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AOA board predicts future of optometry, outlines its involvement
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SEATTLE – Optometry’s Meeting attendees had a unique opportunity to present questions directly to the entire American Optometric Association Board of Trustees and hear the board’s stance on issues ranging from the future of private practice to the Affordable Care Act to the profession’s demographic shift.
AOA President Steven A. Loomis, OD, then president-elect, addressed a question on the future of private independent optometry from an attendee at the session, “A Conversation With the AOA Board.”
“It will look differently in 15 to 20 years,” Loomis told the audience. “Over 80% of MDs now don’t work independently; they work for a hospital system. Optometry has a long history of independent practice. What we will see in the future is more group practices.
“The cost of one doctor running a practice and seeing just a handful of patients a day is not sustainable with reimbursements the way they are,” he continued. “I think it’s important to always be a part of the larger system. It’s important for optometry to affiliate with Accountable Care Organizations and recognize their role as a primary eye care professional.”
Steven Loomis
Loomis said the number of ophthalmologists is decreasing. “It will be more critical for optometry to step in and take care of the needs of the population,” he said. “The difficulty is being sure we continue to integrate into the system.”
Trustee Robert C. Layman, OD, said AOA Excel provides tools to equip optometrists to remain independent if they so choose.
Another attendee pointed to the difficulty today’s new graduates encounter paying off their student debt.
Samuel D. Pierce, OD, current secretary-treasurer, also pointed to AOA Excel’s career center that matches students seeking opportunities with doctors needing associates.
“AOA Excel has a program that will assist new graduates in financing a practice purchase,” he said.
AOA Federal Relations Committee chair Roger Jordan, OD, added from the audience that pending federal legislation involving the National Health Service Corps will allow students to serve for a few years and have loans forgiven.
Newly elected vice president Christopher J. Quinn, OD, added: “It’s very important for everyone, the senior practitioner as well as the student, to recognize the investment they have made in their education and translate that to the value of services they provide. Be careful about accepting payment that is less than the value of your services. Low reimbursement is only a function of what you’re willing to take.
“Comprehensive eye exams are a good value to the health care system; we save money in the long run,” he added. “We have to get that message out to the payers.”
President-elect Andrea P. Thau, OD, said: “You can’t help patients if you go out of business. Some of my colleagues have dropped some of the lower paying plans and they say they’re working less and making more money now.”
“You have to be a good business person,” trustee William T. Reynolds, OD, said. “It will be different for every insurance and office.”
Loomis noted that AOA members, on average, have a higher income than non-AOA members – $37,000 a year for practice owners, he said.
Quinn said the AOA MORE (Measures and Outcomes Registry) “will be an important tool allowing you as a provider and us as a profession to demonstrate value to get reimbursement. In 2019 the new reimbursement system will be the Merit-Based Incentive Payment System (MBIPS), and PQRS and meaningful use will all be integrated into MBIPS.
“The system will allow payment bonuses of 9% to 12%,” he continued. “For every provider who’s getting a bonus, there will be a provider getting a penalty. The registry will allow us to collect PQRS and meaningful use data.”
Quinn said the development of the registry has been “an expensive undertaking but a tremendous benefit” that is included with AOA membership. Non-members pay $1,800 per year, and the AOA hopes “it will be a member recruitment tool – once they do the math,” he said.
Quinn added: “We have a stunning statistic; when there’s evidence to support a new technique or procedure or clinical care, it takes 17 years for providers to fully adopt and incorporate that technology or technique into their practice. I think the registry will accelerate that process.”
Committee member Jordan added from the audience that the registry will provide a large amount of evidence-based data to support its advocacy efforts.
Growing number of OD schools
Thau said many members have asked about the proliferation of optometry schools.
The Accreditation Council on Optometric Education (ACOE), which accredits all schools and colleges of optometry, issued new guidelines, effective this year, “which strengthen and slow down the whole accreditation process for a new school,” she said. “Twenty years went by where we had no new schools, and all of a sudden they cropped up, along with the realization that the existing standards were not sufficient for this day and age.”
Thau said all of the schools and colleges educate students for practicing in any state.
“Schools are very responsive to what’s happening in the different states,” she said. “Three states allow laser use, so all the schools are teaching that. We will make sure to work on the state and national level to be sure all ODs can practice to the fullest scope.”
In response to an audience question, Thau explained that the ACOE is an independent organization with three members from the AOA, one from the National Board of Examiners in Optometry and one from the Association of Regulatory Boards of Optometry.
Telemedicine
“Telemedicine is not all bad,” Reynolds said. “We want optometry to be a part of this. One of the biggest problems I see is a refraction being equated with a comprehensive exam.”
The AOA House of Delegates later passed a resolution stating that, “the optimal delivery of comprehensive eye health and vision care requires an in-person examination.”
Cultural changes in the profession
An audience member asked the how the AOA is addressing the lack of Asians and women among board members, to ensure the board adequately represents these groups that are growing in optometry.
“I entered the profession as being one of the few women,” Thau said. “We have been working very hard to try to cultivate leadership. There are cultural and generational differences that create challenges. I spoke to 10 Asians yesterday about running for the board. However, you have to start on the state level and move up to the national level from there. We do have some cultural shifts. There are no physical barriers. If you know someone who fits into a minority group that you don’t feel is represented, let us know how we can help.”
Trustee Barbara L. Horn, OD, noted that many of the state board members are made up of women.
“It’s a lot of work,” she said, “and we have young children at home.”
Cockrell said everyone on the current board has served as president on the state level.
“Right now we have 13 women who are presidents of their state association,” he said. “In another 15 or 20 years, this board will look very different and will probably be a majority of women. The demographics will catch up.”
Legislative developments
In the wake of the King vs. Burwell Supreme Court decision, there will be no changes to the Affordable Care Act, Cockrell said, but meaningful use implementation has continued to move forward.
Reynolds said, “This will probably be the last constitutional challenge to this law. But there are several things that need fixing, and we think this might open up more challenges. There are some anti-optometry forces – medicine, insurance – that want to take away the Harkin Amendment and the children’s essential vision benefit.”
Cockrell added that optometrists have received more than $300 million from electronic medical record (EMR) implementation.
“We will see significant penalties kick in this year,” he said. “Only 40% of us are doing EMRs. Penalties will amount to 10% if you don’t implement this.”
Cockrell also said that HIPAA security audits are ongoing, with which AOA Excel can offer assistance.
Headquarters renovation
The board discussed the major renovation planned for the AOA headquarters in St. Louis.
The building was built in 1968 and has had few updates, Loomis said. Members of a building committee evaluated several options: purchasing a new building, leasing a facility, remodeling the current building or leveling it and building a new one.
“We determined that the most cost effective and convenient option would be to remodel the current 45,000-square-foot facility,” he said.
The $10+ million renovation is scheduled to begin in August and be completed in December 2016.
Quinn said the association intends to borrow $8 million and raise $2.25 million through a capital campaign.
“We want industry partners to have an opportunity to participate in the campaign,” he said. “If not, we are in a financial position to fund the balance out of our budget.”– by Nancy Hemphill, ELS, FAAO
Disclosures: The AOA Board of Trustee members report no financial disclosures.