Archive for March, 2009


Declaration of optometric independence

March 24, 2009

Webster’s defines independence as the quality or state of being independent, and offers several definitions of independent, some of which include: “1: not dependent: as a (1): not subject to control by others : self-governing (2): not affiliated with a larger controlling unit <an independent bookstore> b (1): not requiring or relying on something else : not contingent <an independent conclusion> … (1): not requiring or relying on others (as for care or livelihood) <independent of her parents> … d: showing a desire for freedom <an independent manner>”

The majority of AOA members define themselves, or their practice setting, as independent when they complete practice surveys; yet the independence of our profession is being threatened on many fronts. 
First, and most important, is professional judgment.   When speaking to students or groups of optometrists, I always remind them that regardless of where they choose to practice, or who writes their paycheck, they are the only person responsible for patient care decisions.   Non-licensed employers and employers of different professional designations can often influence employed optometrists in the way they practice, but the ultimate decision – the independent decision – on a patient’s care should always belong to the licensed OD. 
Some organizations and businesses don’t see it that way.  Recently, several state optometric associations found themselves in legislative battles with employers of AOA member optometrists over patient care issues. This places the employed OD in the awkward position of having to decide between his or her professional responsibility and the bottom-line desires of their employer. 
Second, we are seeing challenges to financial independence.  Even traditional solo/private practitioners are having their independence threatened by the growth in managed vision and health care.
As optometry has become a major provider of medical eye care and insurers are vertically integrating, there is downward pressure on reimbursement.  More and more health plans require us to accept a less than financially viable vision plan to have the “privilege” to provide medical care to larger and larger patient populations. And now, managed vision care companies are carving out medical eye care in arrangements that discriminate fees and/or administrative arrangements between optometrists and ophthalmologists.
Ask yourself the question, by your participation, are you supporting or fighting against provider discrimination?

So is this a doom and gloom column? Absolutely not, because we are optometry! Your AOA will continue to fight legislatively for your independence from others trying to dictate what services we can provide and those trying to devalue the quality services we provide.
With the blessing of our team, we will step up the fight.  We will expose vision and health plans that discriminate against our profession in reimbursements and administrative policies so you can make fully informed business decisions rather than feeling pressure to join out of fear of losing patient groups.
Tools being developed by the new Third Party Center at the AOA will prepare any doctor, in any setting, to analyze the finances of the practice.
We want to help you make informed business decisions on all discount vision or health plans. Armed with a clear financial understanding, maybe you’ll have the courage to declare independence from the handcuffs of accepting plans that reimburse less than the cost of doing business and definitely less than the value we provide to every patient.
Ultimately, when they see ODs asking hard questions, maybe plan administrators and employers will realize that they have to be more competitive and equitable with their fees if they want the best and the brightest optometrists to sign on.
So how do you declare independence when you are employed by an ophthalmologist or corporate entity? First, choose your employer wisely.  Discuss philosophy on the future of your profession PRIOR to accepting that first paycheck. 
And if you are considering joining a panel, ask yourself whether you are standing up for your profession or selling yourself short.   Always remember that it is your education, your license to practice and your profession that make up the three legs of your professional stool. Never allow an employer or plan manager to weaken any of those legs.

Please join me in rallying our colleagues in reconfirming the independence of optometry…for our patients, our practices and our profession!


Board Certification Is The Topic

March 14, 2009

Folks there are several comments from readers on the topic of board certification. I apologize for not responding earlier, but travels have gotten in the way. Please be sure to read everyone’s posts and my replies and feel free to respond with your own comments.

I also encourage everyone to visit frequently for the latest Q & A’s on the process and the latest information on the proposed model.

The executive committee of the AOA had a very excellent meeting with state leaders last week at SECO and a lot of good ideas were raised that I believe will further improve the model that is being presented.

My hope is that NO STATE ASSOCIATION will tie the hands of their leaders that attend the AOA House of Delegates this year. Those in attendance at the House of Delegates will need the lattitude to hear all the arguments for and against and make an informed decision for the future of our profession.

Until next time…


Three schools in three days

March 4, 2009

I was fortunate to be able to visit SUNY State College of Optometry, Pennsylvania College of Optometry at Salus University and New England College of Optometry Feb. 11-13.  The AOA sponsored faculty lunches, each attended by 25-30 faculty members and student events (each attended by between 125 and150 students from various classes).  The deans/presidents and administrators at all three schools and colleges welcomed the AOA, discussed their curricula and gave tours of their academic and clinical facilities. 
 The topic of greatest interest at all three schools was board certification.  I emphasized to faculty the “mentor” role they play and encouraged them to encourage their students to be active in organized optometry. 
With students, I emphasized the importance of getting involved, even if they weren’t sure what sort of practice they’d be involved in and that involvement in the profession was the surest way to keep it secure.


Preventing history from repeating

March 4, 2009

For the past 10 years of my life I’ve felt incredibly fortunate to have been an AOA Board member, now serving as your president.
Throughout these 10 years one of my biggest privileges has been the process of learning about each aspect of our profession as a liaison to nearly every committee within the AOA.  An honor that accompanies that learning process is getting to participate in many discussions with ODs who have been leaders throughout our profession’s history.
With the current discussions about optometric board certification this spring, several voices from the past have called and written to remind me of historical conversations in our past as progress brought controversy and fear.

The leaders who were part of our optometric history at the front lines of change shared with me those historical conversations and outcomes in our profession’s history where a vocal minority or even our own house of delegates made decisions that slowed the progress of our profession.

Even during those historical setbacks, those who looked forward trusted their knowledgeable leaders at the national and state level, making the tough decisions to look beyond the short-term downside and refocus on the future for our patients and our profession.

An example of not seeing the future was in 1938 when the AOA House of Delegates passed a resolution: “…with emphasis on the fact that optometry has no desire to extend its practice to include any limited or other form of medical eye care.”

The stories told to me by those who were around in the early 1960s related that optometry did not initially want to participate in the Medicare system that launched in 1965. However, in 1967, realizing their error, the AOA House of Delegates went on record as wanting to be part of the Medicare system.  Unfortunately, because we were not part of the launch of that initial program, it took us 20 years to become full participants in the Medicare system.

Of course the transition into medical eye care with diagnostic and therapeutic pharmaceuticals flew in the face of the 1938 resolution and there were many within our profession vehemently opposed to our transition into medical eye care right up to the day of state legislature votes.

Fortunately, for the millions of patients, and our profession; state and AOA leaders did their homework and had a vision for the future in the 1960s, 1970s and beyond. They were bold and stood against the vocal opposition — and look where we are today as a profession: 37 years after Rhode Island’s first diagnostic law, optometry is in mainstream health care in America.

Today optometry sits at the table to help frame the NEW and changing American health care system.

Trying to ensure optometry’s full inclusion in the future has once again brought vocal opposition. Let’s not repeat history because a vocal few haven’t looked forward or fear the change that will be our catalyst into the future of total patient care.

Our leadership who sees the future does their best to position our profession for success by sharing the information and added wisdom with the majority.

The AOA Board and state leaders continue to do their homework to ensure that optometry will have full participation in the new quality-oriented, value-based healthcare that is being developed in America.

What a great time to be a member of your state association and the AOA in the age of information. Yet, I challenge everyone to do the necessary homework to provide informed feedback to your state leaders by reviewing the board certification materials that are posted on the AOA Web site:

Let’s not get caught up in the negative hype that is being fueled on the Internet.

The misinformation and personal opinions being expressed aren’t substantiated by solid credible information.    I urge you to review the materials that have been developed by the Joint Board Certification Project Team.    Look at the facts both historical and current. You should find total confidence in the findings because of the amount of time and effort the team has invested in this project to ensure that optometry “gets it right” for our patients and our profession.
Value-based health care is the reality. The AOA Board and our state leaders realize that we may lose a few good members depending on the outcome of the vote on board certification, however, we should all be more concerned that as a profession we could be left out of the changing health care system or unable to participate at the full level with equal reimbursement as other board certified professionals.