Dealing With Vision Plans And Managed Care

It seems pretty clear to me that as more and more patients get covered, the payers’ (Medicare, vision plans and health insurance companies) ability to dictate terms to the providers only increases.

 

Of course, it’s one thing to recognize the problem of ‘managed pay’ and quite another to deal with it in your practice. Is there any end in sight?

 

Here is what some of my readers had to say.

 

 

That was a great overview of Medicare’s history! I wrote a cautionary editorial in the October issue of Optometric Management regarding this topic and the AOA’s efforts to lobby optometry into the health care reform ‘fray.’

 

It’s an area where I think optometry should tread lightly until we know what we’re bargaining for.

 

Walt West, OD

 

 

I agree with Walt. Optometry is in a unique position to achieve a higher standing in providing primary care in the future eye healthcare field.

 

The AOA is pushing Optometry into this bubbling cauldron with an ill thought out board certification that is bad timing, and reactive policy. We need a united effort and cannot afford such visible divisions.

 

In my opinion, we need to tread very lightly until we see some stabilization from our government.

 

Joseph Young, OD

 

 

The critical issue is how to evaluate managed care plans. I co-authored an article on this topic that was the lead article of EyeCare Business Magazine earlier this year. My co-author is Greg Stockbridge, OD, MBA (Duke University).

 

Doctors really need to get more sophisticated in their decision making process as to which plans they will or will not participate in. Too many times they just look at the eye exam reimbursement. The issue is far more complex than that.

 

Allan Barker, OD

 

 

You are absolutely right. Providers are virtual prisoners to third-party payment systems.

 

My optometric practice won’t get many patients unless I accept managed care plans. Insurance companies take advantage of this, and set inappropriate fees. Vision plans are the worst.

 

I thought of getting rid of some vision insurance, but know that if I don’t take it then another doctor down the road will. I will then not only lose the patient but also other referrals generated by the visit.

 

Dimple Kapoor

 

 

Thank you Dr. Hayes for the informative, yet saddening article!

 

Ask any pharmacist, and they will tell you that Medicare Part D was written on their backs. Our government is not smart enough to write healthcare policy, period. Part D was written by the Pharma industry for the Pharma industry, with a little help from the insurance companies that ‘processed’ the transactions.

 

Very sad.

 

Jim Williams

 

 

One of the big problems is that our current healthcare system has placed little value on preventative care.

 

As a primary care profession, we are uniquely positioned to provide just that in cost savings by diagnosing and treating problems early.

 

Convincing the politicians of this benefit will be the main hurdle.

 

Steven Kepley, OD

 

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