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!


  1. Dr. Kehoe,

    I recently received a written letter from Humana which stated the following:
    “Humana does not discriminate against a health care provider because the practitioner is an optometrist or ophthalmologist. During the application process, Humana follows the same process for optometrists and ophtahlmologists.

    Parity in Humana’s provider fee schedule for an optometrist and an ophtahlmologist does not necessarily occur. Humana determines fee schedules dirrently according to many criterions (education, geography, etc). Humana does not believe that the statute you previously cited mandates identical payment rates between an ophtahlmologist and optometrist.”

    In your opinion, does this letter sound discriminatory against optometrists? Will the AOA assist state optometric organizations in passing new legislation if it is deemed discriminatory? There are several other health insurer who are on the same band wagon.



  2. Stephen –
    I do believe that the letter is discriminatory – if they are in fact paying optometry and ophthalmology differently in the same geographic location. Please forward that letter along to the AOA and Dr. Chuck Brownlow and we’ll look into the situation. We need to know about these situations around the country so we can begin the battle with all the insurers to be treated equally, just like in Medicare!

  3. Pete
    Here in California we are having serious problems with access to primary eye care. I get some letters that state flat out we do not contract with Optometrists. The Medi-caid in California will not contract Optometrist for medical care because we are listed as “optical” providers. Almost all my HMO/IPA will not allow medical care with Optometry for various reasons. One common one is they will capitated a local OMD but even if it’s a cap pool, we can not bill for medical. I talked with my COA liaison, and he indicated that the issue was more AOA related than COA related. Your article does not seem to indicate that. Right now we have a group of around 70 offices that want to make changes on this subject. We have contacted a congress person that is an OD that we supported to what changes can be made within California. We also need the support of the AOA. I would like to talk to you about this issue and how to proceed. You could e-mail me or call at my office 714-879-2020 on how to proceed. Look forward from hearing from you.

    Steve Chiana

  4. To my way of thinking, optometrist join managed care panels for the need to have more patients due to holes in their schedules. The law of supply and demand. Too many optometrists, too few of patients. Leadership in the AOA informs us of the supply and demand is appropriate however many optometrist like me would beg to differ. So, instead of writing of these topics, why not start a campaign as our AOA president that would really make a differnece to mainstream optometry and begin to work on the supply side of this most basic “law” of economics.
    Kirk Kvitle, O.D.
    Quincy, Ill.

  5. Steve,
    Access to patients for medical eye care is both an AOA and state concern. For national plans, the AOA has successfully brought approximately 36 million more lives to optometry in the last several years. However, for state and local plans – the issues are state association and individual doctor issues. Some states have very solid access and others struggle to get on panels and be paid equal to ophthalmology. The AOA will continue to message to both vision plans and health insurers to explain why it is in the patient’s best interest to have optometry on the panels as full participants with equal reimbursement to ophthalmology.
    You and your colleagues need to work together to get the message out through your patients and directly with health insurers to tell the optometry story.

  6. Kirk,
    As a fellow Illinoisian with a challenging economy – I agree that for the most part, we all would like more patients. And you are correct that most accept vision plans to fill the “holes” in the schedule. My concern is that sometimes we accept plans that really don’t provide a reasonable return for the office and ultimately, like the airlines have discovered – work less and make more. Filling holes with patients that don’t cover the cost of your operations and provide a reasonable profit is not good for most practices and definitely not good for our profession’s long term health.
    The AOA has been investing about $1M per year for the last 4 years to get the message out about what optometry does. We’ve had great success, but we will never have enough money to really move the needle without the help of EVERY OD, in EVERY PRACTICE, with EVERY PATIENT! What I mean is that we all need to take a few extra seconds to explain the scope of care we can provide and encourage our patients to return as directed (and why) and bring their family and friends with them. Hopefully you and everyone is starting the message of: “Lifetime of Healthy Vision” with every InfantSEE exam you do. We can’t change the public’s perception overnight or by ourselves – we all must be part of the solution.

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