Is there nothing to fear about for the future of Optometry? Is this need to organize just hype? Doesn’t the AOA and the NYSOA take care of all the political and legal issues that might affect the future or my practice?
Not infrequently, I hear doctors tell me that they have little or no concern or “fears” about optometry’s future participation in medical eye care. They say that they are competitive and they know that if others will succeed, they will even do better. They say they are not afraid of ObamaCare or the changes it will bring. But, I suggest that you listen to Yoda’s advice about fear and know that, if you are on your own and not afraid, “you will be!” I frequently ask these same doctors if they can tell me what ACOs are or what PCMHs are? They do not offer an explanation. It amazes me that these very bright and successful doctors have no clue about the future. On the other hand, if I ask a NYSOA Society President about these issues, they are indeed informed.
As the president of the NYIPA, I have been fortunate enough to talk to lots of influential people who believe they know the path to follow for our future success. Be forewarned it is not the path you have taken before. Health Care Reform is not about just lowering fees that you may think you can compete with the best on, it is about reforming or restructuring the very institutions that compose the system. Understand that this includes your office. If you are a member of Aetna, BCBS, Oxford, or United Health Care, this will NOT guaranty you participation in the future! Why? Because all around you accountable care organizations (ACOS) and Patient Centered Medical Homes (PCMHS) are forming and they control who had access to the patients that Aenta, BCBS, etc have acquired. Many of these are Hospital based. Are you hospital based? If the answer is “No” then you are on the outside. This is one major reason we formed the NYIPA. You’ve heard of the “Fiscal Cliff”, well there is an Optometric Precipice and it is just around the corner.
This precipice is where your practice falls off the charts of available medical clients and you are left with nothing but low paying vision plans. Previously, to access patients, we have been concerned about being participating providers for various health plans. As the healthcare landscape has been morphing into unknown frontiers, we wanted to be included in the Healthcare Exchanges, where individuals and businesses can buy health insurance. We we are on our own, we are in the wrong place. Without an IPA in any U.S. state we are definitely in the wrong place!
Is and ACO different from an HMO that locked ODs out of healthcare in the 90’s? Here an informed opinion according to Richard Amerling, MD, associate director of clinical medicine at Albert Einstein College of Medicine in New York City, director of outpatient dialysis at Beth Israel Medical Center, and a director of the Association of American Physicians and Surgeons:
Accountable care organizations (ACO) aim to completely revamp how healthcare is delivered in the United States, promising better quality and lower costs. But physicians who have heard these promises before are wondering if ACOs are just the new version of HMOs, the same lofty concept dressed up in a new way.
ACOs are the just the latest fad, according to Richard Amerling, MD, associate director of clinical medicine at Albert Einstein College of Medicine in New York City, director of outpatient dialysis at Beth Israel Medical Center, and a director of the Association of American Physicians and Surgeons.
HMOs also were touted as the revolutionary way to save healthcare in America, Amerling says. In that model, the physician served as a gatekeeper for the insurance companies to control access to high-level care, tests, and hospitalizations. Under a capitation arrangement, the physician was paid a set amount per patient to coordinate care, which Amerling says provided a strong incentive to restrict patient access to care.
In addition, capitation provided a bonus to the physician if total spending on patients was kept below a certain amount. The plan worked well if the physician’s patients were overwhelmingly healthy, which encouraged cherry picking of the most profitable patients. But eventually the very sick had to receive care, and that threw the whole system off, Amerling says.
The differences between the HMO and ACO models are purely cosmetic, he says. ACOs also will have strong incentives to cherry-pick the healthiest patients and limit access to expensive medical care, and eventually that strategy will fall apart just as it did with HMOs, he says.
“It is fundamentally not very different from the HMO model,” Amerling says. “There are a few bells and whistles, but otherwise it’s the same old incentive to do as little as possible and find the healthiest patients you can.” (read the whole article here)
One thing to remember about HMOs, they locked ODs out by their gatekeeper power. ACOs and PCMHs are no different. Though we need the NYSOA and the AOA to be politically active (where we cannot be) to keep pushing on the doors of equal access, be assured that this has not come about for ACOs and PCMHS as they are NOT insurance companies! This is why you need to be a member of the NYIPA and a full supporting member at that! The NYIPA intends to support all efforts of the NYSOA to open doors but we are certain for now, that the only empowerment at this point in time is through forming a large influential network of Optometrists with the financial power of membership and the clout of market control by size. Don’t miss this opportunity to join now! If you sit on the side lines you may end up off the team!
Join us and a growing network of over 5,000 doctors across the USA that are empowered by Vision Care Direct to help you prosper!
Dr Joe Ross, NYIPA President.