Tom Cullinane
MOA President

I want to start by saying it is an honor to be your president. I look forward to continuing the fantastic work of my recent predecessor Dr. Lake. I hope I can live up to the same level as Jason’s performance. I have watched Jason work extremely hard for this great organization over the last 12 months as president and for many years while on the board and you should all be very proud and thankful for his service.

MOA History
The Building: As you all know Zoe Lyle and Dr. Mike Penny our president at that time was instrumental in helping us obtain and secure our building back in 2000. The building was built in 1874 and later named the Albert Schoenbeck building after our long time initial attorney. It is one of, if not the best location in Jefferson City. The lower two floors were vacant until recently. Jason and MOA Executive Director, Dr. LeeAnn Barrett, were instrumental in securing long term leases for those floors. This was vital for the continued success of the MOA.

The “MOA” Vision Insurance Plan: This started back when the state employees were moved from VSP to NVA in 2014. It continues to evolve. Once again Jason and LeeAnn have worked countless hours on this ongoing project and I am looking forward to continuing to work on this new program for the MOA. I will be visiting all of the societies over the next year and will continue to update you on its progress.

Disruptive technologies:  Businesses like Opternative and now 1-800 Contacts attempting to DE-regulate contact lenses is a topic we have been working on with our state legislators to shore up our current state statute. We must get this important change in our statue passed to protect the citizens of Missouri from companies that are concerned only with their bottom line and not the health and well-being of the patient’s eyes.

Looking Ahead
Here are three things that I would like to start moving forward over the next year:

  1. Membership
  2. Having our state pass an exclusionary type law
  3. Start working on trying to embed vision coverage in all medical insurance programs.

Some of you out there are thinking this guy is off his rocker; no way can he get those things done. I would say you are correct. There is probably no way that these things can be accomplished over the next year, however we need to start sometime, and now is the time.

As far as membership, I would say that this is a continuation of many presidents before me. The hardest part about getting more members is figuring out why they are not members. We have a committee that has been trying to come up with ways over the years to show value in our membership in a variety of ways, and for the most part it has fallen on deaf ears.

Our outgoing past President Dr. Jeff Gamble made membership one of his goals during his term and he did a great job. He did something that was unprecedented. He took it upon himself to call every single non -member across the state and urge them to be members. It took him a while; he did a fantastic job and did acquire a few new members. He should be applauded for his efforts. After watching all of these great attempts of trying to increase membership, I have decided it’s mainly about showing value and the all mighty dollar. The new vision plan will definitely show value to our current non-members and hopefully the work of Drs. Lake and Barrett will get us lots of new members when it is up and running in the near future.

I remember when I was in my third year out of optometry school and the membership bill came. I was like “its double what it was last year !!!” I had just started a practice cold that previous year, and money was tight. I thought long and hard and it was tough to write the check, but I did it.

As you all know MOA must comply with the five year escalation scale for dues required by the AOA for our national dues. The first year is 10% or about $200, the second year 25% or about $500, third year 50% ($1,000), fourth 75% ($1,500), and fifth 100% around $2000. Statistics show that we lose members between years 3- 5. I don’t think the average OD, at this point in a career, can justify the cost because most of them have six figures of debt after school and money is tight.

What I would like to see happen and will urge the AOA to adopt it is a TEN year escalation. I really think if dues goes up by only $200 per year, most OD’s would be able to swallow that and continue to be members!! When year ten comes around it will not be such a hardship for them. I will continue to work hard at our national meetings to encourage the adoption of this pay scale and hope to get it accomplished sooner rather than later.

Missouri State Law Changes
As you know, we are a legislative profession and have to fight to continue to expand our scope of practice. Well, I think it is time to flip the playing field. I urge you to come to Legislative Conference in January to learn more about this.

Vision Plans in Medical Coverage
The final thing is implementing vision in medical plans. Vision plans have been choking us slowly over the last decade. When they were created many moons ago, they were great because most OD’s were not on Medical plans and there wasn’t a network for us. The time has come for them to slowly leave the market.

Our new combined vision and dental plan is a start. Hopefully it will flourish over the coming years. Most of our current vision plans are just a pass thru taking money away from our patients and us. I believe we must convince one of the big boys to do it and in a few years they will all do it. It’s just math.!!! As Dr. Lake says, “ we are the pickle on the plate,” meaning vision means nothing to both the employers and the insurance brokers who are selling it.

The employers have no clue about which one is a better plan for their employees, it’s all about the cost.

Like I said earlier all three of these things are not going to get done in the next 12 months, but we have to start sometime. There is no “I “ in team and I need all of you to help this great association continue to move forward for the betterment of Optometry .

If you need to contact me, please do not hesitate. Thank You for allowing me to serve as your president 2017-2018.

Tom Cullinane OD
office – 314-579-0909
mobile – 314-402-6600
[email protected]



Jason Lake
MOA President

I can hardly believe my term as President is coming to a close. In some ways, it has seemed like a very long journey and in others, I’ve run out of time and didn’t get to everything I had hoped to accomplish!

I started my year with a speech expressing gratitude and I feel like I should probably finish the same way.

I have such great respect and gratitude for your MOA board and feel like the future of optometry is in the best of hands. There is no doubt in my mind that the present board will leave the profession in a better place than they found it.

I also hope you have the opportunity to thank Sue Brown and Dr. Lee Ann Barrett at the central office. The high quality and amount of work these two staff members accomplish each year is truly impressive, and we as a profession owe them sincere thanks.

We also owe our legislative team of Jay Hahn and Scott Marrs big thanks for their work. The MOA may not have passed any legislation this year, but we feel stronger than ever that we are very well positioned to move our legislative agenda forward. We have the right team for optometry in our state.

A final thanks to my partners and staff at work. There was never a complaint as they covered for me many times as MOA business simply required my time and efforts. I am humbled to have been so supported and our patients are blessed to have you all take care of them.

Most important of all, I want to thank my wife Suzy and my daughters Avery, Delaney and Edy for taking such good care of me. They were always willing to sit through another discussion about optometry at dinner and gave up valuable time together to make sure I could do my best for the profession. They allowed me to serve and for that I am forever grateful and blessed by their presence in my life.

Thank you, for allowing me to serve this past year. As I look back, I think we have left our profession a little better than when we started. It has been a wonderful year and I am honored to have been able to serve as your President.



Jason Lake
MOA President

I can’t believe that my term as the MOA President is half done!  Above all else, I am extremely grateful for this opportunity to serve my friends and colleagues.  It has been a great honor to help our profession reach its highest potential.

Looking back over the prior year, it still astounds me that we passed so many pieces of meaningful legislation, but none was more near and dear to my heart than our non-covered services legislation.  This has been my personal goal for the majority of my time as a board member and I am just as excited about its potential today as I was 8 years ago.  I must admit, I wasn’t sure what we could do for an encore!

As I sat down to write this letter, I have already had the pleasure to visit with every society in our state.  You were such wonderful hosts and were so gracious to me on my visits to your societies.  It was truly an honor to get to see so many great faces in Missouri and to communicate with you about our work this year.  Again… THANK YOU!

We took an aggressive approach to this year and although the hardest part of most legislation is passing the law and getting the governor to sign it, this particular law may very well prove to be just as hard to implement!  In Missouri, we have the tremendous advantage that many of our good friends in our neighboring states have already done a great deal of the heavy lifting regarding implementation.  Our friends and colleagues in Kansas and Texas, in particular, have proven to be worthy allies.   They have been generous with their time and efforts when we were busy trying to pass our law as well as teaching and guiding your board during the start of implementation.

Your MOA board has also gone to the extra effort to get our association attorney to review our law and several common vision plan contracts to help our membership to legally and willfully enact this valuable piece of legislation.  We have offered to our membership, time with our association attorney at a discounted rate to review your individual contracts to find the best way for you to proceed with bringing vision plans into compliance with our law.  Please, do not hesitate (as so many of you have) to reach out to our central office to ask for help with your particular set of circumstances.

In addition to looking back and working on our law, we looked forward to make sure we are in the front lines of medical care when it comes to diabetes.  We have started to put together an alliance with other providers in our state to make sure that optometry continues to be the primary eye care provider for patients with diabetes.  If you didn’t get to hear the lecture from Dr. Jeff Gerson at our Legislative meeting on how to coordinate benefits with VSP… you really did miss out!  This practice management tool is essential in making sure our patients primary care providers are given full “credit” with the patient’s health insurance for the mutual work in taking care of our patients.  The MOA will continue to work to make sure that optometry, and in particular, MOA doctors are the source for diabetic eye care in Missouri.

In a year following such tremendous legislative success, it is extremely important to begin the process of saying “thank you” and working to further build relationships in the legislature.  We have informally had our patient safety legislation reviewed and are in the process of deciding exact language and timing for our next successful piece of legislation.

Legislative planning doesn’t end there as we are also putting together a long range plan with our governmental affairs team looking at our present law and drawing comparison with recent legislative successes around the country.  If you have any desire to see changes in the way we practice, please consider joining our efforts at our leadership retreat this June in Kansas City.  Just call the central office and we will make sure you have a place on the team!

In regard to MOA building in Jefferson City, we lost our primary tenant that covered the 1st and 2nd floors.  The work we have completed over the last five years was essential in the recruitment process to fill our building (and budget).  We were forced to divide the floors into two separate rental spaces as we were not able to rent both floors together.  However, by the time you read this, we will be the proud owner of two 10-year leases that will get the MOA to a point that our note on the building is nearly paid off and provide financial stability well into the future.  The central office team of Dr. Barrett and Sue Brown were truly remarkable as we worked through complex leases and the construction process.  Bravo!

Finally, as I have shared with so many of you as I traveled through Missouri, we need to address our membership.  The entire AOA is facing an issue and we here in Missouri have reached a critical point.  Our membership is down 11% over the previous five years.  This blow to our membership numbers, as well as losing our primary tenant, put the association in a very difficult financial position.  Your central office team stepped up and opted to not replace Jay Hahn, who has moved on to be our full time lobbyist.  That being said, they can’t do it alone.  Your board mandated massive budget cuts until a time that we could be on more stable financial footing.  The recent lease signings were a very significant piece to our financial stability.  As of this writing, we are also a net positive in membership this year for the first time in over five years.  This was a tremendous start!

However, the work is not done… we need to get our friends and colleagues back out to our local society meetings and annual convention.  We need to stand together to continue to push our profession to be it’s very best.  We have certainly accomplished many great things this year, but our work is far from done.

Feel confident that your MOA board is working hard to make your profession the best it can be.  The past two years have brought a great deal of legislative, association and professional success to Missouri optometry.  Please make a concerted effort to share this good news with a colleague that you haven’t seen and encourage them to become a bigger part of their profession.  We must stand together to move our profession forward.  We all have an obligation and duty to support our profession and together we will continue to prosper!


Jason Lake, OD

President’s Message


Jason Lake
MOA President

First, I would like to say thank you for the chance to serve as the 2016-2017 MOA President. I am honored with this opportunity and I look forward to going around the great state of Missouri to get to see each of your societies over the next year.

As we push into our new goals for 2017, I think it is important to take stock of all that we accomplished in 2016. We passed meaningful legislation that helped to turn the tide on vision care plan abuses. We put a flag in the ground, really for the first time in what seems like forever.

Non-Covered Services and Lab Choice
After years of getting close, our non-covered services bill finally passed. This law says that a vision plan may not tell you what to charge for a service they don’t cover. They may also not tell your patients what lab you will use when filling their prescription.

The MOA worked hard to ensure that optometry is included in the list of providers that may provide telehealth services for MO Health Net participants.

Early Refill of Prescription Eye Drops
We were able to extend the sunset provision by 3 years (to the year 2020) to cover the early refill of prescription eye drops. In the past, a patient could have run out of glaucoma drops before the end of the month and insurance could deny the refill.

Workforce Data Collection
This enables the Board of Optometry (and other state boards) to work with the Dept. of Health and other state organizations for the purpose of collecting and analyzing workforce data to ensure the accessibility and availability of qualified health care services and practitioners in the future.

Optometry Students
This law provides that the statutory prohibition of the unlawful practice of optometry shall not apply to students enrolled in optometry school as long as they are under the direct supervision of a licensed physician or optometrist.

Medical Practice Freedom Act
This specifies that state licensure requirements for optometrists and other healthcare providers must be granted based on demonstrated skill and academic competence and not conditioned upon participation in a health insurance plan or system.

That was an amazing year, but there is no time to stop pushing as our momentum needs to be utilized on our new goals.

My legislative goals for the year center on a two headed plan. We have an immediate need to address disruptive technology. Internet eye exams from companies like Opternative and abusive practices funded by companies like 1800-Contacts must be addressed now. We must protect our patients from those that are only influenced by profits. These companies are attacking our profession on multiple fronts and in multiple states. They employed over 10 different lobbying firms in Arizona and are looking at other states.

They would deregulate contact lens prescriptions with 5 year expiration dates and give themselves the ability to switch brand and fitting parameters based on what is the most profitable. They suggested that optometry as a profession is not only unethical, but needed to be prohibited from selling contacts and glasses in our offices. We need to protect our patients and our profession before it is too late.

Our long term legislative goals are centered on creating an exclusive practice law similar to that what was recently passed in Louisiana. Today we have an inclusive law which means that anything we want to be able to do we must lobby to be included. The new face of our state law should be an exclusive law where if we are trained to do it, our opponent must lobby to exclude it. As we see new pharmaceutical treatments appearing almost daily, it is inevitable that many of the conditions we treat will require injectable medication and other types of technology that we have not even dreamed of yet. We need to make sure our law allows us to be able to take care of our patients.

I also wish to form an alliance with the family physicians of our state. North Carolina and Pennsylvania have both started the process of helping unify an effort to make sure the primary care doctors of their state receive their full HEDIS and STAR scores from insurance. As we head into the new Merit based incentive programs (MIPS and MACRS) and the additional myriad of changes, we need to be on the forefront as THE primary Eye care providers in our state. It is time to plant a flag as the profession that takes care of the vision of the state of Missouri. Diabetes is the leading medical issue we face and we need full access to provider panels to make this happen.

The good news? For once the insurance companies are on our “side”. They need us to see the patients and they need us as part of a patient centric care team to provide this service. They know if their patients see us for dilated diabetic exams and preventative care they will make more money because they will have a healthier patient. We will be launching an initiative to press forward to make MOA members the place for physicians to send their diabetics for care. The majority of the people in this room are already doing this, but we need further access and a unified system of reporting to meet the needs of medicine, insurance and our patients.

In a complete turn of the table, vision plans are offering to help. The MOA leadership is working with VSP to help provide training to teach our members to coordinate benefits with the health insurance. We have spent extensive time and effort to “get the word out” to optometry about billing medical insurance for all medical procedures, but we still are not meeting the need. Health insurance companies are literally “begging” us to report those codes to them to satisfy those requirements. Too many exams are simply billed to the vision plan, and as a result, the health insurer believes the patient was never seen for the exam. This is as much PR campaign to our own members as it is a shift in paradigm to create the medical model in every practice in our state.

Finally, we will be spending a great deal of time helping our membership with implementation of our new non covered services legislation. This implementation is most certainly considered a long term endeavor. Our neighboring states have learned a great deal already, and we hope to share our resources with our membership at the legislative conference this year. We have planned a white paper crafted by our association’s legal counsel to help our members negotiate their contracts and understand their rights under our new law. We will also be conducting a seminar at the legislative meeting to help gain further understanding of this important law.

In closing, I am pleased to serve as your president, but the MOA takes everyone to make it work. We are all busy, but sometimes just showing up to your local society meeting, offering a colleague a word of encouragement, calling your local rep or senator or simply paying your dues is what allows us to keep moving optometry forward.

In the last six years we have seen an 11% decrease in membership from the MOA. This trend is both alarming and devastating to the work we must do. I implore each and every doctor and get those members back. Make sure we are all making the MOA better. If each doctor reached one member, the change in our organization would be immense. Let’s start with a great turn out to our legislative meeting this coming year. We have top notch education and information of interest to all optometrists in our state. In fact, bring a non member and show them what they have been missing!

I look forward to seeing all of you at our legislative meeting this January!
Jason Lake, OD

Summer 2016


Jeff Gamble, OD
MOA President, 2015-2016

Wow. What a ride!

As I write this column, there are no less than four pieces of legislation waiting on the Governor’s desk that directly benefit our patients, Missouri optometrists and the profession as a whole. I can’t begin to express to you my appreciation for your time and resources that allowed our association to effectively move meaningful legislation through the process in truly historic fashion.

I would like to commend our home office and the tireless work of our executive director and legislative director in forging a path to success this legislative session. The heartbreaking loss of our children’s vision law reignited our leadership to take a hard look at the structure of our association. The board worked diligently with the executive director and the legislative director to implement changes to more effectively communicate with our membership, strengthen our keyperson system and overhaul MOPAC.

The challenges of passing meaningful legislation have shifted with the changing landscape in Jefferson City. Gone are the days of calling the twenty year veteran of the house who knows your issues and needs. Term limits have changed the game. It is quickly becoming commonplace for bills to take five to six years before passage. The strain such demands place on members of an association are palpable.

The board understands the frustration of repetitive requests for support when there appears to be little evidence of success. However, I would suggest we have been given a template for the future through our efforts over the past five years. First, we must have passionate leadership on the board. Secondly, we must have a home office that effectively communicates with the membership. Next, we must have a lobby team effective in translating to the board where to compromise on the non-essentials and stand firm on the essentials. Finally, we must have members willing to sacrifice time and resources to support their legislators. At the end of the day, it was the after-hours chats between MOA members and their legislators that secured our legislative victories this year.

The MOA functions very similarly to an optometric practice. A united group of individuals with a clear direction is capable of achieving unlimited success. My hope for the association in the coming years is to set a tangible example of the path to success. I certainly know you have passionate leaders on the board for many years to come. Our executive director has a unique perspective of knowing the needs of the members while also understanding the hard work required to effectively manage an association. Our lobby team has demonstrated unparalleled effectiveness this year while maintaining a reputation of being honest and willing to negotiate when necessary.

Now, it really comes down to you, the member. Please help us keep the momentum as we plan for the future of our association. We need engaged members, and we need more of them. We need members who understand they have a personal responsibility to their professional responsibility. If you are already an engaged member, which I suspect you are if you are reading this, then spread the word. An association with 43% membership is not a viable association.

I continue to have the same passion to leave our association in better shape than I found it and I will continue to hold that banner for those follow me. It was an undeserved gift to have the benefit of passing significant legislation during my watch. It could have just as easily happened last year or next, but I promise to you I will not let our leadership sit back and relax. We have work to do, and now we know what it takes to be successful.