CLINICAL

  optical

How Will the Optical Evolve?

Will healthcare reform have an impact on our largest revenue center?

DAVE ZIEGLER, O.D.

For most practices, more than 50% of their revenue is derived from optical sales. That said, we must ask whether healthcare reform will have any effect on the largest revenue center of the optometric practice.

While I can’t see into the future, here are some of the areas that we need to consider as we examine how healthcare reform may impact the optical through the next decade and beyond.

Patient volume

Many practices anticipated an influx of “new” patients from healthcare reform that has yet to materialize.

In addition, the Affordable Care Act’s mandatory pediatric benefit led to talk about many new patients who would flood our offices. Although some offices may be experiencing an uptick, it is unlikely that any of us will readjust our retirement plans based on the volume shift from this pediatric benefit… at least not now.

Managed care

Through the last few years, there has been a movement of many of the large medical managed care plans (health insurance companies) to acquire managed visioncare programs and embed them into their medical plan offerings in varying degrees. In most instances, these plans provide basic vision care benefits and rarely cover vision wear materials (unless there is medical necessity).

While managed care plans may increase the consumer volume within a practice from a clinical standpoint, there is no guarantee that this will translate into optical sales.

To capitalize on the increase in volume, we need to focus on improving our optical capture rate. In addition, we have to attract these consumers by providing the right inventory, sales processes and experience (See “Optical Strategy Articles,” below).

Changes in managed care may also cause modifications in stand-alone managed visioncare plans. This may create situations in which being profitable with these plans in the optical becomes increasingly challenging.

For example, if more plans become embedded, we may see more materials excluded from the benefit package forcing consumers to pay out of pocket. This may not be all bad though if we can keep the consumers in our opticals.

Legal changes

We still operate in an environment where optical goods are a medical carve out.

If this changes or there is an attack on Stark laws, ASCs, preventative screenings and in-office ancillary services could all change. This even has the potential to extend to our ability to sell eyewear in an attached office.

An uncertain future

While we may not be seeing short-term changes in volume, managed care or legalities, continue to monitor healthcare reform and its potential long-term impact on the optical. OM

DR. ZIEGLER IS A SENIOR PARTNER IN A GROUP PRIVATE PRACTICE IN MILWAUKEE, WISC., AND A FELLOW OF THE AMERICAN ACADEMY OF OPTOMETRY. E-MAIL HIM AT DAVEAZIEGLER@GMAIL.COM, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.