Op-Ed: Vision Service Plan vs. The United States of America

[Stewart Gooderman]

To Quote: "Patients and their families that I had seen for years changed immediately to a new eye doctor that took Eye Med insurance."

Not to be disrespectful, but what does that say about you, your practice, and the actual relationship you have with your patients? I don't take EyeMed, and don't plan to. Here in the San Francisco Bay Area, Hewlett-Packard switched from VSP to EyeMed in a cost cutting move. When my patients look at the EyeMed listing, the two things they see are 1) LensCrafters, LensCrafters and more LensCrafters; and 2) A handful of private practitioners, NONE of the major practices on the list. My Hewlett-Packard patients have stayed with me because they trust their vision to me and they're savvy enough to know that what I give them ain't gonna be gotten at LensCrafters, LensCrafters and more LensCrafters.

When you sign up on these plans, you do them the greatest service imaginable: you legitimize their existence. In return, what do they do for you? What do they REALLY do for you?

[Laurence Craig Thomas]

Dear Dr. Gooderman,

Thank you for not being disrespecful. Since that was my first post on OD wire.org and you obviously don't know anything about me, my practice, or my relationship with my patients, please let me tell you so that my comments will have more context and meaning. Clearly, you misunderstood my intentions and the message that I wanted to give to the optometric community.

First, I have been in private practice in Dallas, Texas for 26 years. I am reasonably successful and I own and practice in a 6,000 square foot free-standing building two blocks from the area's regional hospital. I am active in the community and in local politics. I have received many awards from area churches, organizations, and local politicians. I served ten years in the Circle Ten Council of Boy Scouts of America as a Den Leader, Cubmaster, and Scoutmaster. My oldest son is an Eagle Scout. I am also a speaker, consultant, and have been an Assistant Adjunct Professor at the University of Houston. I was named Optometrist of th Year in 2001 by the Texas Optometric Association.

My practice is large and medically-oriented. In 2009, I grossed $760,000 working 3 three days per week. When I worked five days per week, I routinely grossed over $1,000,000. I have modern instrumentation that includes Stratus OCT, Visante OCT, B-scan ultrasound, corneal topography, digital fundus photography, Konan specular endothelial microscope, Humphrey perimeter, two hand-held tonometers, two hand-held slit lamps, pachymeter, and three slit-lamp digital imaging systems in my five examination room office. I prescribe contact lenses for dozens of patients with keratoconus or gas permeable bifocals each year. My optical displays about 700 frames and I have had in-office surfacing for twenty years.

My relationship with my patients is good. I have been in the same geograhical area for my 26 years of practice. I grew up here and went to grade school less than seven miles from my office. My patients like me and I like them. Comically, I gained ten pounds in December from all the old ladies bringing us cakes and pies and hot wings during the holidays. Since November, I have made six house calls at night to examine shut-in elderly patients at the request of family members that were existing patients of mine. I think that says enough about the relationship I have with my patients.

That's the point. If patients will leave a practice like mine and an optometrist like me to save $50, we may have problem and we may underestimate the power of money over the power of the doctor-patient relationship.

[Michael Morris]

Dear Dr. Gooderman,

Thank you for not being disrespecful. Since that was my first post on OD wire.org and you obviously don't know anything about me, my practice, or my relationship with my patients, please let me tell you so that my comments will have more context and meaning. Clearly, you misunderstood my intentions and the message that I wanted to give to the optometric community.

First, I have been in private practice in Dallas, Texas for 26 years. I am reasonably successful and I own and practice in a 6,000 square foot free-standing building two blocks from the area's regional hospital. I am active in the community and in local politics. I have received many awards from area churches, organizations, and local politicians. I served ten years in the Circle Ten Council of Boy Scouts of America as a Den Leader, Cubmaster, and Scoutmaster. My oldest son is an Eagle Scout. I am also a speaker, consultant, and have been an Assistant Adjunct Professor at the University of Houston. I was named Optometrist of th Year in 2001 by the Texas Optometric Association.

My practice is large and medically-oriented. In 2009, I grossed $760,000 working 3 three days per week. When I worked five days per week, I routinely grossed over $1,000,000. I have modern instrumentation that includes Stratus OCT, Visante OCT, B-scan ultrasound, corneal topography, digital fundus photography, Konan specular endothelial microscope, Humphrey perimeter, two hand-held tonometers, two hand-held slit lamps, pachymeter, and three slit-lamp digital imaging systems in my five examination room office. I prescribe contact lenses for dozens of patients with keratoconus or gas permeable bifocals each year. My optical displays about 700 frames and I have had in-office surfacing for twenty years.

My relationship with my patients is good. I have been in the same geograhical area for my 26 years of practice. I grew up here and went to grade school less than seven miles from my office. My patients like me and I like them. Comically, I gained ten pounds in December from all the old ladies bringing us cakes and pies and hot wings during the holidays. Since November, I have made six house calls at night to examine shut-in elderly patients at the request of family members that were existing patients of mine. I think that says enough about the relationship I have with my patients.

That's the point. If patients will leave a practice like mine and an optometrist like me to save $50, we may have problem and we may underestimate the power of money over the power of the doctor-patient relationship.

I think Dr. Thomas' post above goes a long way in saying that when it comes to saving a buck, we are not as important in the patient's "eyes" as we think we are. This can vary somewhat in different regions for sure.

Optometrists do the SAME EXACT thing patients do. I have a friend from OD school who is residency trained, laser certified in Oklahoma, two fellowships behind him, a master's degree, and an FAAO. He hates commerical optometry with a passion, has practiced in that mode before and vows never to return. He owns a private practice and is very medically oriented. A few weeks ago when he got a really bad sinus infection, he made a trip to one of those Wal-green's (drugstore) walk-in clinics and got treated by a nurse practioner. It wasn't a money thing for him, it was a "time thing". The drug store walk-in clinic was handy and quick and he didn't want to take the time to go to his PCP. He admits he would do the same with other types of illnesses beyond a sinus infection because he is a busy professional and time is money. Yet, again, he opposes commericial optometry.

Our patients are the same way. They pick and choose what's important. Some are highly interested in receiving what they perceive to be the "best care" wherever they decide to go. For some, they thing saving $10 on a copay iw worth changing docs for. For others, it's a time issue. Whatever it is, for most folks, eye care is not high on their radar. Wished it weren't true

[Stephen McDaniel]

Dear Dr. Gooderman,

Thank you for not being disrespecful. Since that was my first post on OD wire.org and you obviously don't know anything about me, my practice, or my relationship with my patients, please let me tell you so that my comments will have more context and meaning. Clearly, you misunderstood my intentions and the message that I wanted to give to the optometric community.

First, I have been in private practice in Dallas, Texas for 26 years. I am reasonably successful and I own and practice in a 6,000 square foot free-standing building two blocks from the area's regional hospital. I am active in the community and in local politics. I have received many awards from area churches, organizations, and local politicians. I served ten years in the Circle Ten Council of Boy Scouts of America as a Den Leader, Cubmaster, and Scoutmaster. My oldest son is an Eagle Scout. I am also a speaker, consultant, and have been an Assistant Adjunct Professor at the University of Houston. I was named Optometrist of th Year in 2001 by the Texas Optometric Association.

My practice is large and medically-oriented. In 2009, I grossed $760,000 working 3 three days per week. When I worked five days per week, I routinely grossed over $1,000,000. I have modern instrumentation that includes Stratus OCT, Visante OCT, B-scan ultrasound, corneal topography, digital fundus photography, Konan specular endothelial microscope, Humphrey perimeter, two hand-held tonometers, two hand-held slit lamps, pachymeter, and three slit-lamp digital imaging systems in my five examination room office. I prescribe contact lenses for dozens of patients with keratoconus or gas permeable bifocals each year. My optical displays about 700 frames and I have had in-office surfacing for twenty years.

My relationship with my patients is good. I have been in the same geograhical area for my 26 years of practice. I grew up here and went to grade school less than seven miles from my office. My patients like me and I like them. Comically, I gained ten pounds in December from all the old ladies bringing us cakes and pies and hot wings during the holidays. Since November, I have made six house calls at night to examine shut-in elderly patients at the request of family members that were existing patients of mine. I think that says enough about the relationship I have with my patients.

That's the point. If patients will leave a practice like mine and an optometrist like me to save $50, we may have problem and we may underestimate the power of money over the power of the doctor-patient relationship.

Welcome Craig. I'm jealous I wasn't able to visit your office this past Christmas and help you eat those pies and cakes. Perhaps you could chime in on BC as well.....?

[Tom Stickel]

FYI,

I bhis is a public forum. Any search engine will pick it up eventually. Anyone who has posted financial information they would not be thrilled for their patients to see may want to edit their posts.

And Adam or Paul, correct me if I'm wrong on articles and comments posted on the "Public Articles" forum.

[Jonathan Warner]

The reason that Dr. Thomas lost some patients when they went on EyeMed from VSP is not because he does not have a good relationship with his patients. It's because most of the docs who take VSP also take EyeMed. That's not true with Specterable. If they had switched to Specterable, it would have been easier to retain them. But since there are so many docs who take EyeMed, it is harder to retain EyeMed patients if you don't sign up. And that, BTW, is one reason why EyeMed is such a threat to our profession.

[Stewart Gooderman]

Personally, I don't see EyeMed as a threat. I see *Optometrists* being a threat to themselves. If optometric practitioners acted like their dental cousins and were savvy about not joining plans that payed pennies on the dollar, then plans like EyeMed would not exist.

I'll repeat what I said before: when you join a plan, you give that plan an incredible gift: you *legitimize* them. What do *YOU* get in return? What do you REALLY get??

Why do you think EyeMed was calling me over and over to sign up with them after the Hewlett-Packard switch over? Because there were so few practitioners in my area who have joined EyeMed!! I don't know about AT&T, but at HP, if the workers are upset, they listen. That's EyeMed's selling point: they claim to have the same doctors as VSP and are charging less (and paying doctors less.) VSP tried to get its members to understand this, but VSP has antagonized its membership so much over the last few years, that its membership could care less with what VSP has to say. The membership in general hates VSP so much that it results in them making decisions that ultimately are not in their best interest. Sad.

[AdminWolf]

FYI,

I bhis is a public forum. Any search engine will pick it up eventually. Anyone who has posted financial information they would not be thrilled for their patients to see may want to edit their posts.

And Adam or Paul, correct me if I'm wrong on articles and comments posted on the "Public Articles" forum.

you are indeed correct, this is why it is called the Public articles forum, vs. the Members Only articles forum.

adam

[michael berger]

why is an article quoting items from 2003 to 2005 even being discussed

[Paul Farkas]

why is an article quoting items from 2003 to 2005 even being discussed

What is old news to some may be new information to others.

Please point out items from 2003 and 2005 that you consider inaccurate or irrelevant. We like to keep ODwire.org current.

This topic is on a Public Forum. Accuracy and veracity are essential. Your monitoring and updating will be most helpful.

[Terry L. Bonds,O.D.]

There are evolving alternatives to the current commercial vision plans. For example, Vision Care Direct (VCD) is starting to make significant impact as a doctor owned entity in several states.

I've had more than a few HR folks tell me directly that they'd not even consider a vision plan that had ZERO local private ODs as providers. Your participation is seen as a DIRECT endorsement by HR AND PATIENTS.



Regarding Third Party - “THE RULES” have not changed.

During a down economy it’s easier to be tempted by “Vision Plans” offering increased patient volume for reduced fees. You must carefully analyze each plan prior to rejecting, or accepting, their invitation to participate.

First, you must know your chair costs to analyze third party contracts.
What makes sound financial sense for one practice can devastate another, dissimilar practice. A plan’s professional fees must cover your chair costs. Typical chair costs are $110 - $185 per clinical hour.

Second, you cannot recover discounts via increased patient volume. Practice nets vary wildly, but overall net has declined sharply. Mature practices net 30%, on average. A 30% discount means zero net.

Don’t gross yourself to death while torpedoing your quality of life. Forty percent net on $400,000 is healthier than twenty percent net on $800,000.

Third, everything is negotiable.

1. NEVER consider signing any boilerplate contract. Their first mailing is just a starting point. Third party administrators know that practice capabilities & overheads vary widely. They expect you to NEGOTIATE a specific, final contract “starting with” their boiler plate offer. You have more negotiating leeway than you realize.

2. Clarify as many non-covered services as possible up front. What can be balance billed & what cannot? Once you sign up - it’s too late.

3. It’s not all about fees. Modifiers, bundling, timely filing requirements, arbitration & special procedures must be clear.

For example, many boiler plate contracts require you file clean claims within 60 days. You can negotiate a more reasonable period. One year is common, especially for paper claims.

4. Clarify the “how to” pertaining to late, unpaid, or underpaid, claims.
Understand their appeals process up front.

5. Does the contract renew automatically? If so, how often? Will you be able
to “re-negotiate” @ some future date? What if you want
out? What if they want out? Notification lead times matter & they’re negotiable.

6. Finally, NEVER throw any vision plan offers in the trash. Never decline a plan without explaining why. Third party administrators want and need your input, especially when you decline participation. Educate them.

Mark every one up with your acceptable changes (including a fair, acceptable fee schedule) and send it back for re-consideration. After your first negotiation, most of this will be handily available in your word processor.

Explain your reasoning thoroughly. Be specific. ALWAYS send your rejections in writing. Be cordial & educational.

Don’t start any negotiation process unless you are 100% willing to walk away from an unacceptable deal. They need you more than you need them.

The most successful practices I know of participate in two, or less, vision plans.

Terry L. Bonds, O.D.

[Jonathan Warner]

Terry,

Are you serious in believing anyone can negotiate with VSP, EyeMed, Spectera, or Davis, especially VSP and EyeMed?

I have tried the "take as few plans as possible" approach for the last 17 years, but I am now having to consider signing up for something besides VSP. My strategy worked better when the economy was better, but with the decline of the last 15 months, it's been a different story.