Naive OD Students

[IndianaOD]

The gist is anyone who works as an "indepentent" doctor under a commercial entitiy is actually in a illegal contract:

Who is an Independent Contractor?
A general rule is that you, the payer, have the right to control or direct only the result of the work done by an independent contractor, and not the means and methods of accomplishing the result.

Per the IRS definition, the corporation cannot control your hours or your fees.

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[IndianaOD]

Other considerations when identifying someone as an independent contractor may include:

• If the worker supplies his or her own equipment, materials and tools
• If all necessary materials are not supplied by the employer
• If the worker can be discharged at anytime and can choose whether or not to come to work without fear of losing employment
• If the worker control the hours of employment thus indicating they are acting as an independent contractor
• Whether the work is temporary or permanent

 

[IndianaOD]

I had a thought today (scary I know!)

Why do commercial docs charge soooo much less on average than private docs? Yes there are some awful private goobers out there as well. Commercial docs always say they are "independent" and thus LEGALLY can charge what they choose.

For example. Why do the local private docs in town charge $95 for a new exam while the local optical and wally charge around $40? Why not charge $75 and still be the low ball? You'd still get the price shoppers.

Is this too close to the point that the commercial docs can't compete with private if the prices are anywhere near each other?

My only thoughts are:
1. The docs aren't independent and are illegally controlled by the commercial entity that wants the most exams to sell the most glasses.
or
2. Commercial docs can't compete with private if the prices are remotely similar.

Any thoughts?

Crickets are chirping....tweet tweet

 

[eyestrain]

Crickets are chirping....tweet tweet

I thought birds tweet and crickets chirp?

Anyway, I think if there were only ONE commerical place in a town, they would (or should) be able to set their exam at least CLOSE to what the private practice guys are. But since there are so many of these places in many towns, they start competing for the uh....budget-conscious consumers, and the exams get cheaper and cheaper. That's my guess, anyway.

 

[IndianaOD]

I thought birds tweet and crickets chirp?

Anyway, I think if there were only ONE commerical place in a town, they would (or should) be able to set their exam at least CLOSE to what the private practice guys are. But since there are so many of these places in many towns, they start competing for the uh....budget-conscious consumers, and the exams get cheaper and cheaper. That's my guess, anyway.

Yeah, I didn't know how to write the chirping noise they make. Chirp, chirp would have been better.

I think its important to understand its illegal for the commercial places to set exam fees.

 

[KHE]

Yeah, I didn't know how to write the chirping noise they make. Chirp, chirp would have been better.

I think its important to understand its illegal for the commercial places to set exam fees.

It's also illegal for private practice employers to employ associate doctors as independent contractors yet that happens all the time all over the place. Where's the outrage over that?

The fact is is that when you take on a commercial lease, there is a tacit understanding between you and the commercial entity that you will both work to meet each others needs. You agree to provide quality eye exams at a certain price on certain days and times, and they in turn agree to provide you a steady stream of patients and national brand name recognition and advertising.

They are not setting your fees....you are. The fact that you are agreeing to their request means that you set the fee at what they requested. If you don't like it, then leave. This type of crap, while technically illegal is simply not worth battling over. If you don't like the proposed arrangement that is offered, just say no. It's that easy.

 

[docwatson]

It's also illegal for private practice employers to employ associate doctors as independent contractors yet that happens all the time all over the place. Where's the outrage over that?

I think it's an outrage and I brought it up. I'm sure I'm not the only one who thinks using the tax code like this is absolutely wrong.

 

[docwatson]

Why do commercial docs charge soooo much less on average than private docs? Yes there are some awful private goobers out there as well. Commercial docs always say they are "independent" and thus LEGALLY can charge what they choose.

For example. Why do the local private docs in town charge $95 for a new exam while the local optical and wally charge around $40? Why not charge $75 and still be the low ball? You'd still get the price shoppers.

There really shouldn't be a difference except that the commercial entity believes there is some kind of advantage to advertising a low price, and the optometrist assumes this what the commercial entity wants. And many private docs think "this is how I can drive business in my door."

I think this is simply an extreme lack of optometric business knowledge. There is no point in advertising below the average going rate for the area since we all know people don't choose a doctor on price alone.

Look at Wal-Mart. They are not, I repeat, are not always the cheapest... Always.

 

[Ben Chudner]

I think it's an outrage and I brought it up. I'm sure I'm not the only one who thinks using the tax code like this is absolutely wrong.

You are definitely not the only one. Not only is using the tax code like this wrong, but so is taking advantage of young OD's.

 

[IndianaOD]

There is no doubt almost all IC ODs private or commercial are in an illegal arrangement. I don't understand why some wally ODs and others don't sue for social security tax reimb after they loose their leases.

I think its simply unethical to have a non-medical entity controlling an OD.

My guess is that in the future the unending compition will squelch all material profits. Maybe then we'll all HAVE to function as the real doctor we were trained to be.

I think I've decided that we should all boycot the ODs from the new schools. Hmm.

 

[IndianaOD]

There really shouldn't be a difference except that the commercial entity believes there is some kind of advantage to advertising a low price, and the optometrist assumes this what the commercial entity wants. And many private docs think "this is how I can drive business in my door."

I think this is simply an extreme lack of optometric business knowledge. There is no point in advertising below the average going rate for the area since we all know people don't choose a doctor on price alone.

Look at Wal-Mart. They are not, I repeat, are not always the cheapest... Always.

This is very true but most people don't know it. Just like some walmarts charge more than other wallys.

 

[prettygreeneyes]

I thought birds tweet and crickets chirp?

Maybe the crickets in Indiana sound a little different than they do here on the West Coast.

 

[Ben Chudner]

I think I've decided that we should all boycot the ODs from the new schools. Hmm.

Wal-Mart has stated that their expansion plans will allow them to hire every graduating OD for the next couple of years. That plus the fact that Wal-Mart will have a financial interest in at least one of the schools means it won't matter if you boycott. I envision a time in the future where Wal-Mart will offer free rides to their school in return for 4 years of work in a Wal-Mart location. There is no other reason for them to invest in OD training. This is yet another reason why we need to fight the creation of new schools before they get as far as Pomona.

 

[eyestrain]

Wal-Mart has stated that their expansion plans will allow them to hire every graduating OD for the next couple of years.

Did they actually say that? I don't see how that's possible. Didn't they stop putting opticals in all their new stores?

 

[Ben Chudner]

Did they actually say that? I don't see how that's possible. Didn't they stop putting opticals in all their new stores?

I have now heard it from 2 different sources. The first was John Rumpakis who is a consultant to Wal-Mart, and the second was Bill Nolan from Williams Consulting Group. I don't know where they plan to expand, but I assume that includes replacing doctors that leave current locations.

 

[KHE]

Wal-Mart has stated that their expansion plans will allow them to hire every graduating OD for the next couple of years. That plus the fact that Wal-Mart will have a financial interest in at least one of the schools means it won't matter if you boycott. I envision a time in the future where Wal-Mart will offer free rides to their school in return for 4 years of work in a Wal-Mart location. There is no other reason for them to invest in OD training. This is yet another reason why we need to fight the creation of new schools before they get as far as Pomona.

Why do they need to invest in a school? Right now, it seems that all but the most dead of Walmarts have ODs clamoring over themselves to sign up for those leases. Not only that, it doesn't seem like the optical department is anywhere near the most profitable section of the store. In most cases, it almost seems like the optical functions close to a loss leader. Why would Walmart want to invest a pile of money so that they can produce more loss leaders? There has to be another motivating factor here.

 

[docwatson]

Why do they need to invest in a school? Right now, it seems that all but the most dead of Walmarts have ODs clamoring over themselves to sign up for those leases. Not only that, it doesn't seem like the optical department is anywhere near the most profitable section of the store. In most cases, it almost seems like the optical functions close to a loss leader. Why would Walmart want to invest a pile of money so that they can produce more loss leaders? There has to be another motivating factor here.

Why do you think they are a loss leader? They make a higher profit % off the optical than any other department in the store.

How much does it cost to run an optical? All those frames they have cost less than $1 and their help costs them next to nothing.

I worked at Wal-Mart and I've heard it from more than one manager that the optical is a HUGE profit maker.

 

[Ben Chudner]

Why do they need to invest in a school? Right now, it seems that all but the most dead of Walmarts have ODs clamoring over themselves to sign up for those leases. Not only that, it doesn't seem like the optical department is anywhere near the most profitable section of the store. In most cases, it almost seems like the optical functions close to a loss leader. Why would Walmart want to invest a pile of money so that they can produce more loss leaders? There has to be another motivating factor here.

I am sure there are many motivating factors and I bet we will only discover them once it is too late.

 

[KHE]

Why do you think they are a loss leader? They make a higher profit % off the optical than any other department in the store.

I have only heard that. I have never worked at Walmart, so I honestly don't know. However, I am skeptical of the claim that it's the highest % profit in the store. If that were the case, then the whole store would be the optical.

.[/QUOTE]

 

[IndianaOD]

Its been awhile and no one is disputing the statements, so I must conclude that:

Commercial ODs can't compete with private ODs at a similar price structure, and/or they knowingly choose to work in an illegal agreement. Nice

Either way, any OD that charges low ball fees or accepts low ball insurance plans propagates the idea that an eye exam is not worth spending good money on.

 

[Ben Chudner]

Either way, any OD that charges low ball fees or accepts low ball insurance plans propagates the idea that an eye exam is not worth spending good money on.

I agree with this, but I would like to know what you consider a low ball insurance plan. I think we can agree that Spectera and Davis are low ball, but what about VSP? And do you lump commercial OD's in the same group as private practice docs that take Spectera?

 

[IndianaOD]

I agree with this, but I would like to know what you consider a low ball insurance plan. I think we can agree that Spectera and Davis are low ball, but what about VSP? And do you lump commercial OD's in the same group as private practice docs that take Spectera?

Ben,

Yes any private doc that gives away exams or accepts low ball plans is in the same group.

Defining a low ball plan is difficult I agree. I would assume that the low ball plans are causing VSP to take a downward trend to compete. I guess we could come up with a certain dollar amount or percentage of medicare.

Anything under $50 IMO is a low ball.

 

[Ben Chudner]

Ben,

Yes any private doc that gives away exams or accepts low ball plans is in the same group.

Defining a low ball plan is difficult I agree. I would assume that the low ball plans are causing VSP to take a downward trend to compete. I guess we could come up with a certain dollar amount or percentage of medicare.

Anything under $50 IMO is a low ball.

I think that's reasonable. I use VSP as my benchmark for low ball. I don't take any insurance that reimburses less than VSP.

 

[JeffChou]

Regarding the quality of applicants, I see no reason to suspect that less qualified students are getting in now. If anything, we have seen an increase in average GPAs and OATs over the past decade. This is anecdotal, but two of the schools I have dealt with have said that last year's admissions cycle was the most competetive they've had. I would guess that this year's is just as competetive, if not more. There are more people applying these days and the new ODs are more and more educated following graduation since the curriculums are often being changed to include the latest technologies and procedures, medicines, and treatments (in anticipation of expansions in scope).

Quantitatively, we can even see that the average GPAs and OAT scores have increased or at least stayed the same between the 2000 and 2008 entering classes (http://www.opted.org/pdf/profile1.pdf, http://www.opted.org/pdf/profiles2008.pdf). If you want to see more in between, typing "profile" into the search function of the website will provide links to a few more years (2002, 2005, 2006, 2007 + 2008 PDFs are on the same webpage).

SUNY's entering classes saw a dip but the trend now is positive (http://www.sunyopt.edu/admissions/od_demographics.shtml). The latest class information printed in a handout but not published there shows the class of 2011 with an average overall GPA of 3.46 (down from 3.51 previously) and pre-req GPA of 3.43 (up from 3.4) and OAT avg 361, up from 341! Berkeley's classes seem to be just as smart as always (http://spectacle.berkeley.edu/opt_txtpp/admissions/admitprofl.html).

I will admit that opening up 5 more schools on top of our 17 will certainly make space for less qualified candidates. I would be more reserved in making the statement that we are already seeing less qualified applicants than before, or that the extra graduating ODs to come, will be any less competent than the last decade of graduating ODs.

That said, it is also up to the admissions committees to be admitting qualified students. Many ODs don't seem to trust that admissions committees are following through with their charge of admitting the best candidates because of the students who get in under "extenuating circumstances." Although I don't have any experience with being on any admissions board, I have no reason (at least not yet) to believe that any of these students get pity acceptances. Any student not qualified for a program who drops out, only serves to waste a seat for the subsequent years (or to let a transfer student come in). It really is in the school's best interest to accept competent and qualified students, and I'm convinced that there is substance behind an acceptance of a low score applicant.

If the schools do all follow through with their plans to open up, I definitely think that there will be an effect on the economy for the next generation of optometrists. It seems, in my opinion, that the best way to combat whatever negatives we often associate with more schools, is to have more students apply (increased competition for OD programs), and to increase the public's awareness of optometry's role in health and improving problems (systemic disease screening, VT before surgery, learning disorders caused by visual deficits). I think these changes may improve optometry's public image, and hopefully, the demand for its services. An aside--the public needs to be more informed about health and medicine (we have too many people popping antibiotics like candy and too many people relying on surgery rather than healthy living).

Anything said too naive? Please clarify.

 

[JeffChou]

I'm curious about the way optometrists are hiring other ODs. What it is about some of these private practice agreements that makes them technically illegal? What is the/a legitimate way to have a multi-doctor practice? I know that corporate can't (or should I say shouldn't) control hours or fees, but how do the private practice agreements infringe on the no-no side of the laws?

 

[VA Hopeful Dr]

Its been awhile and no one is disputing the statements, so I must conclude that:

Commercial ODs can't compete with private ODs at a similar price structure, and/or they knowingly choose to work in an illegal agreement. Nice

Either way, any OD that charges low ball fees or accepts low ball insurance plans propagates the idea that an eye exam is not worth spending good money on.

I've wondered about this for awhile. Is working as a not-really-independent contractor illegal in every state, or just some of them? I'll look at the SC laws later and get back to you, but I'd be curious of the exact wording in other states.

 

[IndianaOD]

I've wondered about this for awhile. Is working as a not-really-independent contractor illegal in every state, or just some of them? I'll look at the SC laws later and get back to you, but I'd be curious of the exact wording in other states.

I would believe that the tax laws are federal.

Has anyone noticed that almost all of the ODs that are helpful on here are private practice ODs, including all of the mentors.

I truly believe we are the only ones who really care about the profession.

At least with docs like myself and Watson you know what we believe. Warm fuzzies and ignorant optimism won't help any of us.

I welcome a civil debate upon any of my opinions including:

1. We are in an oversupply situation and with 4 new schools rumored it will only get worse.
2. Commercial practice is terrible for optometry from an image standpoint, and billing standpoint, and a professional standpoint.
3. Most students have no idea what is going on in the profession.
4. Medical discrimination must be addressed
5. ODs on average don't make nearly as much as similarly trained professions.

 

[eyestrain]

I welcome a civil debate upon any of my opinions including:

1. We are in an oversupply situation and with 4 new schools rumored it will only get worse.
2. Commercial practice is terrible for optometry from an image standpoint, and billing standpoint, and a professional standpoint.
3. Most students have no idea what is going on in the profession.
4. Medical discrimination must be addressed
5. ODs on average don't make nearly as much as similarly trained professions.

No debate here, I agree on all five points.

 

[Ben Chudner]

I agree a lot of your points, but here is where we differ:

1. We are in an oversupply situation and with 4 new schools rumored it will only get worse.

I would have stated that we have some oversupply issues in urban areas, especially cities near a school of optomety. I completely agree with the part about the new schools.

2. Commercial practice is terrible for optometry from an image standpoint, and billing standpoint, and a professional standpoint.

I don't know if I can honestly say that our image is hurt by corporate. The evidence that people bring up is patients going to the ER or their PCP's for emergencies. In my opinion that's not because of an image problem, but rather a problem with education. When one of my patients ends up in the ER I don't blame commercial OD's, I blame myself for not educating the patient so that they know I am on call for them. Futhermore, if the issue is that we are not seen as doctors because of corporate OD's, then why aren't our patients calling the OMD's? I think it's because our patients just don't realize they can call us and not that they don't want to because we aren't real doctors.

As for billing, I don't see how this would be true. True insurance companies (not vision plans) base the reimbursement levels on the RBRVU system. All they do is decide on the conversion factor. They don't look at commercial practices. As for vision plans, you can't blame commercial docs for VSP. That fee is based on the private practice docs in your area. Plans like Spectera, EyeMed and Davis should not be taken by private docs anyway, but if more private docs bailed on low ball plans, there would be change.

I don't know what you mean by professionally, but I think that's covered under image.

3. Most students have no idea what is going on in the profession.

Completely agree.

4. Medical discrimination must be addressed

Completely agree.

5. ODs on average don't make nearly as much as similarly trained professions.

I don't know that there are that many similarly trained professions. We like to compare dentists to us, but aside from length, is the training really that similar? I never went to dental school so I don't know. There are plenty of professions with less training than ours that make much more than us. There are professions with more training than ours that make less than us. I personally think it's pointless to compare. If you thought the average salary was too low for the amount of training, then you should have chosen a different career.

 

[JAZZEYE]

Its not just the amount of training that accounts for how much earning potential there is when comparing professions.
It is has to be taken into account the type of work that is being performed everyday.
Personally .....Dentistry is not something I want to do.
As an Optometrist right out of school I am hoping to earn around 100K ,I am told Dentists earn around 200K ....if so good for them, I wouldn't want to be a Dentist for any amount of money.
Also I like the earning potential of the Optical retail side.
Being entrepeneurial and a Doctor is very respectable IMO....most of the O.D.'s I've met are down to earth , successful , and pretty cool.
At the least, all of them make a decent living and for the most part enjoy their work.

 

[eyestrain]

As an Optometrist right out of school I am hoping to earn around 100K

Where do you plan on working after graduation? Private? Commercial?

 

[JAZZEYE]

Yes

 

[jefguth]

I'm curious about the way optometrists are hiring other ODs. What it is about some of these private practice agreements that makes them technically illegal? What is the/a legitimate way to have a multi-doctor practice? I know that corporate can't (or should I say shouldn't) control hours or fees, but how do the private practice agreements infringe on the no-no side of the laws?

What makes the IC arrangement (whether in a commercial or private office) illegal or not has more to do with tax law than anything else.

When an OD or commercial entity contracts you as an IC, you are basically your own business. To meet the IRS rules for that your should be setting your own fees, setting your own hours, paying your own taxes (social security, etc) - basically not be under influence from anyone.

However, not many IC's either in commercial or private practice are really going to have that much latitude. They might let you pay your own taxes b/c it saves them some money and hassle, but hours and fees are two things you could have a problem with.

 

[qwopty99]

Has anyone noticed that almost all of the ODs that are helpful on here are private practice ODs, including all of the mentors.

I truly believe we are the only ones who really care about the profession.

to be fair, it should be mentioned that commercial OD viewpoints aren't often well received on chat forums. go look at ODwire - the minute someone brings up an opposing viewpoint, they are met with hostility. heck - McDs (u know who i'm talking about) practically goes temper-tantrum-ballistic (he's a nutcase).

anyhoos - the trend probably is that PP docs are more helpful etc. on such forums, but keep in mind they are the same ones who suppress and attack all opposing arguments, to the point those points aren't even raised, and those posters stop participating.

 

[eyestrain]

anyhoos - the trend probably is that PP docs are more helpful etc. on such forums, but keep in mind they are the same ones who suppress and attack all opposing arguments, to the point those points aren't even raised, and those posters stop participating.

I don't think the PP docs are suppressing any opposing argument. I just think the commercial docs don't really have any good ones.

 

[qwopty99]

go visit ODwire and u'll see how commercial docs are treated. heck, u don't even have to be commercial - u just have to ask the question. then all hell breaks loose.

i've seen some try to play devil's advocate there before. they are met with online violence. i certainly don't see them post much any more. would u?

you seem to be on one side of the fence, which is why u can't see that it happens. but it does. unless u choose not to read S.McD's (et al.) posts.

 

[IndianaOD]

go visit ODwire and u'll see how commercial docs are treated. heck, u don't even have to be commercial - u just have to ask the question. then all hell breaks loose.

i've seen some try to play devil's advocate there before. they are met with online violence. i certainly don't see them post much any more. would u?

you seem to be on one side of the fence, which is why u can't see that it happens. but it does. unless u choose not to read S.McD's (et al.) posts.

IMO its because private docs are much more passionate about their careers and the profession as a whole.

Why is it so hard to believe that private docs have a problem with other ODs who propagate a negative image of optometry and pull down professional fees?

 

[qwopty99]

Indy. ur being a bit sloppy here. u've changed the content of your point.

u wrote:

Has anyone noticed that almost all of the ODs that are helpful on here are private practice ODs, including all of the mentors.

to which i replied,

to be fair, it should be mentioned that commercial OD viewpoints aren't often well received on chat forums, etc.

then i see,

Why is it so hard to believe that private docs have a problem with other ODs who propagate a negative image of optometry and pull down professional fees?

i don't think anyone made the point that people don't believe that private docs are mad. in fact, my posts generally agree with you given all my references to what goes on at ODwire.

my point is, ur right that PP ODs are more helpful on these boards, but i think u have to consider whether OD chat forums are a level playing field for commercial docs.

keep in mind - there ARE successful chat forums on the optical side of things. opticians have their own chat forums too (optiboard.com), so its not like u have to be a disease-treating PP OD to talk about things related to the eyes.

btw - i'm not trying to be pro-commercial. i cringe when i hear about classmates who work commercial. that said, u gotta be fair, otherwise your arguments become meaningless.

 

[eyestrain]

If commercial docs want a forum to go to without being harassed, they can always start one and talk about who did the most refractions that day.

 

[IndianaOD]

Indy. ur being a bit sloppy here. u've changed the content of your point.

u wrote:



to which i replied,



then i see,



i don't think anyone made the point that people don't believe that private docs are mad. in fact, my posts generally agree with you given all my references to what goes on at ODwire.

my point is, ur right that PP ODs are more helpful on these boards, but i think u have to consider whether OD chat forums are a level playing field for commercial docs.

keep in mind - there ARE successful chat forums on the optical side of things. opticians have their own chat forums too (optiboard.com), so its not like u have to be a disease-treating PP OD to talk about things related to the eyes.

btw - i'm not trying to be pro-commercial. i cringe when i hear about classmates who work commercial. that said, u gotta be fair, otherwise your arguments become meaningless.

Must have been how I said it, I was trying to get accross why more PP ODs are vocal on these forums.

 

[qwopty99]

If commercial docs want a forum to go to without being harassed, they can always start one and talk about who did the most refractions that day.

exactly. this is the attitude that commercial docs face on online forums.

here's a question for you then. please explain why a PP OD exam is necessarily better than a commercial OD exam.

 

[Ben Chudner]

IMO its because private docs are much more passionate about their careers and the profession as a whole.

Why is it so hard to believe that private docs have a problem with other ODs who propagate a negative image of optometry and pull down professional fees?

Please explain how you believe that commercial docs pull down professional fees. I mean this as a serious questions as most OD's are seeing mainly managed care patients. Those fees are dictated by the RBRVU system which affects all providers, not just eye care providers.

 

[IndianaOD]

Please explain how you believe that commercial docs pull down professional fees. I mean this as a serious questions as most OD's are seeing mainly managed care patients. Those fees are dictated by the RBRVU system which affects all providers, not just eye care providers.

I'll just speak from local experience in the last 3 cities/towns I have lived in. If I recall correctly the 3 walmarts ranged from $39 to $46 for a full exam including refraction. Contact lens exams from $55 to $70. There have been other commercial interests even lower than that. We have a local place with a huge sign saying $43.

The local docs around here charge $80-$100 for a full exam with refraction. We are at $93 for a new exam, contacts add extra.

I'll address 2 cohorts here; the joe public and the insurance companies. Joe public sees the $40 eye exam every time he goes to walmart. Over time Joe believes that this is what an eye exam costs and is worth. He doesn't understand that a doctor should charge more than a hair cut and doesn't know its a ploy by walmart to sell him $3 frames for $80.

Therefore the public thinks optometric services aren't worth spending good money on. Most people who go to the dentist expect its going to set them back over $120 around here.

Okay, lets consider the insurances. Lets say a patient has cataracts and the walmart doc bills medicare $40 for a 92004. How does that help medicare reimb increase when they currently reimb us $115 for that? Our fee is around $140 for that code with the refraction extra. That makes insurance companies think our services aren't worth the money. No doubt the OMD have to be unhappy about that as well, with good reason. Its also important to note that private insurances will pay even more than $115 for that code.

Note the 92xxx codes are only used by optometry and ophthalmology. It could drastically affect these.

VSP is the only vision insurance we take. Yes we do only get $65 for the exam from them, however the patients don't realize this. The cost of the exam is not degraded in their minds.

I hope this answer's Ben's question. I think he already knows this, but it is good for our students out there to realize the damage this has to the profession. If anyone needs help understanding this just ask.

 

[VA Hopeful Dr]

Okay, lets consider the insurances. Lets say a patient has cataracts and the walmart doc bills medicare $40 for a 92004. How does that help medicare reimb increase when they currently reimb us $115 for that? Our fee is around $140 for that code with the refraction extra. That makes insurance companies think our services aren't worth the money. No doubt the OMD have to be unhappy about that as well, with good reason. Its also important to note that private insurances will pay even more than $115 for that code.

Note the 92xxx codes are only used by optometry and ophthalmology. It could drastically affect these.

VSP is the only vision insurance we take. Yes we do only get $65 for the exam from them, however the patients don't realize this. The cost of the exam is not degraded in their minds.

I hope this answer's Ben's question. I think he already knows this, but it is good for our students out there to realize the damage this has to the profession. If anyone needs help understanding this just ask.

I won't address the public perception end of things, so I just deleted that part.

Now, insurance. It is true that, once upon a time, Medicare (and others) took a random sampling of usual and customary fees and set their fees accordingly. That is no longer the case. Even if every single eye care practitioner set their fees at 300% above medicare allowable, the reimbursements wouldn't increase.

 

[KHE]

I won't address the public perception end of things, so I just deleted that part.

Now, insurance. It is true that, once upon a time, Medicare (and others) took a random sampling of usual and customary fees and set their fees accordingly. That is no longer the case. Even if every single eye care practitioner set their fees at 300% above medicare allowable, the reimbursements wouldn't increase.

What if every single eye care practitioner set their fees at 30% of the medicare allowable. Do you think reimbursements would go down?

 

[broadway]

If commercial docs want a forum to go to without being harassed, they can always start one and talk about who did the most refractions that day.

What do you think private practice optometrists do all day?

 

[IndianaOD]

Its nice to hear that OD students realize that ODs like Watson, McD, and myself are actually trying to help.

I get a lot of PMs on a weekly basis, here is one I recently recieved:

Quote:
"IndianaOD,

I must say that before I got into optometry school I did not appreciate your posts. I thought that you were pessimistic and irrational. However, since starting OD school and talking to optometrists and my professors, your posts are incredibly insightful and true. Students need to understand that they cannot just breeze through their 4 years and get that cushy private practice or hospital or OMD co-management job that all of us want. That is why 50% (at least) of OD graduates go commercial. They don't think about their futures or they think they're gonna "pay off their loans first". They've never heard of the golden shackles have they? I'm already putting plans in motion to get what I want out of my education and I actually wanted to thank you because I, for one, DO get a lot out of your posts both here and on ODwire.

Thank you!"

Those kind of posts keep me around here

 

[Ben Chudner]

I'll just speak from local experience in the last 3 cities/towns I have lived in. If I recall correctly the 3 walmarts ranged from $39 to $46 for a full exam including refraction. Contact lens exams from $55 to $70. There have been other commercial interests even lower than that. We have a local place with a huge sign saying $43.

The local docs around here charge $80-$100 for a full exam with refraction. We are at $93 for a new exam, contacts add extra.

I'll address 2 cohorts here; the joe public and the insurance companies. Joe public sees the $40 eye exam every time he goes to walmart. Over time Joe believes that this is what an eye exam costs and is worth. He doesn't understand that a doctor should charge more than a hair cut and doesn't know its a ploy by walmart to sell him $3 frames for $80.

Therefore the public thinks optometric services aren't worth spending good money on. Most people who go to the dentist expect its going to set them back over $120 around here.

Okay, lets consider the insurances. Lets say a patient has cataracts and the walmart doc bills medicare $40 for a 92004. How does that help medicare reimb increase when they currently reimb us $115 for that? Our fee is around $140 for that code with the refraction extra. That makes insurance companies think our services aren't worth the money. No doubt the OMD have to be unhappy about that as well, with good reason. Its also important to note that private insurances will pay even more than $115 for that code.

Note the 92xxx codes are only used by optometry and ophthalmology. It could drastically affect these.

VSP is the only vision insurance we take. Yes we do only get $65 for the exam from them, however the patients don't realize this. The cost of the exam is not degraded in their minds.

I hope this answer's Ben's question. I think he already knows this, but it is good for our students out there to realize the damage this has to the profession. If anyone needs help understanding this just ask.

Indiana, I think your post demonstrates one of the biggest issues I have with these types of sites. While you have articulated your position well, you state your opinion as though it is fact. I can't argue with you about joe public because I have no idea what the public thinks about low cost eyecare. Your opinion makes sense. Maybe the public devalues the cost of an eye exam because they see $49 exams at Wal-Mart. Or maybe the public doesn't really believe they are getting as good as an exam at Wal-Mart (whether or not that is really the case) and they just don't really think the extra money is worth the perceived difference. I know that when I go to Great Clips for a haircut, it is not as good as Kenneth L Salon, but I don't care because I would rather pay less. It's not that I don't think a great haircut should cost $150, it's just that I don't need a $150 haircut. I have no facts to back that idea up. It's just a theory as to how some people may think about $49 eye exams.

As for insurances, your opinion also makes sense in theory, but the facts don't confirm your hypothesis. We can talk about Medicare because it's national and most medical plans follow its lead. Here is the formula used to calculate the reimbursement for any code:

[(Work RVU*Budget Neutrality Adjustor (0.8806 in 2008)(Round Product to 2 Decimal Places)*Work GPCI)+(Transitional Non-Facility PE RVU*PE GPCI)+(MP RVU*MPGPCI)]*Conversion Factor

Notice that you don't see anything that mentions how much doctors charge for the code. The fact is that this calculation is applied to every code that Medicare reimburses for. Not just OD/OMD codes, but ortho codes, ENT codes, derm codes, etc. Now you can say that when comming up with the specific OD/OMD RVU values to plug into that calcluation, the government takes into account what doctors are charging. If that were true, the reimbursement for a code like 92004 would be going down because of all of the commerical doctors billing $49. A quick look at the Medicare Physician Fee Look-up will reveal the following for Indiana:

2000 - $99.49
2001 - $114.17
2002 - $116.90
2003 - $117.10
2004 - $120.87
2005 - $122.83
2006 - $122.32
2007 - $114.96

The fact is that reimbursement has increased 15% between 2000 and 2007. It may not have kept up with inflation (and in fact decreased by $7.36 in 2007), but neither have the majority of Medicare codes across all medicine specialties. I am not going to say whether or not I believe corporate optometry is bad for optometry. That was not the point of my question. I just wanted to point out that it is your opinion that commerical optometry results in lower reimbursements and posting an opinion on this site does not make it fact. That's not to say that your opinions aren't valid, because they are. I just think it's important that the students know which posts are factual and which are opinion based.

 

[Ben Chudner]

What if every single eye care practitioner set their fees at 30% of the medicare allowable. Do you think reimbursements would go down?

If you are including OMD's then probably the reimbursements would go down. But the fact of the matter is that whenever there is an annouced decrease in the reimbursment for the ophthalmologic codes, the American Ophthalmology Association, and the American Optometric Association go to Congress to make sure it doesn't happen. In one year they turned a proposed double digit decrease into a slight increase. Other times they are not as sucessful, but to my knowledge Congress has never said anything about how much Dr. Smith at Wal-Mart charges when negotiating.

 

[VA Hopeful Dr]

Its nice to hear that OD students realize that ODs like Watson, McD, and myself are actually trying to help.

I get a lot of PMs on a weekly basis, here is one I recently recieved:

Quote:
"IndianaOD,

I must say that before I got into optometry school I did not appreciate your posts. I thought that you were pessimistic and irrational. However, since starting OD school and talking to optometrists and my professors, your posts are incredibly insightful and true. Students need to understand that they cannot just breeze through their 4 years and get that cushy private practice or hospital or OMD co-management job that all of us want. That is why 50% (at least) of OD graduates go commercial. They don't think about their futures or they think they're gonna "pay off their loans first". They've never heard of the golden shackles have they? I'm already putting plans in motion to get what I want out of my education and I actually wanted to thank you because I, for one, DO get a lot out of your posts both here and on ODwire.

Thank you!"

Those kind of posts keep me around here

I'd be careful here, the powers that be get a might upset when folks post PMs they've received without getting the sender's permission. While I certainly don't often agree with you, you do at least generate discussion and I'd hate to see you banned/post held.