Vision Plans
Can You Survive Without Vision Plans?
In the second part of our two-part feature, optometrists weigh in on the practice management aspect of managed vision care plans. Click here for part one.

When Price Is the Issue
This O.D. tells how his practice survives in an area where price is synonymous with quality.
KEN BOVA, O.D., Uniontown, Pa.

	DIGITAL IMAGERY BY ANTHONY CERICOLA

I practice in Fayette County, Pennsylvania, a once-flourishing mining community that is now the second poorest county in the state. For many people in my area, price spells quality. In today's economy, the smartest O.D. practice management expert isn't going to convert a bargain hunter who shops for three or four children.

Here's how I survive:

• I accept many insurance plans (decent, but not low ball).
• I have a good reputation for being thorough. I've practiced in Uniontown, Pa., for 30 years, and for 6 years in a row I've won the People's Choice Award in the local newspaper.

My practice is about 80% vision plans. If I dropped them all, I'd get perhaps 6 patients a week.

A realistic approach

How does my practice make the best of it? We accept plans that pay realistically. I don't mean $25 for an exam. In my decision to accept or reject plans, I determine my chair cost, the amount of empty spaces in my appointment book, how much paper work is involved, and how many people in my area are on that plan. If you take large corporate vision plan patients in volume, you can increase your income by using staff properly.

I taught my dispensing technician how to submit to Vision Service Plan (VSP) over the Internet. She's also added more stylish and expensive frames to my frame bar. My wife, who's worked with me for 6 years, scrutinizes every explanation of benefits from insurance companies. Previous employees did not.

I try to keep my overhead realistic, but I don't skimp. I experienced limited success with newspaper ads, which were expensive. I recently downsized one of my yellow page ads that covers a town where I get few patients. That saved about $600 per year.

Not for the money

I've had some success showing patients the advantages of extras. I demonstrate the different types of lenses on display (high index in different powers compared with CR-39, anti-reflective lenses, photochromatic, etc.). I market by first showing the patient a lens approximately his power in a thick CR-39, and compare that to a great-looking, thin, high-index lens with an anti-reflective coating. I basically do my marketing in the exam room.

My criterion for success is happiness and contentment -- not making $500,000 or $1 million per year. I don't plan to retire, and I'm satisfied right now.

Dr. Bova has a solo practice in Uniontown, Pa. He has been in practice for a total of 33 years. He practices general optometry and he is certified in therapeutics.

An Advantage from the Start
This O.D. accepted vision plans when she started practicing.
BY APRIL S. OMOTO, O.D., Sacramento, Calif.

When my husband and I graduated from optometry school, we couldn't find jobs in our area, so we "opened cold." If it weren't for vision plans, we probably wouldn't have succeeded. We weren't in the phone book for the first year and many of our patients selected us from the plan's doctor listings.

Now, I participate in only one vision plan -- Vision Service Plan (VSP). My husband participates in three. We found that vision plans were a necessity, as they cover many people in our area. It's not necessary, however, to accept all vision plans. If I compare my patient load with my husband's, I don't see a major difference even though I only participate in VSP.

Advantages and disadvantages

The advantage of vision plans is that they bring in new patients and keep existing patients coming back at regular intervals. They can provide access to patient bases that you might not obtain on your own.

The disadvantage is that you must understand the guidelines for each program and you must follow its rules for what it covers, what it will pay you and what your patients will pay you.

It would be difficult, especially in California, to accept no plans. I believe, though, that belonging to all vision plans is unwise. Evaluate what each plan brings to your practice, its rules and its reimbursements. Then decide which plans are right for you and your practice.

Looking back

If I had to do it all over again, would I join vision plans? Yes. Would I join all plans? No. Would we be better off without any vision plans? Definitely not!

Dr. Omoto has a partnership practice with her husband in Sacramento, Calif. She consults for the California State Board of Optometry and she is on the regional professional committee for VSP.

Third Party Care -- to Be or not to Be
It pays to be critical when considering vision care plans.
STEPHEN GLASSER, O.D., Washington, D.C.

When my practice considers any new third-party payer, we use a set procedure to evaluate the plan.

We first determine what percentage of our usual and customary fees it will pay. In addition to examination fees, we look at dispensing fees, the company's policy on second pairs of glasses, how it handles contact lens fees, and the frequency of patient eligibility, among other factors.

This gives us an instant picture of the plan's priorities and restrictions. Unfortunately, many practitioners only consider the examination fee when they're evaluating a proposal.

Some of the better insurance companies base their payments on the doctor's own usual and customary fees. So if you file your present fees with the plan, you receive the maximum reimbursement. In many cases, the practitioner is his own worst enemy in this regard. I have spoken to doctors who haven't refiled their fees in years.

How attractive is the plan?

We look at how many prospective patients we will attract by accepting the plan. If the vision plan can't supply us with a listing of companies under the plan, we reject it.

Many plans build their practitioner base with promises of high fees and an increased patient load. This sounds attractive, but the written details of the plan are the reality.

We also look for on-line eligibility determination and claims filing. This may be the most costly area you could overlook. When a staff member waits for an answer to an eligibility request, it costs the practice in time, money and patient care. Online claims filing eliminates paper forms, copies, envelopes, stamps and the wait for a reply as to whether the claim has been filled out correctly.

With online transactions, we discover errors before the insurance company accepts the eligibility request or claim. When the filing is accepted, we know that we've supplied the necessary information. We reject plans that can't provide for online eligibility and claims.

Another item we evaluate carefully is the frequency of payments. When we examine a patient under an insurance plan, we bear the brunt of the costs until we receive the payment. The more quickly we get paid, the less it costs us to see those patients. Monthly payments are a minimum. Points are added for bi-monthly payments.

Everything in moderation

Needless to say, we sign up for very few plans. It doesn't make sense to accept a plan when I can see significantly fewer fee-for-service patients, have more income, enjoy more free time, dedicate less staff time and provide better care to the patients I do see.

I'm happy with the plans we do accept. They pay a high percentage of my usual and customary fees, provide quality patients and serve as a source of referral for both insurance-covered and fee-for-service patients.

Eye care plans are a reality of our competitive times. Choosing the right ones to accept and making them work for your practice, rather than against it, should be what drives your decision making process. Make the wrong choice and you, your staff and your wallet will suffer. So do the math, study all angles of the question, and make an informed decision.

Dr. Glasser, a past Board member of VSP, has been a consultant in the field of computer eyecare to both small corporations and Federal Government agencies. He has also written numerous articles on the effects of the computer environment on the individual. He maintains a private practice in downtown Washington, DC.

Do the Math
This optometrist found success without vision care plans. Could it work for you?
BY JOHN LEETH, O.D., Waynesboro, Vir.

There was a time when I signed up for just about any vision plan that crossed my desk. CE courses in management advocated these plans, saying that you must "be a player" to survive the 1990s. About 8 years ago, I noticed that even though my gross was going up, my net was going down. I worked harder than ever, but took home less. I was participating in too many vision plans.

At the time I decided to drop plans, they comprised 60% to 70% of my practice. All of the other practices in my area took vision plans and there was competition from Wal-Mart, Lenscrafters, Costco, and independent discounters.

Yet I realized that most vision plan patients could afford my services. Many drove luxury cars, had cellular phones, or paid $40 every 3 weeks to get their hair styled! With a low net, I couldn't afford to have them as patients and continue to provide the best care and invest in high-tech instruments.

The net value

The net in optometry practices is probably more highly leveraged than in any other healthcare business. This means that even a small increase or decrease in fees has a great impact on net. For example, if you net $30 for every $100 gross and you discount your fees by just 15%, it will cut your net 50%, or $15 per $100 gross. In effect, you will need to see twice as many patients with the discount to keep the same net.

True, you may lose some patients by dropping your vision plans, but you'll find that you can net the same or higher with fewer patients. I did, and the math works! (For a closer look at the math, see "Can You Survive Without Vision Plans, " beginning on page 32, in the April issue of Optometric Management.)

Give patients a reason

Before dropping any plans, be sure you offer services patients won't find in another practice. Differentiate your practice -- give patients a reason to come to your practice and stay there. As I said earlier, they can afford you. Install instruments that pay for themselves because patients love technology. Topography and digital imaging are great, but less expensive items, such as computer-controlled eye charts with flat screen monitors, get the "wow effect" also.

Mail newsletters quarterly to your patients to let them know that they're truly a part of your practice. Employ a super-friendly staff that greets all patients with a smile and treats them like friends. Do "happy calls" 2 weeks after they pick up a new prescription to see how they enjoy their new eyewear. Most plans will let patients go of out of network for a small fee. Make it worthwhile for them to do so!

Step by step

I don't think anyone can drop all plans at once. It's easier to drop one plan every 3 to 6 months, starting with the most steeply discounted plan. It may take a few years to drop all plans, but you'll find the financial transition smooth and rewarding.

You'll lose patients when you drop the vision plans, but we're looking for a select group of patients who appreciate the quality of care we give them, while we seek a fair compensation for the quality of service we provide. As you drop plans, you'll find that appointment slots fill up with private-pay patients and other vision plan patients going out of network.

My practice net is now larger than it's ever been, and I even had to take on an associate last year. The staff is delighted that they're free of the vision plan hassles and work stress is greatly reduced. Dropping vision plans is one decision I haven't regretted.

I would encourage you to do the math on your practice and experience the rewards. You'll probably be glad that you did.

Dr. Leeth has been in private practice in Waynesboro Virginia for 29 years. He graduated from Southern College of Optometry in 1972, and is a member of the AOA, VOA, and Virginia Academy of Optometry.