Power Hour Optometry: AOA Leaders Take on Vision Benefit Managers

Podcast Title: Power Hour Optometry
Host/Author: The Power Practice
Episode: AOA Leaders Take on Vision Benefit Managers: Legislation, Advocacy, and the Future of Eye Care
Release Date: August 13, 2025

Introduction

In this insightful episode of Power Hour Optometry, host Eugene Shotsman engages with prominent leaders from the American Optometric Association (AOA) to delve into the pressing issues surrounding Vision Benefit Managers (VBMs). The discussion centers on legislation, advocacy efforts, and the future landscape of eye care, providing valuable perspectives for optometrists navigating the complexities of VBM interactions.

Panel Introduction

Eugene Shotsman welcomes an esteemed panel of AOA leaders:

• Dr. Jackie Bowen – AOA President
• Dr. John Peterson – AOA Trustee
• Dr. Tommy Lucas – Director of Advocacy at the Texas Optometric Association

Shotsman sets the stage by highlighting the universal frustration among practice owners regarding vision plans and VBMs, emphasizing the episode's focus on legislative changes and advocacy strategies.

AOA's Current Focus and Concerns

Dr. Jackie Bowen (03:28) provides an overview of the AOA's recent activities and primary concerns:

• Vision Benefit Manager (VBM) Reform:
  "Chief among those priorities is the Vision Benefit Manager reform that we've been working on significantly in the last several years."
  She underscores the impact of VBMs on reimbursement rates and the integrity of the doctor-patient relationship.

• Doctor-Patient Relationship:
  The AOA is committed to preserving this relationship, especially in legislative discussions, ensuring that optometrists maintain oversight of contact lens fittings and other services.

• Reimbursement and VA Concerns:
  Addressing annual reimbursement cuts and advocating for fair compensation for VA optometrists remain top priorities.

Vision Benefit Managers (VBMs) and the Need for Reform

Dr. John Peterson (06:30) elaborates on his role and the necessity for VBM reform:

• Scope of Influence:
  "There are between 20 and 30 states that have some sort of VBM laws on the books."

• Challenges with VBMs:
  VBMs often bypass existing laws, exploiting loopholes to exert undue control over pricing, supply chains, and patient referrals.

• Objective of Reform:
  Establishing a level playing field to restore the preferred doctor-patient relationship and ensure fair practices within the industry.

Legislative Efforts: Texas HB 3211 and Other States

Dr. Tommy Lucas (08:58) discusses the landmark Texas House Bill 3211:

• "Any Willing Provider" Concept:
  "House Bill 3211... allows any doctor who meets the credentialing criteria of the plan and who is willing to sign the contractual terms to become an in-network doctor for that plan."

• Unanimous Passage:
  The bill's unanimous approval highlights strong legislative support: "this passed unanimously in Texas, meaning that every single legislator voted for it."

• Impact on Discrimination:
  The bill eliminates discriminatory practices by VBMs, ensuring that all optometrists can join networks regardless of their practice setting.

Expansion to Other States:
Following Texas's lead, states like Oklahoma, Arkansas, Illinois, and Nevada have enacted similar legislation to curb VBM abuses.

Challenges and Counterarguments from VBMs

Dr. Tommy Lucas (11:15) addresses the VBMs' primary argument against reform:

• Premium Costs:
  VBMs claim that reforms would increase premium costs.
  "But we debunked that successfully... premiums for vision care have gone down historically every single year."

• Actual Impact of VBMs:
  VBMs manipulate plan designs to disadvantage practitioners, not consumers, contrary to their claims about premium increases.

Dr. Jackie Bowen (19:35) counters the marketing argument:

• Marketing vs. Cost:
  "Vision benefit plans should be thought of as marketing opportunities," but emphasizes the need for practitioners to understand and manage the financial implications.

• Contract Awareness:
  Encourages optometrists to thoroughly review VBM contracts to avoid unintended financial burdens:
  "It's hard to commit to reading those contracts as they change and just a lack of awareness of how much each patient encounter is costing relative to what we're being paid."

National Efforts and Future Legislation

The panel discusses ongoing federal initiatives and the necessity for national-level reforms:

• Laboratory Choice and Non-Covered Services:
  Ensuring optometrists can choose laboratories that best serve their patients and protecting them from VBMs dictating prices for non-covered services.

• Doc Access Bill:
  A comprehensive bill that includes lab choice, limits on contract lengths, and non-covered service protections, aimed at enhancing practitioner autonomy and patient care.

Dr. John Peterson (37:14) highlights the importance of federal involvement:
"Because you can't fix this just at the state because of ERISA plans, you're going to have to fix this at a national level too."

Scope Expansion and Modernization

Dr. Jackie Bowen (44:03) introduces the concept of "contemporary optometry," focusing on scope expansion:

• Scope Modernization:
  "We want every optometrist to be able to practice at the top level of their expertise and training as they want to in every state."

• State Successes:
  Achievements in West Virginia and Montana, allowing optometrists to perform minor surgeries and use lasers for specific procedures.

• OD to OD Referrals:
  Promoting referrals between optometrists to utilize specialized skills within the profession, enhancing patient care.

Advocacy and Member Involvement

The panel emphasizes the critical role members play in advocacy:

• Grassroots Efforts:
  "Optometry wins through grassroots." Members are encouraged to engage with state associations, meet legislators, and participate in advocacy initiatives.

• AOA on Capitol Hill Events:
  Opportunities for members to network and influence policy directly, ensuring that optometrists have a strong voice in legislative discussions.

• Support Resources:
  Utilization of AOA resources like AOA First Look emails and platforms such as stopplansomersoa.org to report and address VBM abuses.

Dr. Jackie Bowen (52:11) advises optometrists on actionable steps:

• Share Personal Stories:
  Personal experiences with VBMs can be powerful tools in advocacy.

• Volunteer Opportunities:
  Even with busy practices, dedicating time to advocacy can yield significant rewards for the profession.

Conclusion

The episode concludes with heartfelt thanks to the panelists and a reiteration of the AOA's commitment to combating VBM abuses and enhancing the scope of optometric practice. Listeners are encouraged to engage with the AOA, utilize available resources, and participate in advocacy efforts to shape the future of eye care.

Notable Quotes with Timestamps

• Dr. Jackie Bowen (03:28):
  "Chief among those priorities is the Vision Benefit Manager reform that we've been working on significantly in the last several years."

• Dr. John Peterson (06:30):
  "VBM benefits are intentionally incredibly confusing. They are burdensome to the practitioner, they are not clearly understood by the consumer being the patient."

• Dr. Tommy Lucas (08:58):
  "House Bill 3211... allows any doctor who meets the credentialing criteria of the plan and who is willing to sign the contractual terms to become an in-network doctor for that plan."

• Dr. Jackie Bowen (19:35):
  "It's hard to commit to reading those contracts as they change and just a lack of awareness of how much each patient encounter is costing relative to what we're being paid."

• Dr. Tommy Lucas (21:22):
  "We look at ourselves and like, geez, okay, we see, you know, the value that these companies are placing on us and it's not very much."

• Dr. Jackie Bowen (22:44):
  "Vision benefit plans should be thought of as marketing opportunities."

• Dr. Tommy Lucas (26:29):
  "Over 200 million Americans are covered by a VBM now. That's about almost 2/3 of the country has a VBM."

• Dr. Jackie Bowen (27:07):
  "We have more of an ear by the lawmakers and their staffers. So we have a lot of punching power when we're on the Hill."

This comprehensive summary encapsulates the key discussions and insights shared by AOA leaders on the intricate issues surrounding Vision Benefit Managers, legislative reforms, and the proactive steps being taken to secure the future of optometric practice.