What ECPs Are Asking About Health Care Reform


NEW YORK—After all the turmoil surrounding this year’s passage of health care reform legislation—and all the confusion about what happens between now and the 2014 implementation of many of the legislation’s provisions—eyecare providers are wondering about their position in this new health care landscape.

And many are asking the managed-vision companies with which they deal for some direction.

“Providers are justifiably concerned about the impact health care reform will have on their practices,” Carl Moroff, OD, chief vision officer of eyeQuest, told VM. “We hear that they recognize the need to provide coverage for the uninsured, and especially to provide early preventative care for children. Yet at the same time, they are concerned about the erosion of reimbursements to defray the cost of expanded coverage. Perhaps the most concerning part is the unknown as the political process continues.”

Gary Brooks, president of VSP Vision Care, said he’s heard two “burning questions” about health care reform from providers: what will be the eyecare benefit under reform—“which is not defined yet, so it could be anything from a vision screening to a comprehensive eye exam”—and how vision care will work under the yet-to-be-created health-care exchanges. As currently structured, those exchanges will require that any plan provide a full spectrum of health care, which would limit stand-alone vision plans’ ability to offer their services. “We feel that’s bad for our doctors and patients,” Brooks said. “It wouldn’t be good to decrease utilization of vision benefits.”

On the other hand, Erich Sternberg, president of AlwaysCare Benefits, said providers could see more utilization of benefits due to health care reform, since more consumers are likely to have vision coverage. However, he agreed, “We hear concern about the impact reform may have on stand-alone vision plans, which contribute significantly to the revenue in many practices.”

And Steve Holden, president of Davis
Vision, commented, “I think after health care reform the pie is going to be bigger, because some people will have coverage that didn’t before…and I’d like to think that vision care will be in there.”

A key question from providers, according to Jeff Spahr, staff vice president-vision and voluntary services, for WellPoint Vision, is, “‘Will health care reform allow greater access to medical members and the opportunity to provide expanded medical eyecare services?’” In response to those questions, Spahr said, “We continue to review and monitor the various components of healthcare reform which take effect between now, 2014 and beyond. There are many aspects yet to be defined, including the requirements for ‘essential health benefits’ within certain health care policies.”

Andy Alcorn, president and CEO of Block Vision, said his company has not received a lot of questions about health care reform from its providers. He told VM, “Our conversations with our participating providers have revealed that providers are following the topic closely, but they are reserving their reactions, as there are still many uncertainties surrounding the detail of health care reform.”

Most questions Block Vision has received, he noted, are from ECPs who participate in Medicare Advantage programs. Said Alcorn, “Such providers have expressed anxiety and confusion regarding the effect changes in compensation from CMS to Medicare Advantage health plans will have on their compensation for services rendered to members enrolled through such programs, especially in light of ongoing uncertainty about how providers will be compensated directly from CMS for treating Medicare patients not enrolled through Medicare Advantage plans (the ‘physician fix’ situation).”

And Rick Corbett, president and chief executive officer of Superior Vision, noted, “Providers are asking about reimbursement rates and the impact on the delivery of overall employee benefits to our members. Superior Vision is indicating that in our view the delivery of vision benefits will not change dramatically in the near term, and that there will be continuing price pressure on benefits offered.”