Grow your thriving interdisciplinary eye care practice for Optometrists, Ophthalmologists, and Opticians
By Barbra Dey for #Spyglass by Anagram
The optical industry has undergone significant changes in recent years in general and more specifically in the MD/OD space.
Those challenges have been further exacerbated by the rise of Private Equity and the increasingly prominent role those groups play in shaping the present and future landscape.
Whether your business is owned by Optician, OD, MD, or Private Equity, it is essential to run it with intention, to keep your finger on the pulse of practice culture, to understand vision plan reimbursements and complexities, to stay up to date on industry trends and technology, as well as finding ways to understand your data to be sure you are doing all you can to maximize your revenue and continue on a path of growth and success.
That’s a lot to keep in mind in addition to patient care and everything that entails, but nobody said owning an eye care practice in 2023 would be easy.
Private Equity’s entry into the eyecare space provided both opportunities and challenges for optical businesses. As part of a larger entity, leaders could go to market and negotiate favorable contracts with frame, ophthalmic lens and contact lens vendors which would reduce their costs significantly. However, they also faced challenges.
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Vision plan profitability and complexities
With multiple different businesses merging, the consolidation of vision plans each individual business was credentialled with, came added complexities. ODs, MDs, opticians, and billers alike found themselves not with a streamlined process because of their larger organization’s buying power, but on the business end of a much more complex billing, reimbursement, and write-off process than they expected.
In these scenarios, tracking data to verify the employee’s understanding of what to offer patients and when, and why, is difficult. In a highly organized system, however, a practice leader can and should go through each plan methodically to understand how the practice needs to address each in order to be profitable. Assess the profitability of each individual vision plan using your own historical data, and determine which plans in their present state are worth retaining and which are not.
It is important to consider the capacity of your employees to fully understand how each plan works in terms of delivering quality work for your patients and keeping your practice’s financial success in mind.
In my experience, being in-network with more than 3 plans creates confusion among team members; this can lead to mistakes being made not only in the money collected for overages, but in selecting the right brand of lenses as dictated by the insurance plan’s reimbursement schedules. This result can be disastrous for the business and can be readily seen in the dwindling profit margins and worsening execution in the optical.
For plans that are not profitable, the business entity can become an out of network provider, clearly marketing their “why” among the plan members along with providing an attractive package for their eye care and eyewear so that they continue receiving care at your office.
It is essential in these scenarios to make it as easy as possible for patients to do business with you, which may include using a tool like Anagram to pull their out of network benefits and submit their OON claim on their behalf. This approach can also be an effective way to see other vision insurance patients that you already know are not profitable for you on an in-network basis.