Managed Care

6 Ways My Practice Was Profitably Freed From Dependence on Managed Care

By Susan Resnick, OD, FAAO, FSLS

March 17, 2021

Some 35 years ago, as I embarked on the road to a career in optometry, I had two distinct goals in mind. The first was to deliver the best vision care (back then ODs could not treat eye disease), and the second was to ultimately be my own boss, seeking work-life balance as well as control of patient care. Through hard work, and “making my own luck,” I achieved both.

These goals may resonate with many of you and, fortunately, with proper planning, are often no less achievable today–if you know how to control, reduce, and even eliminate, your practice’s dependence on managed care.

As optometrists, we take an oath to deliver the best patient care. Optometry at its best is an extremely gratifying profession and embraces many avenues to success. When we lose the freedom to choose how to deliver care and which products and technologies to use, however, both professional satisfaction and patient care suffer.

Here are key ways to reduce or eliminate your dependence on vision care plans (VCPs).

Overcome Paralysis with Analysis of Key Metrics
The decision to drop one or more VCPs is a daunting one and should be made with careful analysis of your practice’s location, patient demographic and clinical focus. The good news, however, is that this is not an all-or-nothing proposition. You can maintain membership in select plans that clearly meet your financial, clinical and quality-of-care goals. Start by looking at the distribution of your entire patient base among the current plans you accept. Divide the annualized gross revenue from each cohort by the respective number of patients to determine per patient revenue. Then calculate revenue per chair time cost. This will allow you to identify those plans which are not worth keeping.

Build Your Brand: Focus on People, Place & Products
The benefits of branding, both individually and as a member of a quality optometric alliance, include allowing you to stand out in a saturated market, promoting and ensuring consistency of care, conferring credibility, generating referrals and promoting patient loyalty, attracting “ideal” patients and defining and positioning your value. To build your brand, focus on the 3 Ps: People, Place and Products.

Screen for and hire individuals who are “people oriented” and demonstrate excellent communication skills; all else can be trained. Your place – the physical surroundings and amenities of your clinic, should be comfortable, clean and inviting. Pay careful attention to the structural flow and accessibility of your office to optimize clinical efficiency and patient convenience. Select products and technologies that meet your clinical goals and budget, but shoot for those that stand out in quality and uniqueness. Devices such as neurolens, TearCare and EyePrintPro custom scleral lenses are among the most recently introduced cutting-edge technologies in our practice. Adding a robust platform for online frame selection has also been an important addition to our pandemic-driven virtual service upgrades.

Develop a “Counterculture”: Educate Staff on Impact of Managed Care for Better & Worse
Before you can assert your growing independence from VCPs externally, your internal office culture must fully support your goals. Start by educating your team on why you are dropping certain plans, and then set a well-thought-out plan in motion to implement the how. Provide sample scripting to ensure consistent messaging at all patient touch points, reinforce training by role playing and “ghost shop” your office to evaluate your team’s engagement and polish. Your leadership in enabling them to embrace this change, no matter the perceived and real ups and downs, is critical to your long-term success. Believe in your mission and continually reassure your team that this is the best path for the practice as well as their personal professional and financial satisfaction.

Let Specialization Be Your Signature
Your success in achieving independence from VCPs, whether by eliminating all or some plans or simply adding to your private-pay revenues, hinges on your offering of specialty services and products. While embracing a medical model can be beneficial if you participate in quality medical plans, here again you may be somewhat limited in your clinical independence.

Choose to sub-specialize in areas such as specialty and medically necessary contact lenses, myopia management, ocular surface disease and retinal health and nutrition. Growing your patient base and fully differentiating your practice may be best achieved by bringing in a new associate to launch and promote your new dedicated center of excellence.

The Devil’s in the Details: Create an Action Plan for Dropping Unbeneficial VCPs
So, what are the key internal administrative steps toward freedom from third-party payers? First, decide which plans to drop and consult your contractual obligations. Discuss individually with patients as they schedule, explaining you are now out-of-network, but will provide necessary invoicing for them to submit. Your loyal patients will stay; those are the ones you should care about. The exact verbiage we use with patients is: “We will provide documentation for you to submit for possible reimbursement.” We let them know it is a great out-of-pocket expense.

Do It Your Way
As the song says, “I did it my way.” And you can, too. In the end you will have achieved fee autonomy, reduced billing overhead and improved cash flow, clinical independence, quality over price and patient loyalty. But most importantly, you will be in the driver’s seat, recharging your dedication to patient care and regaining the professional satisfaction you deserve.

Susan Resnick, OD, FAAO, FSLS, is president of Drs. Farkas, Kassalow, Resnick & Associates in New York City. To contact her: sresnick525@gmail.com

 

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