Tips4EyeDocs Daily – 01/05/2012 – No.18 – Why Are So Many Doctors Upset at VSP

FROM THE EDITOR

At least in two of the most popular Optometry (OD) –only social networks, Optcomlist and ODWire, there is a growing vocal sentiment that VSP is deviating, digressing and even deceiving the independent private practice optometrist (IPPOD) with business strategies and policies that don’t support them. Let’s take a look at some of these assertions.

First, VSP’s move to include pure retail eye care outlets (PRECO) as out-of-network (OON) providers might seem like a gentle change in direction for VSP. But for many IPPOD panel doctors, the worrisome news is that PRECO might have an exclusive inside portal to simplify their lookup of patient eligibility that had not normally been granted to OON providers. In brief, OON providers would not seem to need an eligibility lookup because they bill the patient directly and VSP pays the patient.

Second, OON providers are not contractually obligated to hew the same kinds of examination documentation standards as an IPPOD panel doctor. It’s a difference that incenses doctors as much as the first. However, as an OON provider, it would seem improbable that VSP could dictate the kind of documentation standards on an OON provider as an in-network provider. There is simply no contractual obligation for the OON provider to do so.

Third, PRECOs and OON providers may be given advantageous pricing and treatment by VSP’s frame company, Marchon, that in-network IPPODs do not have. This implies that VSP is diversifying quickly and intimates a loss of confidence in the IPPOD community to continue their support of VSP. This also seems improbable, Marchon is not restricting its sales to anyone and as a frame company available to any purchaser, it has the duty and obligation to any willing customer to provide a satisfactory customer service level.

In summary, the VSP – IPPOD panel doctor relationship does not appear to be in any immediate danger. But verbal dissent, almost unheard of even three years previously is growing louder and louder. The verbal minority might not change minds in mass, but it does signal a continuing weakness in the VSP communication plans as it fails to satisfactorily meet their objections. Of course, not being an insider, I can only guess at VSP’s efforts, but it does appear that there is much work ahead still.

PRACTICE MANAGEMENT (Curated)

  1. How do we carry ourselves in our daily professional life? Do we appear confident and self assured? Or do we convey doubt, skepticism or even fear? Spotted on Twitter via @DrLauraHills: “The posture of a self-confident, poised person is upright and proud, chin lifted, chest open, and quite often, a smile. #confidence #posture”

     

  2. A recent story in the Los Angeles Times might make you rethink your resistance or skepticism to health care privacy laws. A California woman received medical care at a Northern California hospital that is coincidentally under investigation for potential over- or fraudulent billing of Medicare for her medical charges. Although she publicly proclaimed that she did not have the medical condition that was the basis of the hospital’s billing, she never consented to the release of her medical information. Without regard to this consent, the hospital opened up her medical chart to the press. Litigation is likely. Spotted on Twitter via @physicianspract: Case demonstrates why #healthcare privacy laws exist (@latimes): http://lat.ms/xnHFh5)

 

CLINICAL CARE

 

  1. Do we consider the behavioral health of our young adult patient population? Here is a short list of things to watch in our patients should childhood depression be of interest to you. Spotted on Twitter via @dialdoctors: 10 Symptoms to Look for Depression in Children http://goo.gl/ml8fX

 

  1. Pinhole vision is an important part of any eye exam. To me it helps me quickly distinguish a refractive problem from a potentially functional or organic cause of poor vision.

     

    1. I actually am trained to take a pinhole vision directly after any entrance vision that I think is abnormal. For me that is about 20/80 or so. If my pinhole cannot improve vision at all, there is simply no reason to refract at all and I believe that the time is better spent investigating and potentially explaining the etiology for such a vision decrease.
    2. I’m aware that there may be a requirement to refract when pinhole vision doesn’t improve the entrance, but I’m not sure if that is realistic.
    3. The ideal pinhole device is an occlude with multiple holes. This is to be differentiated from some occluders with a single hole. An example of such a device is given in the image below.

      (source: http://meded.ucsd.edu/clinicalmed/eyes.htm

About Richard Hom OD, MPA

Dr. Hom holds Doctor of Optometry and Masters in Public Administration degrees and practices family eye care and consults on public policy, health information technology and program evaluation.
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