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Just what are they getting into?

April 29, 2013

By Ronald Hopping, O.D., MPH, AOA president

As much of this edition of the AOA News is about our professional students (and as I start to write my commencement addresses) it seems to be a good time to ask ourselves “What profession is the new grad getting into?”

As I described in my December President’s Column “Best of Times—or Worst of Times?” in which I referenced the opening lines of “A Tale of Two Cities,” our profession is practicing at the highest level it ever has and we are providing care for our patients at the highest level ever.

Legislatively we are as strong as ever, and our successes in most states and in Washington, D.C., are at an all-time high. As a profession, we have worked hard together to achieve the enviable place we are today. As I have said many times: I am exceptionally proud of our profession today, as I believe you are.

However, just as those lines from “A Tale of Two Cities” were written about French revolutionary times, we are in the midst of our own health care revolution. And there are very dark clouds on our horizon. Whether optometry will succeed as an independent profession, able to provide the best care possible for our patients, is being decided today and tomorrow. It will be decided by all of us.

We are in fact a small profession. There are around 36,000 optometrists in this country – and that’s a bunch. However, there are over 3 million nurses, around a million physicians, 300,000 occupational and physical therapists and 180,000 dentists – and just like when you are the littlest guy on the team, you must run faster, jump higher and work harder to make up for your size.

I point this out because we need every optometrist, new graduate and veteran, to play. In high school in Dayton, Ohio, when playing football, I remember the big schools would bring their football teams to play our small school. There would be players from goal line to goal line wearing the opposing colors lined up across the field and my team went from the 40-yard line to the 40-yard line. With fewer players, we knew we had to out play that team – and that meant every one of our players had to contribute at the highest level. We had to run faster, jump higher and work harder.

Unfortunately, we are not playing in a game. There are no timeouts, no referees, and no water breaks. We are playing for keeps – for our patients and for our profession. What is decided as the regulations and laws are written in Washington and state capitals will define our profession for years to come.

But I believe the best way to predict the future is to create it. Our recent victory with the Affordable Care Act is a clear example of what happens when the AOA works together. The AOA set our sights on increasing access to our practices, and we had a hugely successful win with the Harkin amendment: the first non-discrimination language in federal legislation. We know the Harkin amendment is not perfect, but it is a substantial win and opens the door in our practices to more than 80 million patients. So far, the AOA has been able to defend that win.

The AOA also set our sights on establishing vision care as a fundamental part of the health care of a patient and, once again and together, we achieved the monumental pediatric vision benefit as one of only 10 essential health benefits as defined by federal law.

Defining the pediatric vision benefit has been a very tough fight for the AOA. Ophthalmology, pediatricians and insurance companies wanted this benefit to be a screening, but with the late February final ruling by the Department of Health & Human Services (HHS) this essential benefit has been defined as a comprehensive exam with materials. Once again, together, we were successful!

The AOA has also fought exceptionally hard to keep this vision benefit from becoming optional. At least one large insurance company wanted the vision benefit to be treated like dental stand-alone plans. However, just as the AOA believed would happen, because the dental plan is a stand-alone plan it has now been deemed an optional benefit. As shown by this final ruling, the existence of a stand-alone vision plan in the exchanges would likely have made the pediatric vision benefit optional. Again, with the recent final HHS rulings the pediatric vision benefit is not optional. Once again, together, we were successful!

Let’s think a minute about what these final rulings mean. They mean that together we have fundamentally changed the way vision care, our care, optometric care, is viewed in the country. That for the first time in our lives and going forward optometric care is not outside looking in. Optometric care, vision care, by law is an integral part of our nation’s health care.

Our profession has had a few significant milestones such as optometry being recognized by Medicare and optometry earning diagnostic and therapeutic privileges. I believe this pediatric vision essential benefit will also be one of our hallmark milestones.

Of course, we will need to constantly defend these successes. As you read this, ophthalmology, pediatricians and insurance companies want to make this essential vision benefit only available upon prior authorization requiring a patient to obtain a referral by a pediatrician or primary care physician – so we must continue our fight for the patient’s right of self-referral and direct access to our care.

So, I think the future of our profession into which we welcome the new graduates, including my son, is exceptionally bright.

But it is necessary to remember that all of us working together brought us to this place that we and our patients enjoy. To be successful for our patients and our profession, our team must run faster, jump higher and work harder – or, as I learned after a few football games in high school, the ride home on the bus will be very, very quiet.

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