Advocates build support for priority legislation, urge federal crackdown on unscrupulous contact lens resellers

Ohio Optometric Association members and students pose on the steps of the Cannon House Office Building on Capitol Hill.

Advocates took a united message directly to Capitol Hill and federal agency officials this week—that AOA doctors and students will do whatever it takes to better safeguard patient health and ensure that millions more Americans have expanded access to the doctor of optometry-provided comprehensive eye and vision health care services that they need.

More than 600 AOA-member doctors and students convened in Washington, D.C., April 17-19, as part of the 2016 AOA Congressional Advocacy Conference to focus the national spotlight on the needs of patients and advocate for the profession's top priorities, including better safeguarding contact lens wearers against increasing abuses of online resellers, confronting anti-patient, anti-doctor vision and health plan mandates, and ensuring that more Americans—including our nation's veterans—have access to the primary eye and vision health care services that doctors of optometry provide.

Cracking down on unscrupulous contact lens sellers

AOA engaged multiple stakeholders directly in a special health policy listening session, sponsored by Alcon and Johnson & Johnson Vision Care, focused on voicing concerns for contact lens patients, both in their wear and care of such medical devices, as well as the unscrupulous manner in which some online contact lens sellers conduct business.

On the heels of  crucial AOA-backed legislation introduced only a week earlier by Sen. Bill Cassidy. M.D., (R-Louisiana)— S. 2777, the Contact Lens Consumer Health Protection Act of 2016—the "Patient Vision Care Safety: A Discussion on How to Best Protect Contact Lens Patients" forum spoke to the federal efforts to curb illegal sales and poor contact lens hygiene practices, while also stressing the importance of maintaining appropriate doctor oversight in prescribing contact lenses.

Rep. Derek Kilmer (D-WA), who in 2015 led more than three dozen U.S. House members in urging the U.S. Federal Trade Commission (FTC) to do more to safeguard the public from unscrupulous Internet contact lens sellers, opened the session with a call for more coordinated and effective Federal enforcement efforts. Sally Greenberg, executive director of the National Consumer League, discussed the importance of annual comprehensive eye exams and dangers connected to illegal contact lens sales. 

Stakeholders participating in the listening session included:

• AOA.
• Rep. Derek Kilmer (D-WA).
• U.S. Food and Drug Administration.
• U.S. Federal Trade Commission.
• U.S. Centers for Disease Control and Prevention.
• National Consumers League.
• Johnson & Johnson Vision Care, Inc.
• Alcon.

Contact lenses are FDA-regulated, Class II and Class III, medical devices that are safe when worn properly, but can easily lead to complications when abused. Doctors understand the benefits and risks of wearing contact lenses, and too many have had to treat patients with injuries resulting from improper use, AOA Past President David A. Cockrell, O.D., told participants.

Dr. Cockrell asked all doctors in the audience to stand. He then asked all of those who had never seen an adverse patient event stemming from a contact lens to sit. Not a single doctor took a seat.

"Maybe it's the teenager who purchased a decorative contact lens at the local gas station on spring break, or the patient who hasn't received needed medical care, suffering from neovascularization because they're wearing a lens with the same prescription over and over from an online retailer that keeps filling that expired prescription. These are incidents that are painful for patients, upsetting for doctors and the frustrating part is most of the time they could've been prevented," AOA President Steven A. Loomis, O.D., said.

"When a bottom line-driven retailer attempts to disrupt the doctor-patient relationship and downplay the importance of the eye examination, we know that patients fail to get the information they need, and they fail to develop a relationship with a doctor to serve them well," Dr. Loomis said.

Representatives from the FDA and CDC stressed their multimedia campaigns to fight poor contact lens hygiene and illegal sales, while the FTC noted their recent efforts to enforce the Fairness to Contact Lens Consumers Act (FCLCA) and Contact Lens Rule. Industry reinforced the importance of the doctor-patient relationship and preventing contact lens deregulation, while the National Consumers League bolstered their support for strict enforcement of the FCLCA.

"We face many challenges in front of us, but we strive to provide our citizens with optimal vision and eye comfort," said Jeff Walline, O.D., Ph.D., AOA Contact Lens and Cornea Section chair. "We ask that you help us by joining the fight."

Look for more about the health policy listening session in the July/August edition of  AOA Focus.

Conference highlights

Additionally, optometry's advocates worked to build support for AOA-priority bills on Capitol Hill. Among these included the national push to restrict anti-patient, anti-competitive health and vision plan abuses, strengthened by a new study.

The  AOA/American Dental Association (ADA)-backed, bipartisan bill,  H.R. 3323, the Dental and Optometric Care Access Act, would outlaw detrimental policies by ERISA and other federally regulated health and vision plans, including restrictions on medical plan participation, limits on doctors' lab choice, and mandates on non-covered services (NCS) and materials.

In a news conference on Capitol Hill, Avalon Health Economics—with the AOA and ADA—presented the findings of a new study looking at the impact of NCS provisions of vision and dental plans, or the absence of such provisions, on patients' true costs in North Carolina and Texas, states which recently enacted laws prohibiting plans from forcing providers to adhere to NCS mandates. The study authors describe the concentrated nature of the vision plan market and note their findings that while a monopsony—an economic term for a single or concentrated buyer interfacing with many sellers—is usually desirable for a consumer if providers were "overcharging;" in this instance, the plans' monopsony-like behavior is only benefiting plans themselves.

"NCS mandates have another effect—they lead to higher overall costs for these consumers and, did especially, for all other consumers in the market as doctors were forced to compensate for the 'transfer' of operating margins to the plans," the study brief from Avalon states.

Two additional bills were addressed at the conference, including:

• H.R. 1312/S. 898 reinstating doctors of optometry into the National Health Service Corps (NHSC). This bill would make eye health and vision care a priority in underserved communities by making doctors of optometry once again eligible for NHSC scholarship and loan repayment programs. Terri Gossard, O.D., AOA Community Health Center (CHC) Committee member, says roughly 140 full-time equivalent doctors of optometry work in CHCs nationwide, yet 1 in 5 people live in a primary care shortage area. Support continues to build for this legislation with nearly 120 co-sponsors in the House and 15 in the Senate, the highest level of co-sponsors in the U.S. Senate yet for this legislation.
  
  
• H.R. 1688 adding new U.S. Department of Veterans Affairs residency slots for doctors of optometry. Matthew Maki, O.D., AOA Federal Relations Committee (FRC) member, says the bill would carve out 20 optometry-specific residency positions of the 1,500 spots already allocated to the VA. Eye care is one of the most sought-after services in the VA with many veterans of the Iraq and Afghanistan conflicts returning with eye injuries or vision problems.

Even if you weren't able to attend the congressional conference, there's still time to capitalize on your colleagues' momentum. Visit the  AOA's Online Legislative Action Center to read more or take action on H.R. 3323, H.R. 1312/S. 898, and H.R. 1688. Doctors can select any of the legislation and send an electronic letter to their legislators, urging support on the bill.

"We are now advancing legislation," Dr. Loomis told attendees. "We are on the offensive now, instead of the defensive."

Attendees enjoyed a special political luncheon—thanks to Hoya Vision Care—with former White House Senior Advisor Karl Rove. The current Fox News contributor spoke about the current political landscape with an emphasis on the uniqueness of this presidential campaign cycle.

Recognizing optometry's champions

Annually, the AOA Advocacy Group honors legislators and government officials who advance efforts related to eye and vision care with AOA Health Care Leadership Awards. Some of these awards were presented Tuesday during the Breakfast with Optometry's Champions. This year's awardees included:

• Senator James Lankford (R-Oklahoma).
• Senator Claire McCaskill (D-Missouri) (presented in absentia).
• Congressman Buddy Carter (R-Georgia).

Representatives spoke to the importance of citizen activism in the political process and several spoke to their own personal stories of how doctors of optometry made a difference in their lives.

AOA members were also recognized for their exceeding commitment and service to advancing the profession of optometry: Jerald Combs, O.D., AOA Advocacy Group Executive Committee chair, and Dr. Cockrell received the AOA President's Award.