Opening Cold – Part 2 – Tips4EyeDocs Daily – 17 Jan 2012 – Number 28

It is rare and uncommon that a new practice can ignore the importance and relevance of medical or vision plans to it success.  They are ubiquitous and avoiding or declining participation involves careful consideration.  For some practices, a good first year can occur due to participation in plans.  On the other hand, injudicious participation can constrain future practice growth and development.

Both commercial medical and vision plans are pre-tax benefits to the beneficiary, a perquisite of either employment or special membership in an organization.  In the simplest view, plans package patients and funnel them to plan doctors.  If a plan has a set fee for benefits regardless of usual and customary fees, it is a managed care plan. Practically all vision plans are managed care plans.   Medical plans that pay a capitated fee per enrollee with the risk borne by the provider if care exceeds this fee is a managed medical plan.

While membership in a vision plan is open to most optometrists, most managed or fee-for-service medical plans are not. Although optometrists in certain states have gained easy entry medical plans in certain states or circumstances, as a general rule  participation is limited for most in one way or another.

While medical plan participation is much coveted by optometrists, such is not the case for vision plans.  Much of the disenchantment with vision plans lies with their fee schedules,  complex business processes and perceived favoritism of one kind of optometry over another. Therefore,  participation in vision plans require a deft balance between practice strategy and the economics of the overall eye care marketplace.  In a highly competitive environment,  one plan may forsake reimbursement levels for the potential of large number of patients. Reflecting an axiom of the economic theory of price elasticity, the allure of managed vision plans will continue as long as there are willing doctors who will accept whatever fee schedule for the promise of more patients.

In summary,  medical and vision plans are part of a strategy within the business plan. At the practice level they can grow a practice.  But wholly reliance to these plans can also encumber growth. While doctors would  rarely purchase whimsically  equipment,
an equal amount of diligence should be applied to plan participation.

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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