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The best of times or worst of times?

December 17, 2012

As I write this I am looking forward to what I think will be among the most enjoyable events of this year serving as your president. Over the next weeks, Desiree and I get to travel to St. Louis and to Washington, D.C., to enjoy holiday lunches with the AOA staff. They are an important part of our optometry family, and I look forward to thanking each of them for their work helping all of us serve our patients.

My trips to Washington are always full of meetings, so I will also have a critical meeting to push for more optometry involvement in the Vision Center of Excellence, which serves our service men and women and our veterans. Optometry has a vital role in helping our armed forces and veterans, and we have much more to offer than is being utilized.

But while in Washington I will also be thinking about some other meetings going on there as I suspect the president and Congress will still be meeting to decide how to deal with the federal debt crisis (also known as the “fiscal cliff”) and the chronic failure to agree on some basic national priorities. I think their meetings will be more stressful than mine.

The problems our country is facing are real and daunting and while many of us are probably glad we will not be in the government’s difficult meetings, the outcome of those discussions will certainly affect each of us as citizens and as optometrists. And it will impact the work the AOA does for you.

Just this past June, a report from the Congressional Budget Office indicated the federal government recorded the largest budget deficit since 1945, both in dollar terms and as a share of the economy. Very significantly, the report goes on to say that the “aging of the population and the rising cost of health care would cause spending on the major health care programs and Social Security to grow from more than 10 percent of GDP today to almost 16 percent of GDP 25 years from now. That combined increase of more than 5 percentage points for such spending as a share of the economy is equivalent to about $850 billion today. Absent substantial increases in federal revenues, such growth in outlays, would result in greater debt burdens than the United States has ever experienced.”

As you well know, the government is already looking at reducing its health care costs. Since the U.S. government pays for more than 60 percent of the health care costs in this country, you can bet that whatever the government does to control its health care costs will impact us as optometrists.

So should we be concerned about our future as optometrists? As my son enters our profession should I be concerned about his future? I think I can sum up my answer in a quote from anthropologist Jane Goodall: “The greatest danger to our future is apathy.” And that means our apathy. Will we focus on our future and will optometry do what needs to be done to successfully adapt to the coming new world of health care?

One thing I am certain of – which gives me great confidence – is the AOA’s and many members’ continuing commitment to the hard work of advocacy. I also have great confidence because I also know that the core of our optometry family is strong and that together we can be heard loud and clear as critical decisions impacting our profession and our patients are made in Washington and in our state capitals.

Why am I so certain? Because we’ve been doing it, and this year offers some impressive examples of the success the AOA and our state associations have had as new public policy opportunities occurred and in responding to groups who oppose us.

Just ask the leaders of the mammoth-sized American Medical Association (AMA) and its soon-to-be former ally on Capitol Hill, Rep. John Sullivan, how hard it is to get a bill passed through Congress that optometry opposes. They couldn’t do it.

Remember the many years the AOA fought the “Sullivan Bill”? It was an attack on us that questioned the very idea that optometrists should be recognized as doctors, and it was defeated in each of the last six sessions of Congress. Additionally, in a rarity for a six-time incumbent, the bill’s author, Rep. Sullivan, was defeated in November– and nationally many gave optometry much credit for his ouster.

Organized medicine also learned this year that your AOA plays hardball to protect our most important patient access gains. Let me share a couple examples that I really appreciate:

  • Ophthalmologists and pediatricians aggressively lobbied for the pediatric essential vision care benefit to be a screening in a pediatrician’s well-child exam and not the comprehensive care, including medical eye care, for which the AOA fought. As federal regulations proposed just prior to Thanksgiving revealed, we have prevailed; the new benefit will be a comprehensive exam with follow-up care including medical eye care. Millions of new patients will have direct access to our services.
  • Also, for two years all of medicine and many insurers have demanded that Congress repeal the AOA-backed Harkin Law that bans discrimination by health plans against ODs on the basis of licensure. Harkin was a huge win for optometry as it is the first-ever federal standard for provider non-discrimination. However, AMA admitted last month that it has made no progress against us in overturning Harkin—so another win and our non-discrimination law remains on track for implementation.

Some of our federal and state wins take a while to make a major difference in the lives of our patients and our practices. For example, until just a quarter century ago, optometry was excluded from the Medicare program. Today, in 2012, for the first time, Medicare payments to ODs will exceed the $1 billion level. If Congress can resolve the fiscal cliff issues, payments to ODs are likely to increase again in 2013.

Similarly, when Congress and the Obama administration were developing a new Medicare EHR incentive program, optometrists were going to be cut out until the AOA rallied support on Capitol Hill to secure changes that got us included. As a result, in the most recent numbers reported this year, about 3,200 optometrists were paid a combined $52 million through the Medicare EHR incentive program.

In another essential win for optometry, the AOA and affiliates worked together and convinced federal officials to stop the discriminatory practices by a Medicare contractor who wanted to restrict our optometric scope of practice.

Also, through our Third Party Center work this year, optometrists have been added to the medical panels of GM, Chrysler and the South Shore Health System. We were also able to correct unfair denials under TRICARE for higher level E&M codes.

Thanks to our members’ support and many dedicated volunteers and staff, 2012 has been another great year for AOA and affiliate advocacy efforts. As for our future, certainly 2013 will be year full of big challenges, but I believe the best way to predict the future is to create it. I also know that through the AOA and our affiliates, each of us, working together, can help shape the future we desire for our patients and our practices.

We can continue to be successful. I believe we will be successful. 2013? I’m looking forward to the best of times.

Ronald Hopping, O.D., MPH
AOA president

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