the bargaining power— especially considering that the two most dominant vision plans control roughly two-thirds of the vision plan market. Added to that, while plans are exempt from various antitrust laws, it is illegal for health care providers to band together for the purposes of negotiating contracts.
• A 2016 report released by a group of independent health economists (Avalon Health Economics) found that the kind of monopsony behavior exhibited by vision plans “is not the kind that’s good for consumers—it’s the kind designed to transfer operating margins from providers to plans without benefiting consumers.” Further, Avalon says that “such mandates have another effect —they lead to higher overall costs for these consumers and, especially, for consumers without vision plans as doctors are forced to compensate for the transfer of operating margins from doctors to the plans.”
• While more than 40 states have enacted legislation addressing these and other plan abuses—some states having both a dental and vision law, some with only a dental law, and some with only a vision law—roughly one-third plans operating in any given state are able to sidestep those state-level laws because they are instead federally-regulated. That is why a federal effort is now needed. HR 1606 will not mandate increased coverage or benefits or raise coverage costs for patients because this effort would not require health plans, vision plans, or consumers to add any additional services. HR 1606 would not supersede state law.

Veteran's Groups and AOA United in Support of Essential Care

• Due to injury, increased rates of eye disease and health risk factors, America’s veterans require assured access to quality eye health and vision care, including baseline comprehensive eye exams and the ongoing in-person, doctor-provided care they need and deserve.
• Unfortunately, some at the VA want to deprioritize eye health, lower the standard of care and even abolish the VA’s Optometry Service, comprised of doctors of optometry and optometry residents providing efficiently-delivered and highly-sought frontline care in medical centers and community-based outpatient clinics across the country.
• Together with leading Veterans Service Organizations and concerned Members of Congress, the AOA is fighting to strengthen veterans’ eye health and vision care and shed light on the expansion of TECS, an experimental protocol which is providing a substandard level of care.
• AOA urges U.S. Senators and House members to be aware of and to oppose efforts to drastically-reduce or eliminate the VA Optometry Service, including its highly-successful and cost-effective residencies, or to continue or expand the experimental TECS program in its current form.
• The VA Optometry Service provides care for nearly 70 percent of the total unique veterans visits involving eye care services annually, with more than 1.7 million unique and 3.1 million overall patient visits. Roughly 73 percent of the 2.5 million selected ophthalmic procedures and nearly 99 percent of the eye care services in low vision clinics and blind rehabilitation centers are provided by VA doctors of optometry. In addition, through the VA Polytrauma System of Care, doctors of optometry provide vision rehabilitation services for veterans who have suffered a traumatic brain injury (TBI).
• The VA is home to the largest optometric clinical training program in the U.S. Every year there are more than 1,250 opportunities for doctor of optometry candidates to rotate at VA medical facilities for clinical education and training. Each year roughly 70 percent of the 1,400 to 1,500 graduates of accredited school and colleges of optometry have performed public health services at VA . For FY 2019, there are 221 post-graduate residency and fellowship positions available for development of advanced clinical competence.

FTC Contact Lens Plan

• Contact lenses are a safe, effective, and popular choice for vision correction. Because ill-fitting or improperly-used contact lenses can result in serious eye conditions, the U.S. Food and Drug Administration regulates contact lenses as Class II and Class III medical devices which require an eye doctor’s prescription and oversight. Both the FDA and the U.S. Centers for Disease Control and Prevention inform consumers that contact lenses are not “one-size-fits-all” devices and that regularly-scheduled eye examinations are critical to ensuring continued health of wearers’ eyes.
• The Fairness to Contact Lens Consumers Act (FCLCA) became law in 2004 and, under the law, Congress charged the Federal Trade Commission (FTC) with enforcing its key provisions, including prescription release and prescription verification requirements. While eye doctors have overwhelmingly-complied with their requirements under the law, lax FTC enforcement of prescription verification requirements has led to growth in illegal sales, including through the filling of expired or non-existent prescriptions and filling of prescriptions with devices other than what was prescribed.
• As part of its scheduled 10-year review of the Contact Lens Rule, the FTC issued a proposed change which, instead of better addressing the growth in illegal sales, would mandate that every one of the more than 50,000 eye doctors in the United States obtain from each of the 40 million American contact lens-wearing patients for each new prescription a signed documents indicating that the patient received a copy of their contact lens prescription.
• The FTC paperwork proposal is both unnecessary and overly burdensome. Based on publicly available information, the Commission has issued a total of 55 warning letters to contact lens prescribers within the last decade. Further, data obtained through a Freedom of Information Act request, shows that FTC received a total of 309 consumer complaints regarding prescription release between 2011 and 2016 out of roughly 200 million prescriptions issued. While violators should be held accountable, the broad new mandate is expected to cost roughly $18,000 per doctor, per year.
• The AOA supports ongoing efforts in Congress to urge the FTC to rework its proposal and instead focus on combatting illegal sales. More than 100 U.S. House and Senate members—through a nearly 60-member House sign-on letter last year and nearly a dozen individual Senate letters, FY 18 appropriations language, and direct questioning of incoming nominees—have so far taken action expressing concern, more voices are needed. U.S. House members are urged to join the Burgess–Rush House sign-on letter and U.S. senators are urged to send their own, similarly-worded letter opposing the FTC plan.