QUESTIONS & ANSWERS

THE PROFESSION’S FUTURE

REIMBURSEMENTS AND THE CORPORATE OPTOMETRY TREND

Scot Morris, O.D., Conifer, Colo.

Q: Will managed vision care plans increase reimbursement rates in optometry; will health care reform (HCR) create greater equality for optometry with other medical professions, or what will the impact be on the managed vision care carve-out that we experience now?

A: To start, it is unlikely managed vision care reimbursements will increase because of competitive pressures, such as HCR, competing managed vision care plans and overall third party reimbursement changes in the current health care environment. That said, revenue per patient (even if he or she is covered by a managed care entity) can still increase. Remember: Revenue per patient is completely dependent upon the provider and his or her team’s ability to prescribe and/or sell what the vision care consumer needs and demands.

As a result, providers must accept plans that enable profitability, and must adjust their pricing structures appropriately based on these plans. They must evaluate the profitability of the managed care plan to ensure revenue per patient exceeds chair costs per patient. Translation: Providers need to reject plans that do not fit in their business models and avoid plans that are not profitable.

It is this author’s belief that HCR will not create greater equality for optometry unless health care providers are willing to change what they do and how they do it. Simply put, health care providers need to:

• Accept that they need to become significantly more efficient by creating patient encounters per hour. This must be achieved through workflow improvements, increased scheduling efficiency and greater staff delegation.

• Provide consumers with the products and services they need, rather than only those provided by their managed vision care plans.

• Collect what is due to them as part of the plans that they choose to accept.

It is difficult to predict how HCR will impact managed vision care plans, but by using the three steps above and also evaluating plan profitability, optometric practices can adapt to the changing health care landscape.

Q: There seems to be a trend toward corporate optometry vs. private practice and a movement toward group practice vs. single provider practices. As a result, what will happen to the independent private practice?

A: I am sure that an entire issue could be devoted to this subject.

Personally, I think our profession needs to drop the corporate vs. private practice and commercial vs. independent categorizations. I am not sure what the definition of private practice is at this point. For example, thousands of providers throughout the country have “traditional” private practice settings that happen to be located next to a large optical that they don’t own. Instead of focusing on the different practice entities, we should focus on the issue of how the practice of optometry can continue to adapt and improve in a changing world.

It is very likely that portions of our business will become virtual. The visual solutions we sell will change as technology progresses. For more information on that subject, check out September’s 50th Anniversary issue in which I talk about the next 50 years. Some businesses will adapt, survive and even thrive. Others will simply close their doors and disappear. Which one will you be? OM