What Does the Affordable Care Act Mean for Your Practice? 'Nothing Yet,' Say Leading Regional Optical Groups

 

One of the most controversial health care laws to pass in recent history, the Patient Protection and Affordable Care Act (also known as the ACA), continues to generate disagreement among health care providers and patients. With pediatric vision care being one of the ten essential health benefits that became effective Jan. 1, 2014, the ACA requires that all covered children through age 18 receive regular comprehensive eye exams, including follow-up care and treatment.

However, surveys by The Vision Council and the American Optometric Association, as well as comments from some regional optical leaders, indicate that there has not been a corresponding increase in pediatric vision patients.

The Vision Council's VisionWatch Economic Situation Study, found that by May 2014, "recent developments with the ACA have not had too much of an immediate impact on the optical industry. However, the long-term prognosis on the impact of the ACA on the eyewear industry is still in doubt."

The American Optometric Association's ninth annual American Eye-Q Survey, conducted online in conjunction with Penn, Schoen & Berland Associates, March 20-25, 2014, with 1,000 Americans 18 years and older, found that "the majority of parents (66 percent) are unaware that children now have access to yearly comprehensive eye exams thanks to the Pediatric Essential Benefit in the Affordable Care Act." (see chart below)

Pediatric Vision Care Essential Health Benefit Awareness

Are you aware the Affordable Care Act (ACA) now defines a comprehensive eye exam as an essential benefit, meaning your insurance must cover this expense, including glasses, for your child(ren)? (Asked only of those with children under 18 living at home.)

Source: American Optometric Association's ninth annual American Eye-Q Survey

To see what effect the ACA is having on regional, multiple-location optical groups, dba asked the following optical leaders throughout the country, What impact has the ACA had on your practice?

David Brown, ABOC, NCLE, optical director, Houston Eye Associates, Houston

Up to this point the ACA has only been able to generate anxiety in the optical arena. There has been little to no effective impact to date. However, once fully implemented, the ACA will result in more covered lives rotating through our practices. The biggest opportunity in optical will come from pediatric vision care, especially for MD/OD practices that operate using an integrated vision care model. This will require many of us to reevaluate how our business model should apply to pediatrics. Another major obstacle will be educating employees on the various state and federal regulations that will come along with these newly covered lives. There are plenty of challenges ahead, but there are also new opportunities as well. If parents entrust your practice to care for their children's visual needs, than it's fair to expect that you stand to gain their business too.

Robert Evangelista, president, Co-Op Optical, Detroit

We have not seen a significant increase in young patients. We expected to, however, it has not materialized. We did see a marginal increase in Medicaid traffic at the beginning of each of the last two years. However, that increase was almost entirely on the adult side. We are a regular Medicaid provider, and our percent of Medicaid patients has been consistent throughout the year.

David H. Hettler, OD, Diplomate, American Board of Optometry, Drs. May & Hettler, Alexandria, Va.

The ACA has not changed the demographics of our patient population. It seems as though parents still only bring kids with symptoms to our practice. All vision organizations need to do a better job of spreading the word about the importance of children's eye exams. The other effect on our group is that our costs for employee insurance rose 30 percent when our health insurance changed to comply with the ACA. This has been a noticeable hit to our bottom line. There is a line item for children's benefits even if the employee has no children. All of these extra costs have not covered a higher level of care.

Robert Rich, CEO, Spex Optical, Chicago

Overall we have felt very little impact. In Illinois, all kids entering kindergarten have been required to have eye exams for many years now, so that aspect has been nothing for us.

Con Ward, chief operations officer, Eyecarecenter OD PA, Rocky Mount, N.C.

Now that we're near the end of the first year of full implementation of ACA, what is your opinion of its effects? In looking back over the first year of full implementation of the ACA, my evaluation is that we have seen a small increase in patients as a result of referrals from primary care providers, primarily diabetic patients. At the Eyecarecenter we take the position to ensure our doctors have the resources and equipment to manage these and other eye-related medical conditions. This allows our doctors to more actively maintain strong clinical relationships with the primary care providers in their communities. In some cases these new patients to our practice are newly insured possibly as a result of the ACA being referred as a result of a recent visit to their new primary care provider or as a result of their first annual physical exam.

Has there been an increase in the number of young patients you've seen, and has this also increased the number of their relatives coming in for care? We have not seen any significant increase in the number of younger patients at our practices, nor have we seen any significant increase in optical business from our younger patient base resulting from the ACA.

Overall, what have been the effects on your business as a result of the ACA? There has not been any major challenges that I recall in regards to adhering to the new laws created directly as a result of the ACA. Our greater challenges have been around Meaningful Use requirements in implementing the various reporting, documenting, and procedural requirements. We have been able to effectively overcome these challenges in part thanks to our great doctors and staff who choose to understand and embrace these requirements and use them to enhance our patients' overall care and continue to expand the medical model of optometry in our practices.