The Oregon Health Plan Gets Serious About Optics

The Oregonian/OregonLive.com/OregonInsider.com — The Oregon health plan is rolling out some big changes for optometrists and their customers.

Oregon Health Plans is announcing the first wave of changes to its Optometry Benefits, Optometry Services, and Optometry Outpatient programs, which includes a new fee structure and new requirements for optometric services.

The changes, which will go into effect in July, are expected to increase optometrist fees by $10 per patient per year, to $1,400 per year.

Optometrists will be required to make at least one trip to the doctor each year, or receive additional reimbursements for that trip.

Optometrists also will have to make an additional $10 for each visit to their local optometrical center, which is required by law.

The fee increase is intended to help keep costs down and help pay for the costs of the state’s aging and costly hospital system.

The Oregon Health Board said the fees will help the state achieve cost-effective outcomes and to improve health outcomes for Oregonians.

Oregon Health Plan CEO John Pappas said the new fee is aimed at ensuring optometries are available to all Oregonians, including those who can’t afford to go to a doctor.

“Optometrist costs have risen so significantly over the past decade,” Pappis said.

“We believe we can help bring these costs down.

The increased fees will provide an incentive for optometry services and other optometrics providers to provide the best quality services to Oregonians.”

Oregon Health Plans said the fee structure will allow optometrics to offer more services to patients, including more options for care.

“The fee structure is designed to be more flexible to reflect the current costs of optometry,” Pestano said.

“This fee structure allows optometists to continue to provide better quality care to our patients, as well as to provide more flexible reimbursement arrangements for the state to meet the needs of our most vulnerable patients,” Papas said.

Pestano added the fee increase will allow Oregon Health plans to make savings by lowering costs, as health care costs continue to grow.

“Cost-sharing has been a growing concern among Oregonians,” he said.

The Oregon Department of Finance estimates that Oregon Health plan members pay $2,900 per patient, including a 6 percent co-pay, for an average of more than $4,000 in fees each year.

Pappas added that the new fees, which were designed to address concerns that optometicians are being forced to choose between competing optometric services and patient care, will not affect the ability of optometris to provide services for patients who have health care needs.

“These new fee structures are intended to increase access and affordability for Oregon Optometrist patients, but will not impact the ability for opticians to provide optometry care,” Pappa said.

The fee increase applies to Oregon Health Pacts, Oregon Health Insurance Plans, and Oregon Health Employer Plans.