50^th ANNIVERSARY: LEADING OFF

TIPS, TRENDS & NEWS YOU CAN USE

U.S. HOUSE MULLING BILL THAT IMPROVES PROVIDERS’ RIGHTS

The U.S. House of Representatives is currently considering H.R. 3323: “Dental and Optometric Care Access Act,” or the “DOC Access Act,” which seeks dental and vision plan contract fairness, improved quality of care and the eradication of anti-competitive practices.

The bill seeks to prevent:

• Plans from dictating fees for services and products not covered by the plan. (Also, plan coverage of a service or product must be negotiated and agreed upon by the provider.)

• Provider term changes without the provider’s agreement.

• Plan contracts that offer limited scope benefits to exceed two years.

• Plans from denying doctors provider status or cutting ties with a provider if he or she doesn’t accept the terms and conditions for ancillary services or procedures alone.

• Plans from requiring providers to participate with or acquire credentials from any specific plan or coverage that offers limited scope benefits as a condition to participate.

• Plans from superseding the doctor-patient relationship in such a way that oversteps any state or federal requirement.

• Plans from dictating the provider’s choice of laboratories and source and suppliers of services.

Should a plan violate one of the points above, the bill would enable the provider to file an injunction against the plan and, should the provider succeed, receive $1,000 from the plan for each day it is found in violation in addition to attorney’s fees.

“The fight for HR 3323 and similar state bills is the fight for the future of our profession,” explains Steve Loomis, AOA president. “Every O.D. can and should be working with the AOA and our state associations to educate and inform legislators, and help build support for the nationwide crackdown we know is needed on the anti-doctor, anti-patient and anti-competitive policies of plans and insurers.”

Although 35 states in counting, have similar legislation, Rep. Earl L. “Buddy” Carter (R-Georgia), who introduced the bill, the AOA and the American Dental Association are pushing for national legislation because health insurance companies have been able to evade state laws due to their plans being regulated on a federal level.

“This legislation is necessary to provide doctors with greater flexibility in meeting the needs of their patients,” said Mr. Carter in a press release. “By prohibiting insurance providers from forcing doctors to participate in restrictive insurance plans or networks, doctors will be able to charge reasonable fees for the care Americans need. This legislation is a strong and necessary step in bringing free market principles back into health care by removing anti-competitive business practices.”

To support the “Doc Access Act,” contact your U.S. senators and house members. ■

OVERVIEW OF 1965

• Album of the Year: “September Of My Years,” Frank Sinatra

• Average Cost of New Car: $2,650.00

• Average Cost of a New House: $13,600.00

• Average Income: $6,450.00

• Band Seen the Most on Billboard’s Hot 100: The Beatles

• Best Actor: Rex Harrison, My Fair Lady

• Best Actress: Julie Andrews, Mary Poppins

• Best Country and Western Album: “The Return of Roger Miller,” Roger Miller

• Best Country and Western Song: “King of the Road,” Roger Miller

• Best Picture: My Fair Lady

• Gas Per Gallon: 31 cents

• Life expectancy: Men: 66.8, Women: 73.7

• Loaf of Bread: 21 cents

• Most Popular TV Show: Days of Our Lives

• NBA Champions: Boston Celtics

• Population: 194,302,963

• Stanley Cup Champions: The Montreal Canadiens

• Super Bowl Champions: Green Bay Packers

• Top-Grossing Film: The Sound of Music

• Top-Selling Car: Chevrolet Impala

• Top-Selling Toy: James Bond Aston Martin from Corgi

• Top Fiction: “The Source” by James Michener

• Top Non-Fiction: “How to Be a Jewish Mother,” by Dan Greenburg

• World Series Champ: Los Angeles Dodgers

SHIRE BUYS FORESIGHT BIOTHERAPEUTICS INC.

Shire, LLC, which currently has an investigational pipeline of ophthalmic products, including dry eye treatment lifitegrast, has purchased Foresight Biotherapeutics Inc., maker of topical combination drug FST-100 (0.6% povidone iodine and 0.1% dexamethasone), which is currently in late-stage development for the treatment of infectious conjunctivitis, for $300 million.

In April, the FDA granted a priority review to Shire regarding the new drug application for lifitegrast. The FDA is expected to provide a decision on the drug next month. Meanwhile FST-100 is about to undergo a Phase III clinical trial, which Shire will now oversee.

Shire established its Ophthalmics Business Unit in 2014 and has subsequently acquired SARcode Bioscience, Premacure AB and BIKAM Pharmaceuticals. In addition to dry eye disease and adenoviral and bacterial conjunctivitis, the company is also currently investigating products for autosomal dominant retinitis pigmentosa, glaucoma and retinopathy of prematurity ■

CMS CUTS DOCTORS SLACK AND OFFERS HELP REGARDING ICD-10

The Centers for Medicare & Medicaid Services (CMS) announced that for one year after ICD-10 implementation goes into effect (Oct. 1), it will not reject ICD-10 claims that aren’t specific enough.

“CMS has done more than enough to prepare doctors for the transition from ICD-9 to ICD-10,” explains John Rumpakis, O.D., M.B.A., founder, president and CEO of Practice Resource Management, Inc., a consulting, appraisal and management firm for health care professionals. “Visit their website, and you can see that the organization has been providing a slew of assets that are deep and rich. In addition, the AOA has done a great job in creating a complete set of tools to ease the transition. What doctors need to accept is that the transition is happening — no more delays are coming — and they must have a game plan in place to prepare.”

Claims will be approved as long as the submitted code is in the proper ICD-10 family and the same goes for submitting to quality programs, such as PQRS. Further, CMS says doctors can ask for partial advance payments if claims cannot be processed due to problems on its end ■

CARL ZEISS VISION NAMES NEW EXECUTIVES

Carl Zeiss Vision Inc. has appointed Jens Boy, president and head of Zeiss Vision Care – North America and Greg DiPasquale, senior VP, Independent ECP.

Jens Boy

Greg DiPasquale

Mr. Boy has held positions with Teleflex Medical and Zimmer Dental. Mr. DiPasquale has a background in the ophthalmic lens business and most recently was an executive-in-residence faculty member at Ohio University, where he taught sales management techniques ■