The Intangible Benefits of Membership: The most important benefits we may take for granted

Anthony S. Diecidue, O.D., M.S.
POA Past President

Of course, it’s the intangibles that made membership in the POA and AOA a must for me. My time on the POA Board of Directors and as President of the POA afforded me insight into our profession; insight that revealed a whole other side to our chosen profession, a side that is vulnerable to attacks from ophthalmology, opticianry and third-party payers.

Once I understood what it means to be a legislated profession – i.e., a profession that can be changed by the passing of a bill by people who know little about what we do and who can be influenced by others – I really saw the need for organizations like the POA and AOA. Without them advocating for us, we would likely have a profession that bears little resemblance to our current one, or worse, no profession at all. Our professional associations come to our defense every day, supporting our initiatives and our ability to practice in a way that best serves the public.

In addition to that, our POA provides us with many tangible things like group discounts, services and help when we need it. Many of the programs offered to POA members not only drive patients into our offices, but also educate the public about who we are and what we do. They open doors that would normally be closed to us as a profession.

The POA and AOA both provide world-class educational opportunities for us at discounted fees. They both negotiate with third-party payers to ensure we are not left out or paid any less than any other providers. In a nutshell, they fight for us at every level, enabling us to practice at our highest educational level. Without them, we would be relegated to simple refrationists with no hope of ever expanding our ability to serve the public.

All of this and much more is why I have been a member for over 25 years.

Dollars and Cents of POA Membership

By Donna Buraczewski, O.D.

POA Immediate Past President

Have you ever considered dropping your membership because of the amount of dues or heard colleagues say they cannot afford the price of membership? Then this post -- the first of several analyzing the benefits of membership and why all optometrists in Pennsylvania should be members -- is for you.

I have been a member of the POA for 30 years. I recently received a memento letter opener with the POA logo as a recognition award. If I was a “number person," I could tell you exactly how much that membership has “cost” me. But really, it's more important to know how much more the membership has earned me. 

Let’s start by looking at history. When I graduated in 1983, optometrists were not reimbursed for medical services by Medicare and most other third party payers. Thanks to the efforts of the POA and AOA, we are now reimbursed for those services.

So when I began my solo private practice in 1986, I was able to bill Medicare and be reimbursed for my services. But how many medical services could I provide since I was not allowed to prescribe therapeutic agents? In 1996, the POA passed legislation so Pennsylvania optometrists could not only detect eye diseases, but also treat them.  Again due to the efforts of my fellow members, these privileges were expanded in  2002.

Now how much did you bill in Medicare services last year? What percentage of your income was from the treatment of eye diseases, including glaucoma? Last week alone, I billed 39% of my gross revenue to medical third party payers. 

How many of you have received incentive payments from CMS for EHR implementation? Did you know that optometry was not initially included for reimbursement? The AOA stepped in and changed that, and optometrists have now received a substantial amount in payments. Depending how many Medicare services you provide, each optometrist had the opportunity to receive $44,000 in incentive payments. That more than covers my 30 years of dues.

Do you receive income from the Pennsylvania Medicaid system? Due to the efforts of the POA, optometrists and other providers in Pennsylvania are paid equally for the same services. Many optometrists also received reimbursements for past services.

How many children do you examine in your office? The AOA was instrumental in having pediatric eye care as an Essential Benefit of the Health Care Reform policy. Remember that when you examine a child in your office.

We sometimes forget that these privileges were not handed to us because some other policy maker thought it was a good idea. POA and AOA advocated on our behalf to be included in these elements of the health care system; individual doctors could not have achieved inclusion on our own. Furthermore, never forget that that these privileges could be removed at any time at the whim of another profession, payer or regulator. The only thing preventing a reversal is your AOA and POA.

Would the POA and AOA accomplish these successes even if I or you weren’t members? Maybe, but this type of constant vigilance and proactive advocacy require significant human resources, and a small pool of optometrists -- no matter how dedicated -- could not afford it on their own.

And imagine how much more we could accomplish if all optometrists in the state were members. Share this information with non-members and encourage them to become members today.

And THANK YOU for your membership.

ACA Resources for Optometrists

Need help navigating implementation of the ACA? Following are tools and resources to help Pennsylvania optometrists.

Guidance on employee health insurance marketplace notice requirements: federal government's FAQs or the Department of Labor's Technical Release 2013-02

* * *

Tools and resources on the Health Insurance Marketplace enrollment process and coverage options in Pennsylvania

* * *

Help for Pennsylvania small employers navigating the Health Insurance Marketplace

* * *

Information on the Small Business Health Options Program (SHOP) and tax credits


* * *

Access to Pennsylvania's Health Insurance Marketplace

* * *

Information on new opportunities for optometrists to participate in insurance plans and treat new patients

* * *

AOA Third Party Center resources and FAQs that explain the new marketplaces and assess participation in plans

October 1 Deadline ACA Health Insurance Marketplace Notices

Most businesses – including optometric practices – are required by the federal Affordable Care Act (ACA) to notify their employees about the new Health Insurance Marketplace by Oct. 1, 2013. Whether you have two employees or 100, if you are subject to the Fair Labor Standards Act (FLSA), you must provide this Health Insurance Marketplace Notice.

Employers must provide these Health Insurance Marketplace notices to all full-time and part-time employees, regardless of eligibility or enrollment in health care plans. Practices also must give the notices to all new hires within 14 days of employment beginning October 1.

Executive Director - National Search

The Pennsylvania Optometric Association (POA), a non-profit professional organization representing 1,200 doctors of optometry, is seeking an executive director.  POA advocates for and provides benefits to its member optometrists, and advances eye and vision care for the citizens of Pennsylvania. Candidates must have experience in membership development, finance, legislative, non-dues revenue and third party payer issues. The executive director works closely with the Board and manages staff, and must be comfortable working with a wide range of stakeholders, including members, legislators, third party payer representatives, allied health professionals and paraoptometric staff. Doctor of Optometry degree preferred but not necessary. Position available January 1, 2015. Submit curriculum vitae to attn: Ilene, Pennsylvania Optometric Association, 218 North Street, Harrisburg, PA 17101 by October 31, 2013.

Highlights from the 2013 AOA House of Delegates

By Marianne E. Boltz, O.D., F.A.A.O.

POA President-Elect

The 116^th Congress and AOA House of Delegates (HOD) were called to order on Thursday morning, June 27, at the San Diego Convention Center. As is tradition, the HOD begins with a bit of pomp and circumstance and standard procedures. Delegates were led by former AOA President Dr. Richard Hopping (current AOA President Dr. Ronald Hopping’s father) in a reading of the Optometric Oath. All state affiliate executive directors paraded into the ballroom, immediately followed by the presentation of the Virgil Deering Optometric Executive Director Award. The award was given this year to Bryan Markowitz from Georgia. (If you recall, our own Dr. Charles Stuckey had the honor of receiving this award a few years ago.)

2013 Optometry's Meeting: Proud to be a Pennsylvanian!

by Marianne Boltz, O.D., F.A.A.O.

POA President-Elect

There are some moments in life that you know, even as they are happening, will be memorable…moments that you will look back upon with pride and smile! Just such a moment of relief and joy occurred on Saturday, June 29 in the San Diego Convention Center at approximately 2:00 pm when my long-time friend and former fellow POA Board colleague, Dr. Greg Caldwell, was elected to the AOA Board of Trustees.

Although Dr. Caldwell’s election to an AOA Trustee position was the most significant event for the Pennsylvania delegation, it was just one of several moments and events throughout Optometry’s Meeting that would make any optometrist “proud to be a Pennsylvanian”!

Compliance Date for New HIPAA Rules is September 23

New rules for the updated Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule are effective September 23, 2013. The federal rule applies to health care providers, health plans and other covered entities and their business associates. 

New Rule
The revisions, announced in March 2013 and effective September 23, require the following steps:

• Conduct a security risk assessment;
• Revise their existing privacy, security and breach notification policies and procedures;
• Make copies of those revised privacy policies available to patients;
• Amend business associate agreements to reflect the new regulations; and
• Retrain practice staff on the revised policies

The new rule prohibits the sale of federally protected patient health information (PHI), and prohibits the use of PHI for marketing purposes without authorization from the patient. In addition, a patient may request a practice to withhold disclosure of PHI related to a particular service to a health plan if the patient has paid for the service out-of-pocket.

Federal law requires practitioners to provide all patients with notices of the measures taken to protect patient information. Failure to provide the required HIPAA notices or meet standards may result in investigations and possible civil or criminal penalties.

PA Senate votes to expand Medicare; Bill's future in House uncertain

In a 40-10 vote, the AP (7/1, Levy) reports, “The Pennsylvania state Senate approved legislation to require Gov. Tom Corbett to seek federal approval for an expansion of Medicaid eligibility to hundreds of thousands of Pennsylvanians, although it faces death in the more conservative House of Representatives where Republican leaders have vowed not to bring it to a floor vote.” The AP adds, “All 23 Democrats voted for it, as did 17 of 27 Republican senators,” including Senate President Pro Tempore Joe Scarnati (R-Jefferson) and Senate Majority Leader Dominic Pileggi (R-Delaware). The AP notes, “Corbett has been silent on the bill, although Senate Republican and Democratic leaders say they negotiated the amendment with Corbett’s office, and wrote certain conditions into it to make it more amenable to him, as well as Republican lawmakers who might otherwise oppose the health care law.”

PCMHs and ACOs are Forming in Pennsylvania

March 27, 2013. Drs. Paul Lobby (left) and Greg Caldwell (right), from POA’s Third Party Center, meet with Dr. Paul Kaplan, Vice President of Strategy and Integration of PCMH and ACO, Highmark Blue Cross Blue Shield.

~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~

I share this photo with our members for many reasons. As a past president of the Pennsylvania Optometric Association, I wanted to point out an advocacy meeting for optometry that occurred while most of our members were seeing patients on March 27, 2013. Drs. Paul Lobby (left) and Greg Caldwell (right), volunteers for POA’s Third Party Center, met Dr. Paul Kaplan (middle), the vice president of strategy and integration of PCMH and ACO for Highmark Blue Cross Blue Shield.

Window Tinting Requirements

In Pennsylvania, the level of sun screening (window tinting) acceptable under current regulations is a minimum of 70% light transmittance. This means that 70% of light contacting the window must pass through the window. The current regulations, adopted by PennDOT in 1996, also eliminate the requirement that sun screening be checked at the time of inspection; however vehicle owners who have sun screening materials that exceed the light transmittance requirements may be stopped and cited while operating the vehicle on the highway.

Prescription Requirements in Pennsylvania

Each state has its own requirements for spectacle, contact lens and pharmaceutical prescriptions. In Pennsylvania, prescription requirements are contained in several sections of the Pennsylvania Code. In addition, there are federal regulations for contact lens prescriptions and separate requirements for tamper-resistant pads for prescriptions written for Medicaid recipients. While some requirements are common among the three types of prescriptions optometrists write, others are specific.

Optometry Heeded in Washington, D.C. and State Capitals: Full Eye Health Coverage for Children to be Nationwide Priority in 2014

A recent state-by-state analysis of health plans to be offered under the 2010 health care law indicates that nearly all states will feature a pediatric vision care benefit that is based on an annual comprehensive eye exam provided by an eye doctor and is embedded with other benefits as part of the overall health insurance plan.