Jim McGrann President of VSP Vision Care answers questions
Jim McGrann is responding to some questions today with more answers to follow tomorrow.
For clarity the questions are italicized and the answers highlighted.
1. Please ask Jim McGrann to address the issue of blocking non-VSP docs from participation on the Cigna Medical panel.
Thank you to Dr. Hlis for contributing to this question, your response is spot on as this is not a VSP issue. This is a Cigna decision regarding how they want to implement their panel.
2. Why profits being a VSP provider have shrunk while VSP's profits have climbed?
During the last 10 years, VSP has increased the total payments to doctors by 8.4%, while also adding 1,000 new doctors to the network panel each year. It is important to remember that nearly 90% of VSP's top-line revenue goes back to VSP doctors through exam fees and materials. That is a huge difference when you compare VSP and to our competitors.
Also let me set the record straight that VSP does not set the pace for reimbursements, the marketplace does. For us to have a chance at winning a contract and driving those patients to the VSP network, we have to be competitive. A benefit manager, the one that decides which vision care plan to offer to employees, is using price as a key factor when selecting which vision plan to go with. A vision care plan's contract is based on price, and the majority of that price is based on doctor's fees. It is difficult for VSP to compete against other vision care plans offering lower professional service fees to doctors and passing those savings along to clients, especially when those fees are as much as 20-30% less. Because of that, we are constantly looking for new opportunities to create financial benefits for network providers outside of the standard service fees, like what we are doing with Premier.
3. Have VSP employee and management salaries not gone up in 10+ years as doctor reimbursements haven't?
See answer above
4. Why do you pay doctors different exam fees in different states?
We have more than 30,000 VSP Network Doctors across the U.S. and one size does not fit all when it comes to reimbursement. VSP calculates provider reimbursement on an individual basis taking into account a variety of factors including geographical differences and provider U&C fees. Because of that, each provider receives their own VSP Assigned Fee Report with their individual VSP reimbursements.
5. If they are going to refer to themselves as insurance, are they going to hold themselves both to the standard of CMS guidelines or the authority of the state insurance commissioners?
We do - I talk about this in the interview. Was there something specific that you are asking that wasn't clear?
6. The randomness (or lack thereof) of audits - are they targeted? Random? Something in between?
The key point I want to make sure gets across is that there is NOTHING random about the audits. As I discussed in the interview, there are several potential audit triggers. One is a utilization and billing review. Anomalies or outliers are identified and, if necessary, audits are conducted to verify whether or not mistakes or misleading billing has occurred. Another is by referral. In many cases, someone makes an allegation against a provider. However, VSP's Special Investigative Unit does not audit based on allegations alone. The appropriate time and steps are taken to verify or dispel any allegations before an audit is conducted.
The key to avoiding or working through an audit successfully is to fully document the examination, diagnosis, treatment and all materials provided to a patient. Documentation is the key. In fact, many of the audits conducted by the Special Investigative Unit result in no-action against the provider.
It is important to remember that there is no bigger advocate of VSP's Network Doctors than VSP's audit department. Audits are done to help ensure that provider's engaging in misleading billing do not have an unfair advantage over the 99.9% percent of honest providers out there.
7. Can VSP speak to how much is recovered each year in restitution and penalties, and what a clinician might reasonably expect if they are found non-compliant?
We estimate that from a low of 3% to a high of 10% of our total claims cost each year is lost to fraud. We recover significantly less than even the 3% number.
8. There remains a concern that people who are playing by the rules (or are making a good-faith effort to) will get hit with major penalties for small administrative blunders that their practice may have made. Is this the case?
This is impossible. We realize that honest mistakes can be made which is why our audits are set up to ensure a focus only on prevalent and prolonged patterns of abuse. As I noted previously, many of the audits conducted by VSP result in no-action against the provider. I can't reinforce enough that documentation is the key.
