cleinman appeares to have no clue as to the economics of a large vsp dominated practice, and the aoa is gleefully throwing that practice mode under the bus as well. what a one-two punch for the future of optometry.

Does the aoa want to rid the profession of the crude vulgarity (no matter how profitable) of dealing with glasses and contacts? Why not get rid of refracting while we are at it as well? Would they be happier if we were located between the soap aisle and the pharmacy at safeway, prescribing adolescent punctal plugs after exhaustive special testing?

i hope the aoa members wake up to the profound and harmful changes put in place by the leaders. and as for cleinman, how pathetic does a practice have to be for it to be seen as a savior??

What was the result of the audit? Did you find that VSP was out of line in any way or performed any measures inappropriately? If so what was the follow up action? Just curious.

So you’re saying you’d hold a greater support and regard for EyeMed who supports you less and even competes with you by taking patients simply because they are blatant clear with you about how they do business? Not that I even support the thought that VSP isn’t transparent. I believe they are very clear too.
How is VSP “pretending” to be your friend? What they offer you as a provider is totally voluntary thus your being a panel doc isn’t something they are forcing you to do. Only in OH and CA do they direct a portion of their work to a specific lab. Otherwise, you can go anywhere. Even in those states, the portion of the work which is the Choice Plan is also voluntary. You can still be a panel doc and not support that plan. So given so many options, why is it that you still feel some hate towards them? It’s a choice you’re making not something they are forcing you to do. Unlike other insurance companies such as Davis, VSP absolutely gives you choices. I look forward to your thoughts.

Overall it seems you don’t fully see the reasons for VSP doing business the way they do. Have you ever sought asking them for clarification as to why? I have and I fully understand why they perform chargebacks. It just plain makes sense.

Your comments about not getting a lab bill don’t quite make sense to me. Consider where you’re at on the food chain. You’re a provider office. The patient comes first, next comes their provider contract lab, then you.

VSP performing chargebacks is first and foremost about supporting their patients and contract labs. It insures the labs their panel docs are using do not have to chase 28,000+ doctors for payment. Because as you know, docs for the most part are horrible businessmen and there are any number of reasons lab bills go unpaid. When that happens, patients (ie. Clients of VSP ) could suffer and be left unhappy. Paying the lab bills for you, not only makes it easier for you but more importantly insures patient services will never be delayed for AP/AR issues. It also insures happy contract labs as VSP pays well and pays promptly. Make sense yet?
So now in terms of materials and where you are limited in charging above and beyond on certain plans (again, it’s not that way on all plans such as Choice), there are still plenty of ways to make money with VSP. If you don’t believe so or think so or aren’t experiencing good results, then I would highly suggest you consult with your practice account manager at VSP. That’s their job and I can assure you, based on your notes thus far, you are likely leaving money on the table and don’t even realize it. Your call completely on whether you do anything about it.

You’re right, EyeMed is cheaper. Why? How? They also have far less service. It’s also very well known by employers and in the industry and when patients go from VSP to EyeMed, they are far less satisfied and they also end up paying more out of their own pocket too. Not only are the plans worse, but they also get sucked into the vacuum of retail chains that pillage their wallets far more than private ECP’s tend to do.

So in the end, I think it’s clear why VSP retains so many and does so well. The patients and clients both are clear that they are willing to support VSP and their superior service. In the end you forget that you are not the client or main focus of VSP, it’s a company and plan driven to service the patient and provide them a value that is greater than all the others. You elect to provide services for that plan knowing all the details up front. Again, the choice and how you choose to practice is all yours. Time to look in the mirror and stop complaining about what it is you feel is being done to you and start asking what it is in terms of your own practice and success is happening because of you. Don’t act like VSP is sticking it to us as panel docs. I and a huge number of others know how to create large amounts of success with their business model. If you have suggestions, please, visit them at their booth at VEE. I’ll likely see you there.

You’re right, there are added values to VSP vs EyeMed. However, I’ll say that the two panels have over 82% overlap, thus if you think you are the others on the panel are the real value any more, I’ll clearly tell you that YOU and those also supporting EyeMed are the ones removing that one time value. Why go VSP when the clients has 82%+ of the same choices AND all that retail offers? If you support both panels, you are killing the value add there.

In terms of your exam reimbursements, so let me get this straight, you clearly don’t see how YOU and the other docs supporting the panel are the ones responsible for low rates then? Let’s play hypothetical shall we…if VSP doubles your exam rates, how do you think EyeMed would respond in the marketplace? Do you not see them clearly attacking that with clients? I know as a client I would absolutely say to heck with supporting VSP that charges me more as it’s in turn very clear why…they are overpaying docs who 82%+ of the time are willing to take far, far less from EyeMed for the same work. That makes no sense. So you might be happy for a few months, but in the end you’ll never see the higher reimbursements because EyeMed will have a field day pillaging clients and in turn sticking you with their low rates.

So then you’re also arguing that VSP with the highest patient and client and quite frankly highest service level to their panel docs pays their people too much? Really? Would you rather they take the low road and pay them squat and NOT have happy people helping you and your staff? Not me, if I want that, I’ll go visit Davis and Spectara. Have you read the articles about Davis lately and their striking staff? Again, how about you focus on business issues and not your emotion when talking about the industry as a whole.

So outside fees on exams, how are you maximizing your materials, labs, and all the other many avenues offered to you by VSP? There’s no “race to the bottom” as you imply. None at all. You’re not sharing a load or being cut. Where has VSP taken anything from you lately only to give it to others? How are you holding the bag. Please share some details. I’d love to discuss them.

Al and his blog does nothing but spread FUD without providing any facts. I’ve posted and replied with tons of clarity and questions, none of which get any follow up. He spreads rumors without facts and stirs the pot but disappears when the dust settles. When was the last time he brought forth conversations he’s had with VSP? Has he engaged them for clarity or their input? Let’s see if he visits with them at VEE and posts some facts. Won’t happen. He focuses on the rallying practices that are upset and fuels fire vs. finds solutions. He promotes his own cause and leverages it against VSP primarily because they won’t fight back against his annoyances. In the end they take the high road as in reality the squeaky wheels will always be, but the vast majority do quite well and that’s where they focus.

Sounds like your beef is with managed care overall and to varying degrees with all the companies. Don’t know what to tell you other than it’s not 1965 and it’s hear to stay. There are plenty of practices doing well without it, but for me, I have multiple locations with over 9,000 claims for VSP per year alone and I won’t trade that for anything. You trajectory is all yours to do with as you can. No argument there. Good luck to you.

1. Yes I am. I work in the practice that was audited. [I have worked in a number of practices that have had Vision Plan audits, so I have some experience in the matter.] One of the partners at the time raised his/her objections at the meeting. The audit was initiated within2 weeks of that meeting, was more charts and more in depth than any other audit I or any one I have asked has ever seen, and was off cycle for Vision Plan Audits for that office. Regardless of the Vision Plan line, it was a retaliation. This was years ago. They got their wish, I will attend any meeting with Vision Plan, where they know my identity ever again.

2. EyeMed does not pretend to be something it is not. It does not force me to use a particular lab or dictate the specific fees I will collect for materials (then charge back much of those fees to cover the lab bill.) EyeMed does not purport to be the friend of Private Optometry. EyeMed may even send recall notices to my patients to get seen at one of their outlets next year. They may be horrible. But, they don’t pretend to be my best friend either. Call a spade a spade and don’t dress it in sheep’s clothing.

Vision Plan must make business decisions in its best interest. I must accept those, as a provider. They want the most lives they can get, and they want to hold on to lives at any cost. That is OK. It is not OK to tell me that these changes are for my good and in the best interest of my practice. Not getting a lab bill does not offset the lost revenue from not getting mark up on product. EyeMed does not tie my hands there. Suggesting I should do medical eye care at Vision Plan rates, when I should be submitting those claims to a patient’s medical carrier erodes my margins further. EyeMed does NOT make me compromise there. EyeMed does NOT have a form for me to fill out showing the patient how much “the plan” saved them, nor does the form say that, actually, the doctor’s office is really saving them all that money by not getting paid. Anyone in the industry knows that EyeMed is far cheaper than Vision Plan to employers, by a couple dollars per employee per month or more. Somehow, Vision Plan still retains 1 in 6 Americans (see their website) as members. So…

3. Why would an HR director choose Vision Plan? There is obviously some kind of value add. There are many doctors who accept Vision Plan that do not accept EyeMed. The panel is better, that adds value. EyeMed has all sorts of commercial locations with better hours than private offices, yet that does not always add enough value to draw a group away. It is disingenuous for Vision Plan to say that they must cut reimbursements to remain competitive. There are other criteria in the value proposition. Additionally, I take issue with the contention that a plan must price itself out of the market in order to compensate the doctors fairly. I will refer back to my earlier post; no one at Vision Plan is taking a pay cut or loosing their jobs, while I am asked to do far more for much less. I have not gotten a raise from them in a decade, but I have gotten pay cuts. Their staff get 10% increases in a single year! The doctors cannot be left holding the bag every time cuts need to be made. As we hear in politics daily, the pain needs to be shared. I am tired of shouldering the load. I don’t see any way for my office to win in a race to the bottom. My fees are different than Walmart and theirs are different than Costco. I cannot compete on cost with vertically integrated commercial locations, so I don’t.

I believe the intent of Al’s commentary is to place into focus the trends we are experiencing as practitioners. Vision Plan is not the worst offender. It is the biggest offender, but not the worst. However, I think it important to show what the “friend” of private practice is doing to us, as it serves to pull the wool from our eyes and hopefully shows the poorer plans for what they are as well.

We can keep doing what we are doing and hoping for the best, or we can see the world is changing and act accordingly. Reaction has not served us well in the past.

Vison Plan bashing is a great past time, but without action, it gets us nowhere. Towing the line that Vision Plan is a good thing for my practice gets us nowhere just as fast. Each doctor must look at his/her practice and the plans that own him/her. If an office takes everything under the sun, as most of us do, then Vision Plan likely is not the worst in that mix. A more reasoned approach would be to ditch to biggest looser first, then another, and so on, until a sustainable mix can be achieved. As I look at our office, we continue to escalate volume, throughput, COGS, expense, and wear and tear. The only thing not going up is Net. I believe Al; this trend is not sustainable. I want to change MY trajectory, while I still have a choice in the matter.

Respectfully

In terms of exam reimbursements, I would also post the question to you about how you might think EyeMed would respond when marketing to clients if VSP were to raise fees significantly? Do you not think that getting what you wish for might actually hurt?

I mean, if I’m an HR Director aka client and I find out that one plan pays docs significantly more and also costs me as the client more, then in turn find out a larger percentage of docs are on both panels, doesn’t it make sense that I would go the cheaper route? So in essence, as a panel doc for VSP, you’re not likely going to see that higher reimbursement anyway. You’ll see the lower one from EyeMed….that is when they aren’t directing their clients to retail.

I guess since Vision Plan is non-profit, they expect the doctors to be the same. By the way, according to the 2008 #53 Best Places to Work ranking (http://money.cnn.com/magazines/fortune/bestcompanies/2008/snapshots/53.html), the most common salaried position at Vision Plan paid just over $101,000. (Which was up $10k per year over the previous 2007 listing.) I don’t remember getting a 10% raise in reimbursements from Vision Plan in 2008. Did I miss something? Not bad for a non-profit. It is a shame that the greedy doctors cannot be so altruistic.

Not only did you feel it necessary to respond to each comment, but you also added a 1500 word manifesto on the virtues of VSP.

I am curious – are you just a VSP panel doc, or do you have a larger role in the company?

Perhaps that’s the answer? Why grow the pie of panel docs fighting over patients when many of them can just go serve the private pay market and in turn leave those patients for the panel docs with empty chairs.

You’re right, I don’t know any fellow OD’s with empty slots on their schedules. We are all busting at the seems with private pay patients filling up slots VSP clients are hoping to get in.

I mean how could they not be? We all know tons of independent plumbers and electricians and those idiots appraising our fancy sports cars are all making more than manged care docs right? They are the real millionaires next door aren’t they? Yeah…right…….