THE CLEAR majority of optometrists participate in managed vision care plans (MVCPs) and major medical plans, yet some are more profitable than others with the same plans. Why is this? I believe the more profitable offices adopt certain practices that allow them to either lower costs or increase revenues associated with patients who have MVCPs. These changes have a positive and lasting impact on practices.

Below are five changes that can impact your business and make managed care profitable in your practice. Not only do these changes provide financial benefits, they also offer the opportunity to improve your practice’s level of care and your patients’ overall satisfaction with your practice.

1 UNDERSTAND TRUE VALUE

What is the true value of a patient with a MVCP? Is it the $50 exam reimbursement, plus the optical co-pays, dispensing fees and material add-ons? Most likely not.

To determine the value of a patient who has a managed care plan, evaluate the total net revenues generated from that patient through 12 months. Assess at least 50 to 75 patients from each MVCP for which you provide services.

Include in your evaluation special or added technology options (retinal imaging), testing procedures (reading skill testing), emergency visits, return visits for disease management and additional optical sales. At my practice, we routinely provide additional services of value to the patient during the year, often after the initial encounter.

Once you capture the revenue data through 12 months, you can begin to understand the true value of the patient.

2 SEEK EDUCATION

To learn how to maximize opportunities using MVCP, invest time in webinars, lectures at meetings or consulting services. Before you move forward, however, do a little homework on your own practice.

To review your practice financials as they relate to patients with MVCPs, break your patients into categories according to their managed care plan. Calculate your net revenue (by plan) by adding third-party payments and out-of-pocket payments to reimbursements. By tracking these numbers quarterly, you will be able to establish 12-month baseline averages. The eventual goal is to increase these amounts with small sustainable growth, by establishing frame and lens pricing strategies; in essence, bench-marking over your own trend. You may be doing better or worse than you think.

If you are not experiencing small sustainable growth patterns, consider changes discussed at webinars, lectures or consulting meetings, such as offering products or services of interest to you that provide value to patients and care outside MVCP coverage. Examples may include contact lens solutions, OTC pharmaceutical products, non-prescription sunwear, sports vision, low vision, vision therapy or other specialty services.

3 ILLUSTRATE MVCP ADVANTAGES

Patients who have an MVCP come in for services more frequently, specifically, every 19 months, as opposed to 30 months for those without, reveals focalCenter, a vision industry consultancy. Therefore, you should train your staff to present these plans in a positive light by illustrating their advantages.

Specifically, make it standard operating procedure for staff to check prior authorizations online through the MVCP website on every patient before arrival and confirm the information with the patient, usually at least one day in advance. This serves two purposes: First, it helps prevent the no shows or last-minute cancellations that can devastate your schedule. Second, the review provides front desk staff, technicians and you with the information necessary to explain the patient’s benefits as part of his or her MVCP coverage. Think of this step as preparing the patient to maximize his or her pre-paid entitlements through the plan.

Also, invest in staff training to immediately review verbiage related to how MVCPs are presented to the patient. Consider words and phrases like, “savings plan,” “all options are covered,” “you’re entitled” and “you have a great plan” in your presentations. We all feel good after making a purchase that gives us value, with a savings.

Here’s an example of what I say to patients in the exam room:

“Mrs. Smith, let me demonstrate the change in your prescription between your old glasses and what our new technology is measuring today.” Demonstrate with one button, using digital refraction, the old prescription vs. the new prescription. “Since you are eligible for a new frame and lenses, I’d like my opticians to let you know about all the new lens technology that’s available and how your savings plan is going to benefit you.”

The optical staff then repeats this demonstration, so the patient benefits from the savings his or her plan allows and receives the best technologies to correct his or her vision.

4 IMPROVE PRACTICE MANAGEMENT

While you can’t control an MVCP’s coverage and reimbursement policies, you can control several areas of the practice that can enable you to increase profitability. These include:

• Increasing scheduling and clinical efficiency. In simple terms, if your average chair time costs are $100/hour, when scheduling patients who have a $50 exam reimbursement, you need to see more than two per hour to realize a profit.

One way to improve efficiencies is through advanced technologies, such as a refractive workstation connected to the practice’s EHR and practice management platforms. These technologies not only reduce chair time, allowing you to diagnose and refract quicker, they also enable you to get your findings right the first time, eliminating unnecessary (unpaid) office visits and remakes or, worse yet, misdiagnoses — major wins for patients.

In addition, in my practice, advanced technologies have helped us eliminate transcription errors, reduce data recording time and enhance the patient experience. As a result, I’ve been able to spend a few extra minutes on patient health and vision education, while easily demonstrating prescription changes. That said, you may also need to make other changes to maintain your profitability, including reducing your “get-to-know-each-other” chat time.

• Creating benefits in the optical. In a nutshell, you should have a healthy mix of frame products, including high-margin products. These are “opportunity buy” frames that can be purchased at least 50% of the wholesale cost, which should not be below $50 original wholesale. Use these frames when a patient states outright that he or she wants to stay within the MVCP on frame selection. Otherwise, don’t limit options during frame selection, and promote the great savings the patient’s MVCP allows regarding his or her ability to choose trendy, high-quality or exceptional fashion options. Recommend what the patient needs, not what his or her plan allows.

Next, have your optician(s) explain the benefits of enhanced lens technology, and combine the options according to what you, the doctor, has recommended.

In my practice, we present the patient with the savings from his or her MVCP, the full retail value of the eyewear and the out-of-pocket expense. Presenting the patient’s savings in positive language allows him or her to feel good about the selection of high-quality products for a high quality of visual correction.

If your practice is in one of the states that allows full optical lab fulfillment, you can control your cost of goods — and you should! Statutes signed into law in the following states allow the provider to use his or her in-house laboratory for the preparation of glasses without the use an outside laboratory: Alabama, Arkansas, Connecticut, Florida, Georgia, Kansas, Kentucky, Maine, Oregon, Texas, Vermont, Virginia, West Virginia.

Work with your staff on this team approach of providing excellent services and products, while the patient saves money.

5 USE MVCP LOYALTY PROGRAMS

As an MVCP provider, you may be entitled to additional benefits through vendor loyalty programs, which provide, for example, additional patients, free marketing management and content and savings on office supplies. (Call the MVCPs to which you belong to determine whether they offer such programs.)

MAKE THEM WORK FOR YOU

Recent numbers from the Vision Council indicate that 53% of Americans have vision benefits. Imagine what your schedule would look like if you decided you were not going to participate in any of the MVCP plans available.

Once you understand the value of a patient, seek MVCP education and improve practice management, profitability will be achieved.

To quote a friend and colleague, Jay Binkowitz, CEO of GPN and Optometric Management columnist: “Our opportunity to own profitable businesses is as abundant today as it was yesterday. . .” OM

DR. LIPPIATT is president and CEO of Salem Eyecare Center, Inc., in Salem, Ohio. She has served as a technology consultant for Vision Web and Eyefinity as a pioneer in EHR and healthcare information technology. Email her at LLLEYEDOC@aol.com.