Prospectus Spring 2016

Prospectus

MEMBERSHIP NEWS & UPDATES

VOL. 42 | ISSUE 1 | 2016

A Year in Review Michele Lagana, OD, NYSOA President

As my presidency rapidly comes to an end I’ve been reflecting on the work that the NYSOA has accomplished during the year as well as what the future holds for Optometry.

When I started my tenure I hoped to strengthen NYSOA’s relationship with the three local optometry schools, believing if we engaged students throughout their careers, becoming (and staying) a member of organized Optometry would be a logical step upon graduation. Aided by the strong leadership of Michael Wallerich (president of NYSOA’s student society), we continue to have a fruitful relationship with the students at SUNY and were able to participate in events such as the Vision Expo East student education program, the 3rd annual Networking with Doctors event, lunch symposia, membership and transition meetings, and a LinkedIn workshop. NYSOA will also host a cocktail hour at SUNY in May, with the help of residency director, Dr. Diane Adamczyk, to reach out to Optometry residents prior to their graduation.

After years of limited interaction with PCO/Salus, we look forward to gaining momentum from recent changes. The students were so inspired by Dr. Tom Landry and Dr. Anu Yennamandra’s visit that they decided to take action.

First-year student Melissa Chen recently re-established a student NYSOA club at PCO/Salus. Through hard work and initiative they have elected officers and are coordinating a group of students to attend Vision Expo East later this month, where they will join their colleagues from SUNY and NECO, and attend the NYSOA House of Delegates. For the future we hope to expand our engagement of PCO/Salus and NECO students while continuing our strong association with SUNY students.

Improving communication with members and sharing timely information about new technology affecting optometry are important ongoing initiatives.

Under the direction of Dr. Ken Sorkin and his tech-savvy Technology & Communication Committee, we now have a closed NYSOA Facebook group for members only. The executive board is also more actively using the NYSOA listserve to disseminate information to members on critical issues, such as mandatory e-prescribing deadlines, and to answer questions/ concerns quickly. The group is looking into the use of Twitter and texting as additional communication methods for our membership. In the future, look for literature overviews from the Tech/Comm Committee on topics which

are relevant to all of us: cyber protection, digitally marketing your practice, contact lenses for myopia control/drug delivery/medical monitoring, and smartphone apps for ECPs, as examples.

Dr. Dawn Chivers, John Faso and our Manatt team made tremendous progress this year on the orals bill, finally bringing ophthalmology to the negotiating table for the first time. We remain cautiously optimistic about the outcome. Our legal/legislative team has also worked on holding the Unilateral Pricing Policy bill from advancing in the Assembly. They constructed and submitted the Omnibus bill, S.5862 (LaValle)/A.8153 (Peoples-Stokes), which allows ODs to join with ophthalmologists and other physicians in forming LLCs, LLPs, and professional service corporations, and the Rosenthal bill, A.8637, which requires a licensed optometrist or physician who issues a prescription for corrective lens or non-corrective contact lens to personally examine the person to whom such prescription is issued. They secured final approval from the State Education Department and the Department of Health on CLIA-waived clinical lab tests and the use of amniotic tissue membrane (Prokera). Finally, they have ensured that Optometrists can order laboratory tests (non-radiologic) and receive those test results. Future work focuses on legislation that would allow direct credentialing by insurance companies, and legislation that would reverse the use of non-covered services in vision care contracts.

Continued On Page 2

| Inside | NYSOA OFFICER CANDIDATES 2016..........................2 COUNSEL’S CORNER...................................................4 TO THOSE THAT HAVE GONE BEFORE US..................8 2016 AWARD WINNERS............................................10 ADAMCZYZK RECOGNIZED BY APHA AND AOA �����10 NYSOA BUSINESS PARTNERS..................................14

P ROS P ECTUS | V OL 42 | ISSUE 1 | 2016 Continued From Page 1 The Children’s Vision Coalition team, headed by Dr. Denise Whittam, attended statewide conferences providing information to school nurses and the PTA about the importance of complete eye exams for children. A slide show about children’s vision was also developed and shared with society presidents for members who want to educate the community about children’s vision.

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is due to the tireless work of Dr. Mitch Horowitz and Dr. Aleksandra Wianecka, who continue to set ambitious goals for future revenue.

In addition to working on the business partner program Dr. Wianecka is the current chairperson of the Young OD Committee. Made up of recent graduates from across the state, and SUNY student NYSOA president, Michael Wallerich, the group is working on connecting with recent non-member graduates. Two Young OD networking events have been planned and will take place in May in NYC. Hopefully, similar events throughout the state will be organized in the future.

Third party consultant, Dr. Richard Soden, provided sage advice throughout the year on ICD-10, future healthcare changes, and insurance companies and their policies.

Other vital functions, including AOA and NYSOA PAC fundraising and the AOA Third Party Keyperson program, were handled by Dr. Chris Colburn.

In addition Dr. Jeff Calhoun chaired the Finance Committee, providing oversight and guidance for NYSOA investments and funds.

Our business partner program had a successful 2015 with an increase in the number of supporting partners as well as an increase in non-dues revenue. Nearly 25% of the NYSOA budget comes from this program.

With the support of our business partners we are able to keep our dues lower than many other states. The continued profitability of this program

NYSOA Officer Candidates 2016 The New York State Optometric Association is pleased to announce the following candidates running for officer positions in 2016:

• President-Elect – Kenneth H. Sorkin, OD, FAAO • Vice-President – Jeffrey Calhoun, OD, FAAO • Secretary/Treasurer – Daniel J. Kirchheimer, OD

Without the dedication, devotion and love for Optometry of the executive board, the third party consultants, the business partner co-chairs, the CVC president, the Manatt legal team, the regional Trustees, the local society presidents and our executive director, Jan Dorman and his team, NYSOA would not have been able to accomplish so much in such a short time. For that, I am truly appreciative and honored to have worked with such a great group of people and I am confident that whatever challenges Optometry and the NYSOA may face in the future, this team will continue to serve us well.

VISION THAT HAS WITHSTOOD THE TEST OF TIME OUR VISION. By joining together, independent optometrists will enjoy the strength of size without sacrificing their right to care for their patients individually, personally and as they choose.

and Raymond Pirozzolo, OD

Current President-Elect Dawn Chivers, OD, will become President and current President Michele Lagana, OD, will be become the Immediate Past President.

Elections will take place Sunday, April 17, 2016 at the Annual Meeting of the NYSOA in New York City.

For more information, contact NYSOA at 1-800-342-9836 or nysoa2020@gmail.com.

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Counsel’s Corner What You Need to Know about Managed Care in New York State Manatt, Phelps & Phillips, LLP One of the most buzzed about topics in recent months is optometric participation in managed care and health plans. In short, under provisions of both New York State law and federal law, it is illegal for health plans to deprive optometrists from the opportunity of participating in health plans, generally, and we have been successful in asserting those rights on behalf of optometrists facing discrimination against the profession.

Optometrists should be encouraged to contact the NYSOA whenever they are the subjects of or are otherwise aware of any systematic discrimination by a health plan. Members of the NYSOA should be encouraged to inform managed care companies of these provisions and the laws, regulations and policies that preclude discrimination. Where problems persist, members should provide the NYSOA’s central office with information concerning the plan, the nature of the problem, and any related correspondence, and we will take steps to address the issue, which may include contacting and negotiating with the plan, informing the relevant regulatory agencies, or initiating litigation.

New York State law: Under state law, the legal basis for the inclusion of optometrists in health plan panels rests on a number of statutory and regulatory provisions. Sections 4235(f)(C) and 4301(b)(1)(C) of the New York State Insurance Law guarantee health insurance subscribers the “freedom of choice” of eye care practitioners when the requested service is within the scope of practice of a licensed optometrist.

Section 4403(5) of the Public Health Law provides that managed care organizations may not exclude “any appropriately licensed type of provider as a class” from their managed care network—which thereby prohibits plans from completely excluding optometrists from health plan panels. These rules apply to any health plan—whatever it calls itself— offering health insurance coverage to enrollees in New York.

Even if a health plan does not prohibit all optometrists from participating, plans have an obligation to contract with sufficient numbers of optometrists to meet the needs of their enrollees and to make the “freedom of choice” provision meaningful. Although New York does not have an “any willing provider” statute that would entitle every interested health care professional to be granted the right to participate in a plan, more than “token” participation by optometrists is required. A February 1987 New York State Insurance Department opinion clarified that these freedom of choice provisions required insurers and HMOs to enter into participation agreements with optometrists to assure that “a sufficient number of those participating providers are interspersed throughout the geographic area covered by the insurance program so as to render the services of participating providers of each recognized provider class readily available to insureds.” And, a year later, a court decision affirmed these non-discrimination provisions and clarified that plans that sought to limit optometrists to refractive services only were not acting consistently with New York State law. Cohen v. Metropolitan Life Ins. Co., 143 Misc. 2d 641 (Sup Ct. N.Y. Co., 1988).

Federal law: The Affordable Care Act (“ACA,” aka Obamacare) prohibits provider discrimination in health plans on a national basis. The so-called Harkin Amendment in the ACA provides that a “group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.” ACA, sec. 2706, 42 U.S.C. 300gg–5.

Accordingly, any concerted effort to restrict the participation of any licensed profession that is legally and clinically capable of providing covered services to enrollees of health plans is in violation of both New York State and federal law.

Continued on Page 6

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P ROS P ECTUS | V OL 42 | ISSUE 1 | 2016 Continued from Page 4 Under federal Medicare law, Medicare Advantage plans “shall not discriminate with respect to participation, reimbursement, or indemnification as to any provider who is acting within the scope of the provider’s license or certification under applicable State law, solely on the basis of such license or certification.” 42 U.S.C. §1395w-22(b).

The regulations promulgated to enforce these provisions (42 C.F.R. §422.205) permit an MA organization to “select the practitioners that participate in its plan provider networks,” but provide that, “in selecting these practitioners, an MA organization may not discriminate, in terms of participation, reimbursement, or indemnification, against any health care professional who is acting within the scope of his or her license or certification under State law, solely on the basis of the license or certification.”

Fee discrimination: Even though the Harkin amendment suggests otherwise, there has been a reluctance on the part of the federal or state government to intervene in fee disputes. The Association itself has to approach issues of fees and fee negotiations with an appreciation that we cannot negotiate collectively on behalf of the profession on reimbursement matters. Gross disparities, however, in levels of reimbursement that lack any justification or rationale should not be permitted and we have challenged health plans to explain the basis for disparate payment rates. significantly

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Vision carve-out practices: Plans are permitted to sub-contract with vision plans to cover routine eye examinations and eyeglasses or contact lenses. We have, however, taken the position that limiting optometrists’ participation solely to the limited scope of services that might be covered by the vision plan is not consistent with New York State law. We have been successful in either persuading the vision carve-out plan to expand the scope of its covered services to include other medically necessary eye care or to require the medical plan to credential optometrists within the main plan’s network to cover the full range of services.

What to do if you have a problem with an insurance company, HMO, ACO, Medicaid managed care plan, vision benefits plan or anyone else who should be paying you for care?

1. Keep whatever correspondence or emails, EOBs or other information you have on the issue.

2. Make sure you have whatever agreement you may have entered into with the company or plan—and make sure to read it before you sign it.

3. If there is an appeal mechanism to contest the issue, and you feel comfortable doing so, pursue the appeal and keep records of that process.

4. At any time, contact NYSOA for help. NYSOA will consult either with its third party consultant or with legal counsel and will put you in touch with them to help resolve the matter.

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P ROS P ECTUS | V OL 42 | ISSUE 1 | 2016

Page 8

To Those That Have Gone Before Us Dawn Chivers, OD, NYSOA President-Elect

We all owe a hearty thank you to Michelle Lagana who has done a superb job of leading the NYSOA, while organizing and prioritizing our goals. She has been instrumental in revitalizing the Young OD committee and creating the Technology and Communications committee. Thank you also to the many leaders who have come before her, volunteering to better their profession.

Our fight, and yes, that is what it has been, continues on. We have made huge strides in advancing a bill in New York State that will allow ODs to prescribe oral medications. I remain cautiously optimistic that this is the year we finally raise our scope of practice to bring us in line with the rest of the country and allow us to properly treat our patients. Details are still being negotiated, but we are confident that our new scope of practice bill will allow us to be able to treat 99% of the patients we encounter every day by practicing the standard of care that they deserve.

The opposition to this one piece of legislation has been holding back the practice of optometry and the treatment of underserved populations across the State of New York for almost two decades now, far too long.

This injustice is what propelled me to become more actively involved in the NYSOA. Anyone who knows me knows that the orals bill has been my focus for the past 8 years. I never thought it would be this hard, and it has been the biggest challenge of my career.

The leadership of the NYSOA recently brought together a coalition of ten other professions to draft and lobby a joint bill to allow non-MD licensed professionals to be partners with MDs in business relationships. This bill is gaining momentum and support from outside sources. Another top legislative priority of the NYSOA is protecting the public from misleading online refractions and “visioneers” visiting their homes and offices to do untrained refractions. As a result of our efforts, the Blink mobile refracting service in NYC is no longer accepting patients.

I became involved with the leadership in the NYSOA because I felt strongly about gaining the right to prescribe orals for New York optometrists. As I’ve become more involved over the years, it has become very clear that we have an increasing number of battles to fight. I started this article with a tribute to some of the many ODs that have devoted countless hours, sweat and tears to this organization. It is only fitting that I ask you, who will carry their torch? The future of optometry and health care in our country has been threatened by outside forces such as insurance companies, territorial battles between professions, and business interests for too long. Recruit your colleagues who have not yet seen the light. Get engaged in your local society. We all have busy lives. We all choose our priorities.

Do you believe in your profession or don’t you?

Once our orals bill is enacted, it will allow organized optometry to devote our efforts to other important priorities. Protecting ODs from the increasing squeeze of third party insurers is a top priority. We must pass legislation that will make it illegal for vision plan insurers to force us to discount non-covered services. We should make it illegal for them to force us to join vision plans when we want to only become a provider of the medical plan.

Save the Date!

NYSOA Annual Lobby Day – May 4, 2016

Please save the date for NYSOA’s 2016 Lobby Day on Wednesday, May 4th.

Your support and participation is critical in promoting optometry as a political force and educating New York’s elected officials about our profession.

RSVP for the lobby day via email to nysoa2020@gmail.com or call 800-342-9836. We look forward to seeing you in Albany on May 4th!

N YS OA. ORG | 8 0 0 . 342.9836 | NY SOA2020@GMAIL.COM

P ROS P ECTUS | V OL 42 | ISSUE 1 | 2016

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WELCOME NYSOA MEMBERS NYSOA MEMBERS ATTENDING VISION EXPO EAST ENJOY THESE EXCLUSIVE BENEFITS: Complimentary Exhibit Hall Registration Daily complimentary lunch available in Club Vision Education Discount:

- Buy a package of 6 hours and get 9 hours (approx. $60 in savings) - Buy a package of 9 hours and get 13 (approx. $100 in savings) - Buy a package of 13 hours and get 18 (approx. $130 in savings) - Buy 1-5 hours and get 10% off

MEMBER AMENITIES & EVENTS: The Archer Hotel | NYC Book through the official NYSOA host hotel today! Vision VisionExpoEast.com/NYSOAhotel to get started. Select NYSOA from the dropdown and use code: NYSOA2016 Sign up for our NYSOA World Yacht cruise on Saturday evening, April 16

2016 ANNUAL NYSOA MEETING COLOCATED WITH VISION EXPO EAST | SUNDAY, APRIL 17

REGISTER TODAY AT VisionExpoEast.com/NYSOA OR USE PRIORITY CODE: NYSOA2016 INTERNATIONAL VISION EXPO EAST 2016 EDUCATION: Thursday, April 14–Sunday, April 17 EXHIBITION: Friday, April 15–Sunday, April 17 JAVITS CENTER | NEW YORK, NY

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N YS OA. ORG | 8 0 0 . 342.9836 | NY SOA2020@GMAIL.COM

P ROS P ECTUS | V OL 42 | ISSUE 1 | 2016

NYSOA Is Proud to Announce the 2016 Award Winners OD of the Year

Page 10

NYSOA Elected Officers President Michele Lagana, OD Honeoye Falls, NY rocheyedoc@gmail.com

Young OD of the Year

President-Elect Dawn Chivers, OD Glens Falls, NY drchivers@ drsklineandboyd.com

Educator of the Year

Vice President Ken Sorkin, OD Plainview, NY sorkod@aol.com

Katherine Mastrora, MS, OD, FAOO In recognition of her service as Regional Practice Ambassador for Omni Eye Services.

Daniel J. Kirchheimer, OD In recognition of his volunteer service to his community as a firefighter in the Town of Vestal, where he currently serves as President of the Vestal Fire Department.

Scott Richter, OD In recognition of his outstanding thirty-five year career as an educator, clinician, author, and peer leader at the State University of New York, State College of Optometry.

Arthur M. Gottlieb Memorial Leadership Award

Dawn Chivers, OD In recognition of the leadership she displayed in negotiating with organized ophthalmology to achieve oral prescriptive authority for doctors of optometry in New York State.

Congratulations!

Dr. Diane Adamczyzk Recognized by APHA and AOA NYSOA offers a warm congratulations to SUNYCO Professor and director of Residency Education, Dr. Diane Adamczyk, who serves as chair of the American Optometric Association’s Evidence-Based Optometry Committee. That committee created the AOA’s first evidence-based clinical practice guideline, “Eye Care of the Patient with Diabetes Mellitus,” which was recently honored with the American Public Health Association’s Vision Care Section Outstanding Scientific Paper Award for 2015.

Dr. Adamczyk, pictured here with AOA President Dr. Steven A. Loomis, also recently received the AOA’s President’s Award for Distinguished Service to Optometry.

N YS OA. ORG | 8 0 0 . 342.9836 | NY SOA2020@GMAIL.COM

Secretary/Treasurer Jeffrey Calhoun, OD Williamsville, NY drjeffreycalhoun @gmail.com Immediate Past-President Christopher Colburn, OD Jamestown, NY ccolburn@stny.rr.com

Staff Executive Director Jan S Dorman nysoa2020@gmail.com Prospectus Editor-in-Chief Denise Whittam, OD denisewhittamod@msn.com Prospectus Managing Editor Laura Lyman Graphic Designer Josh Crystal jc@crystaljdesign.com

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WHY JOIN NYSOA? MEMBER BENEFITS ADVOCACY Legislative advocacy at the state and federal levels - giving you the ability to stay current on legislative issues and to contact Congressional representatives regarding federal legislative issues affecting the profession

VoterVoice advocacy tool– allows members to contact their legislative representatives about specific issues affecting optometry

Membership with the New York State Optometric Association (NYSOA) becomes a combined membership with the American Optometric Association (AOA) and a Local Society. Members of the NYSOA are entitled to a wide variety of benefits and resources, some of which include:

INSURANCE & BUYING

Comprehensive malpractice liability insurance policies at competitive rates

Access to Vision West, Inc., an ophthalmic group buying plan

JOBS & NETWORKING EDUCATION & NEWS

Access to the NYSOA member website and job posts

Networking opportunities and access to a listserve to connect with other members and ask questions

Continuing education courses to fulfill state licensing requirements

OPPORTUNITY

Subscription to the association’s digital newsletter, Prospectus, featuring current professional topics and issues. Reminders of upcoming meetings, events and legislative alerts.

JOIN TODAY AT

w w w .NYSOA. o r g Doctor Locator - NYSOA’s online optometrist referral directory

Business Partner opportunities and information on practice management

Questions?

Contact us at: nysoa2020@gmail.com or 1-800-342-9836

N YS OA. ORG | 8 0 0 . 342.9836 | NY SOA2020@GMAIL.COM

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REASONS TO JOIN AND USE VISION WEST

Vision West is the Preferred Eyecare Business Group of the New York State Optometric Association.

To date, Vision West has provided over $320,000 in non-dues revenue support.

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SUPPORT TO ORGANIZED OPTOMETRY—what does that mean for you? With more than $8million dollars in support back to State Associations, Schools and Groups, this provides non-dues revenue to help with legislation, dues and education. A percentage of your purchases billed to your Vision West account provides $ support to NYSOA.

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P ROS P ECTUS | V OL 42 | ISSUE 1 | 2016

Page 14

121ST ANNUAL MEETING HELD IN CONJUNCTION WITH VISION EXPO EAST, APRIL 16-17, 2016

WORLD YACHT CRUISE

JOIN US FOR A FUN-FILLED WEEKEND OF EDUCATION, SOCIALIZATION AND BUSINESS.

This year the NYSOA will be celebrating its 121st Annual Meeting and Congress in conjunction with Vision Expo East, April 16-17, 2016, at the Jacob Javits Center in New York City. A significant number of our members attend Vision Expo East each year and we decided it was time for the NYSOA to go where our members go. Sign up for education courses through VEE, join us on Saturday evening, April 16th for a fun filled cruise on the Hudson River and attend our Annual Meeting and House of Delegates on Sunday, April 17th.

FOR MORE INFORMATION AND TO REGISTER ONLINE, VISIT NYSOA.ORG

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P ROS P ECTUS | V OL 42 | ISSUE 1 | 2016

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WINCHESTER OPTICAL List as of March 31, 2016

Become a NYSOA Partner!

Interested in putting your business in front of New York’s Optometrists?

Contact the NYSOA for details about our Business Partner Program!

518-449-7300 or nysoa2020@gmail.com

New York State Optometric Association 119 Washington Avenue, Second Floor Albany, NY 12210 Toll Free: 800-342-9836 Fax: 518-514-1537 nysoa2020@gmail.com www.nysoa.org Prospectus (ISSN 1055-7407) is published by the New York State Optometric Association, Inc., 119 Washington Avenue, 2nd Floor, Albany, NY 12210. All issues are electronic. The views and opinions expressed are those of the signed author and in no way should be construed to reflect the opinions or position of the editorial staff of Prospectus, or the New York State Optometric Association, its officers, local affiliate societies, or administrative staff. All submissions are subject to editorial change with regard to clarity or length. Final decision regarding acceptance or rejection of any submission lies with the editor.

N YS OA. ORG | 8 0 0 . 342.9836 | NY SOA2020@GMAIL.COM