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!
Pete's AOA Weblog 