Private vs. Commercial

[anguyen531]

I know this is a repetitive question on the forum, but I didn't want to scroll through all the threads to find it...

What are the main pros and cons of each mode of practice? For commercial settings is their any limitations as in what procedures you can actually perform?

Thanks for any input! I need all the advice on this topic as I can get! My parents keep debating with me about the two and I want to see what everyone has to say...

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[iiiimonica]

I know this is a repetitive question on the forum, but I didn't want to scroll through all the threads to find it...

What are the main pros and cons of each mode of practice? For commercial settings is their any limitations as in what procedures you can actually perform?

Thanks for any input! I need all the advice on this topic as I can get! My parents keep debating with me about the two and I want to see what everyone has to say...

sure i could tell you the major differences, but YOU should shadow and find out.

 

[Ben Chudner]

I know this is a repetitive question on the forum, but I didn't want to scroll through all the threads to find it...

What are the main pros and cons of each mode of practice? For commercial settings is their any limitations as in what procedures you can actually perform?

Thanks for any input! I need all the advice on this topic as I can get! My parents keep debating with me about the two and I want to see what everyone has to say...

Paging drgregory.

 

[prettygreeneyes]

Paging drgregory.

 

[drgregory]

i didnt see the strobelight of the OD symbol on the horizon, or i'd have been here sooner. c'mon guys, you know how to summon me.
private vs corporate...lets see, where do i begin...breathing in...

yeah...my physician, AN MD (you know, the providers who are smart enough to not work in shopping malls), said i should take it easy and not get too worked up on explaining the evil of corporate optometry.

oh good. here come the orderlys to sedate me now..

 

[PBEA]

I know this is a repetitive question on the forum, but I didn't want to scroll through all the threads to find it...

What are the main pros and cons of each mode of practice? For commercial settings is their any limitations as in what procedures you can actually perform?

Thanks for any input! I need all the advice on this topic as I can get! My parents keep debating with me about the two and I want to see what everyone has to say...

Commerical OD's provide exams mainly for the purpose of refraction or routine contact lens fitting. There is little opportunity beyond that. No specialization, no disease, no specialty contact lenses, etc.,. The corporate overlords (the OD's boss) frown on an OD who is utilizing their space to provide clinical care, and not selling glasses, or contacts. If this suits you, then you will earn a decent living.

In private practice, mostly you choose how you practice, you can practice exactly as a corporate OD does, or you may decide to specialize, etc. You will also earn a decent living.

What specific "advice" were you looking for?

 

[cpw]

Commerical OD's provide exams mainly for the purpose of refraction or routine contact lens fitting. There is little opportunity beyond that. No specialization, no disease, no specialty contact lenses, etc.,. The corporate overlords (the OD's boss) frown on an OD who is utilizing their space to provide clinical care, and not selling glasses, or contacts. If this suits you, then you will earn a decent living.

In private practice, mostly you choose how you practice, you can practice exactly as a corporate OD does, or you may decide to specialize, etc. You will also earn a decent living.

What specific "advice" were you looking for?

I would say MOST ODs provide exams mainly for the purpose of refraction or routine contact lenses. Unless you work in a retirement community this is going to be 90% of your business. Period. We're primary care.

I do work commercial. I have never been told how to do my exams. I do punctal plugs. I treat glaucoma. I get referrals to screen diabetics. I fit TONS of contacts (including RGP, bitoric RGP, and reverse geometry). I see red eyes, corneal abrasions, etc every day.

The only difference to my practice were I out in private pratice... I'd make money on the sale of glasses. that's the only difference.

 

[drgregory]

The only difference to my practice were I out in private pratice... I'd make money on the sale of glasses. that's the only difference.

and you wouldnt work in a mall. by the way, how much is your exam fee? probably lower than the cost of a hair coloring next door at the hair salon.

 

[xmattODx]

I know this is a repetitive question on the forum, but I didn't want to scroll through all the threads to find it...

What are the main pros and cons of each mode of practice? For commercial settings is their any limitations as in what procedures you can actually perform?

Thanks for any input! I need all the advice on this topic as I can get! My parents keep debating with me about the two and I want to see what everyone has to say...

Where do you live? If you are anywhere near Atlanta come visit me at my place of work. You'll see the hell that commercial optometry is. We're told to never say no to a walk-in - even if we have 40 patients on the schedule. We're treated like techs by the high school drop out "opticians". We are told by general managers to speed up as 10 minute exams are not quick enough.

We sell our time for $39 or less an exam. Our patients have no clue that we went to school to learn how to do what we do. They don't listen, they don't understand why we won't fit them in contact lenses when their eyes look like swiss cheese. They are angry when we tell them they need to pay to see us.

You'll also see that in commercial optometry (I'm an employee of the leasing doc) I can take three weeks off starting next week (without pay) to go to Europe and I'll still come back to a job. I also get paid a truck load of money with no responsibility. Is it good for the profession? No. Is it good for me? Yes. Is it fun? No.

 

[cpw]

and you wouldnt work in a mall. by the way, how much is your exam fee? probably lower than the cost of a hair coloring next door at the hair salon.

$69 comp. exam
$99 contact lens exam
$119 toric
$139 bifocal/ RGP

The only insurance I take is Eyemed

And -- I'm next to Nordstrom thankyouverymuch

 

[Ryan_eyeball]

$69 comp. exam
$99 contact lens exam
$119 toric
$139 bifocal/ RGP

The only insurance I take is Eyemed

And -- I'm next to Nordstrom thankyouverymuch

Here is what I charge... $70 Comp. Exam including Dilation at no charge ( i feel this should be part of a comp exam)
$20 screening FDT field if they chose to have it done
$100 spherical CL exam
$150 Toric, bifocal, monovision, RGP
$170 RGP bitoric, RGP bifocal

practice in a two door state

insurance Eyemed...if they have something else, i give a superbill out, and let them file it themselves.

 

[PBEA]

I would say MOST ODs provide exams mainly for the purpose of refraction or routine contact lenses. Unless you work in a retirement community this is going to be 90% of your business. Period. We're primary care.

Yes, generally most eye exams are for this purpose. I don't work in a retirement community but my numbers are more like 50/50 (not 90%), and I have a healthy dispensary! exclamation mark! Yes, we are primary care, as you state this will often include red eyes, glaucoma, etc. It just depends on how much you see of what.

I do work commercial. I have never been told how to do my exams. I do punctal plugs. I treat glaucoma. I get referrals to screen diabetics. I fit TONS of contacts (including RGP, bitoric RGP, and reverse geometry). I see red eyes, corneal abrasions, etc every day.

The only difference to my practice were I out in private pratice... I'd make money on the sale of glasses. that's the only difference.

I worked in several commercial setting right after graduation, I even had me my own little Wal-Mart lease (after 6 months I forced my way out of the lease agreement, and moved on). Yes, I got some red eyes, etc, but like I said, It just depends on how much you see, and my experience was that it is much less then in private practice. Making money on the sale of spectacles, is ONE of the differences, but is certainly not the only difference. BTW, who was referring diabetic screenings to you? It's my understanding, that PCP's can only refer to providers in-network.

 

[drgregory]

$69 comp. exam
$99 contact lens exam
$119 toric
$139 bifocal/ RGP

The only insurance I take is Eyemed

And -- I'm next to Nordstrom thankyouverymuch

go two doors down and youll find out that the hair coloring costs more than your tiny comprehensive exam fee. do you think the hair stylist went to school for 8 years or 8 weeks? unbelievable people.

 

[xmattODx]

go two doors down and youll find out that the hair coloring costs more than your tiny comprehensive exam fee. do you think the hair stylist went to school for 8 years or 8 weeks? unbelievable people.

What should a CVE cost? How do you address that a lot of the general population has difficulty paying $69 for an eye exam? Why place the blame at the feet of current ODs - the blame lies with our forefathers giving services away. I don't see how the market/society/whatever-you-want-to-call-it can cope with a drastic increase in the price of what most would consider a "basic" eye exam.

 

[drgregory]

the blame lies with our forefathers giving services away.

this is true, but it is up to us NOW to change that.

 

[cpw]

I see the point you're trying to make, drgregory.. and it IS a good one.

I get patients coming in complaining that the place down the street has a "coupon" and will I honor it... I makes me very infuriated. Especially when the people carrying the coupon are carrying 400 dollar Coach bags.

However, if I tried to raise my exam fees to $95 dollars, I'd price myself right out of the market in this area, now. Since the office is new, we start lower now, and as we build a steady, loyal patient base we slowly raise the fee.

The fact that an office down the street has a $39 dollar coupon is not under my control.

 

[drgregory]

I see the point you're trying to make, drgregory.. and it IS a good one.

I get patients coming in complaining that the place down the street has a "coupon" and will I honor it... I makes me very infuriated. Especially when the people carrying the coupon are carrying 400 dollar Coach bags.

However, if I tried to raise my exam fees to $95 dollars, I'd price myself right out of the market in this area, now. Since the office is new, we start lower now, and as we build a steady, loyal patient base we slowly raise the fee.

The fact that an office down the street has a $39 dollar coupon is not under my control.

and i understand your point. what we need is a large scale move, in unison, where all eye care providers bring fees for service to an acceptable level. unfortunately, many commercial places have their prices illegaly controlled by the franchise, and many private places are commercial places in disguise.
and i realize that you would likely be twittling your thumbs all day if you raised them in the setting you are in. tough situation, but the only way i can see it ending is for TRUE independent contractors like you to keep nudging up your fees, and likewise provide the care that justifies those fees (likely the care you are already providing now, only for much less than you value it)

 

[cpw]

I want to know how the franchises are getting away with illegally putting out $39 dollar eye exam coupons the docs are forced to honor.

 

[drgregory]

I want to know how the franchises are getting away with illegally putting out $39 dollar eye exam coupons the docs are forced to honor.

thats ok everyone, i'll field this one. easy...corporate ODs, most of whom accepted their career choice at corporate locations due to the fact that no readily availible opportunity presented itself, fear losing the only job offer they have gotten so far. fear of biting the hand that feeds (borderline starves them) them. you declare open war on your franchise overlord, and you are jobless. what you need, or anyone willing to call this illegal behaviour, is a backup plan. get a position with a "corporate bitter" OD (im the president of this club, so i might have contacts) and let her/him know of your intentions. that way when the high school educated "store manager" at walmart bucks your newly set fees, you kindly hand them the business card of your already "consulting" lawyer. all along you have been carefully collecting documents or, lack of documents that wally world has given you, and now its time that your lawyer says "jump on it".
however, your first plan of attack should have been via the initial lawyer consultation making sure that you wouldnt accrue huge professional fees, and making sure that your time and lawyer time would be compensated by monies gained from a hearing.
i didnt have the balls to do this. i did, however, have the balls to go to a bank and get a loan and open MY OWN PRIVATE PRACTICE.

who knows. maybe a dream. i dont understand law enough (or at all) to be sure the above scenario would work. i do know a good lawyer though. goes by the name of prozack.

 

[rpie]

I want to know how the franchises are getting away with illegally putting out $39 dollar eye exam coupons the docs are forced to honor.

They usually can get away with these “fascinating” coupons because the doctor that holds the lease is the one that is behind it along with corporate HQ playing a major role in encouraging this type of marketing.

Around our neighborhood Doctors Vision works has put out a back to school coupon that offers $1.00 eye exams……. Compliments of Dr, X independent doctor of optometry, leaseholder of 5 Doc. Vision works offices and employer of 7 OD s.


Humm…one-dollar eye exam…… I wonder what kind of patients will come in wanting to use these coupons………

Pt.: Say Doc. Can I use this coupon to get this metal sliver out of my eye? If I go to my regular eye doctor I have to pay$20.00 co-pay so if I can use your coupon I’ll save 19 bucks!

 

[cpw]

Around our neighborhood Doctors Vision works has put out a back to school coupon that offers $1.00 eye exams……. Compliments of Dr, X independent doctor of optometry, leaseholder of 5 Doc. Vision works offices and employer of 7 OD s.

yeah, Vision Works is HUGE with the coupons around here. So is For Eyes. All for 40 bucks or less. I'll have to look out for the $1 ones... that's crazy.

 

[xmattODx]

yeah, Vision Works is HUGE with the coupons around here. So is For Eyes. All for 40 bucks or less. I'll have to look out for the $1 ones... that's crazy.

I think y'all will notice that with VisionWorks/Dr's VisionWorks the leasing doctor leases multiple locations. Here, where I work, our new lease holding doctor holds leases in five states. He employs well over a hundred ODs. They hold multiple leases for a number of reasons. One - volume. You don't make much money doing $39 exams but if you do them in five states...

2) Control. It is much easier for a corporation to control a single leasing doctor than 50.

3) Back room deals. The leasing doctor gets more than just his $39 for the exam. Through some murky legal documents "loans" are made from corporation to leasing doc and "assests" are purchased from the leasing doc by the corporation. All quite illegal I am sure. If not illegal at least unethical.

drgregory - You may have answered this before but what do you charge for a comprehensive new patient exam? In what percentage of patients do you actually receive the full exam amount?

 

[drgregory]

drgregory - You may have answered this before but what do you charge for a comprehensive new patient exam? In what percentage of patients do you actually receive the full exam amount?

depends on which office

office one: new comp + refraction = $309

office two: " " = $259

usually get paid in full except for dreaded VSP, in which case we dont get anywhere near that amount.

 

[xmattODx]

depends on which office

office one: new comp + refraction = $309

office two: " " = $259

usually get paid in full except for dreaded VSP, in which case we dont get anywhere near that amount.

Thanks for the quick reply. What does a new exam entail in your office?

 

[Ben Chudner]

depends on which office

office one: new comp + refraction = $309

office two: " " = $259

usually get paid in full except for dreaded VSP, in which case we dont get anywhere near that amount.

Wait a second. With all due respect drgregory, as I am a big fan of your anti-corporate posts, but simply quoting fees is only part of the story. We need some additional details such as the precentage of your patients that have vision insurance vs those that are truely private pay. Also, the percentage of patients that have VSP. Before we private practice docs attack the corporate docs like CPW that charge $69 for an exam we have to remember that VSP only pays about $70-$80 for a full exam. It make you feel better to charge over $300, but at the end of the day your VSP reimbursement is not much higher than CPW's and she has much less overhead than we do. When you look at some of the California docs that are 75% VSP, maybe it's time to look at some of the other problems our profession has.

 

[drgregory]

Thanks for the quick reply. What does a new exam entail in your office?

most comprehensives go something like this:

technician: history, BP, VAs, CT, FDT screener, wavefront corneal map/autorefraction, NCT, epic refraction, stereo, color vision, titmus peripheral fields

many times the patient sees the extern in between technician and OD

OD: review Hx, pupils, eoms, repeat CT, refraction, dilate and then eye health evaluated per preference of instrumentation.

btw, we had the optos for a while and hated it.

 

[drgregory]

Wait a second. With all due respect drgregory, as I am a big fan of your anti-corporate posts, but simply quoting fees is only part of the story. We need some additional details such as the precentage of your patients that have vision insurance vs those that are truely private pay. Also, the percentage of patients that have VSP. Before we private practice docs attack the corporate docs like CPW that charge $69 for an exam we have to remember that VSP only pays about $70-$80 for a full exam. It make you feel better to charge over $300, but at the end of the day your VSP reimbursement is not much higher than CPW's and she has much less overhead than we do. When you look at some of the California docs that are 75% VSP, maybe it's time to look at some of the other problems our profession has.

one office we are about 70-80% vsp, other we are at about 20%. guess which one grosses more? PEOPLE WILL PAY OVER $300 FOR A THOROUGH EYE EXAMINATION. how much do you pay to see your dentist?

 

[cpw]

one office we are about 70-80% vsp, other we are at about 20%. guess which one grosses more? PEOPLE WILL PAY OVER $300 FOR A THOROUGH EYE EXAMINATION. how much do you pay to see your dentist?

My co-pay $20

 

[cpw]

one office we are about 70-80% vsp, other we are at about 20%. guess which one grosses more? PEOPLE WILL PAY OVER $300 FOR A THOROUGH EYE EXAMINATION. how much do you pay to see your dentist?

My office is less than 20% insurance, but it's going higher since Eyemed just took on Aetna. (*sigh*) But, on the upside, it IS bringing in more patients.

It is also 70% contact lenses = $99 + per exam.

 

[xmattODx]

My office is less than 20% insurance, but it's going higher since Eyemed just took on Aetna. (*sigh*) But, on the upside, it IS bringing in more patients.

It is also 70% contact lenses = $99 + per exam.

But you're still evil!

 

[Ben Chudner]

one office we are about 70-80% vsp, other we are at about 20%. guess which one grosses more? PEOPLE WILL PAY OVER $300 FOR A THOROUGH EYE EXAMINATION. how much do you pay to see your dentist?

You do not have to convince me about the evils of VSP. My office is about 25% percent VSP and yet it only represents about 16% of my revenue. My point is that your office that is 70-80% VSP is not much different than a corporate location in terms of charging for your time. I have no idea where you practice, but I know that on average across the country VSP pays roughly $70-$80 for a comprehensive eye exam. In some places it is worse. You are constantly making the point that corporate docs are a problem because they charge so little for their time. Or as you put it, less than the cost to color your hair. Well, you are doing the same thing for 70-80% of your patients in your one office. How are we (I do it too) any different than the corporate docs, except for the fact that our overhead is much higher and therefore we have to see a ton more patients per hour to be profitable at that reimbursement level?

You also did not answer my question regarding vision insurance patients. If your practice is 20% private pay in one office and 80% in the other, than you are the man. I suspect, however, that you also take Medicare. If so your reimbursement for those exams is right around VSP with the bonus that you can charge extra for the refraction. I think we need to be honest with the students comming out of school. You can charge whatever you want, but if your office takes insurance plans, even those that are better than VSP, you will not be reimbursed at 100%. I do agree that patients will pay over $300 for a thorough eye examination, just not when they have insurance that covers one. So, if you are truely collecting over $300 per exam on 80% of your patients in one office and 20% in the other, I salute you. If you are like the majority of private practices in the country, that's just not the reality.

 

[cpw]

But you're still evil!

Yes, my plan for total global domination is almost complete !!

"same thing we do every night Pinky.... "

 

[sco1styear]

btw, we had the optos for a while and hated it.

Sorry to go completely off subject...but why did you hate it?

 

[KHE]

You do not have to convince me about the evils of VSP. My office is about 25% percent VSP and yet it only represents about 16% of my revenue. My point is that your office that is 70-80% VSP is not much different than a corporate location in terms of charging for your time. I have no idea where you practice, but I know that on average across the country VSP pays roughly $70-$80 for a comprehensive eye exam. In some places it is worse. You are constantly making the point that corporate docs are a problem because they charge so little for their time. Or as you put it, less than the cost to color your hair. Well, you are doing the same thing for 70-80% of your patients in your one office. How are we (I do it too) any different than the corporate docs, except for the fact that our overhead is much higher and therefore we have to see a ton more patients per hour to be profitable at that reimbursement level?

.

I've said the exact same thing for years. Many private practitioners love to bash bash bash away at corporate doctors and their fees yet they are really no different in the sense that they spend 90% of their days spinning and grinning and being reimbursed $70 for 90% of their exams. (though they may "charge" $250.)

Dr. Chudner....why are you still taking VSP? WHy not drop it? Your revenue will go down 16%, but you will do 25% less work. Am I missing something here? It seems that only a fool would take VSP under those circumstances.
Or are you simply relying on VSP to bring in the occasional higher paying "medical" case?

I also agree that patients are NOT willing to spend $300 out of pocket if they have insurance to cover it. I know that I would not pay $300 out of pocket for just about ANY medical procedure if I could have it covered somewhere else, and my household income is way above the national average.

 

[Ben Chudner]

I've said the exact same thing for years. Many private practitioners love to bash bash bash away at corporate doctors and their fees yet they are really no different in the sense that they spend 90% of their days spinning and grinning and being reimbursed $70 for 90% of their exams. (though they may "charge" $250.)

Where do you think I came up with the argument.

Dr. Chudner....why are you still taking VSP? WHy not drop it? Your revenue will go down 16%, but you will do 25% less work. Am I missing something here? It seems that only a fool would take VSP under those circumstances.
Or are you simply relying on VSP to bring in the occasional higher paying "medical" case?

You are absolutely right Ken. I have seriously researched whether or not to drop VSP. I have watched several of my friends do it. They always say the same thing. My gross is down X% but my net is only down X-Y%. Or in other words I could be working 25% less and only reduce my revenue by 16%. In a smaller practice, a 16% reduction in revenue is not that much. In a large practice, it can be a lot of money. Right now I have an associate that is trying to build a practice. VSP is helping to keep her books busy. When she gets to a point where she is booked 3-4 weeks out rather than 1-2 days, then I will have the excuse I need to drop VSP.

I also agree that patients are NOT willing to spend $300 out of pocket if they have insurance to cover it. I know that I would not pay $300 out of pocket for just about ANY medical procedure if I could have it covered somewhere else, and my household income is way above the national average.

That's what caught my attention in drgregory's post. I could charge $500 an exam, but the problem is my practice has less than 10% true private pay. I have a lot of patients that have no routine vision, but they don't like to come back if you don't make a medical diagnosis to charge their insurance. I am still curious as to what drgregory is really getting for an eye exam. I can tell you that for every dollar I charge, I only collect on average 82 cents. I could raise my fees, but then I would collect less per dollar I charge, because I already charge more than most insurance companies will pay.

 

[drgregory]

Where do you think I came up with the argument. You are absolutely right Ken. I have seriously researched whether or not to drop VSP. I have watched several of my friends do it. They always say the same thing. My gross is down X% but my net is only down X-Y%. Or in other words I could be working 25% less and only reduce my revenue by 16%. In a smaller practice, a 16% reduction in revenue is not that much. In a large practice, it can be a lot of money. Right now I have an associate that is trying to build a practice. VSP is helping to keep her books busy. When she gets to a point where she is booked 3-4 weeks out rather than 1-2 days, then I will have the excuse I need to drop VSP.That's what caught my attention in drgregory's post. I could charge $500 an exam, but the problem is my practice has less than 10% true private pay. I have a lot of patients that have no routine vision, but they don't like to come back if you don't make a medical diagnosis to charge their insurance. I am still curious as to what drgregory is really getting for an eye exam. I can tell you that for every dollar I charge, I only collect on average 82 cents. I could raise my fees, but then I would collect less per dollar I charge, because I already charge more than most insurance companies will pay.

at the 80% vsp office, the remaining 20% is comprised of about 3-4% medicare/aid, and 15% medical insurers (which pay in full) and 1% cash payers.
at the 20% vsp office, another 20% is medicare, and another 30% is medical insurers, and the rest is private pay.
a note on the vsp infected office - anything that is medical related is billed to medical insurance. none of this monitoring diabetic retinopathy et al for the measley vsp reimbursement.
another difference from private vs corp is that all of our opticians are CERTIFIED OPTICIANS, all of our techs are either LPNs or COMTs. not high school graduates that transferred from the shoe store three doors down. we also offer surgical treatment (via our ophthalmologists). our contact lens fitting fees are more appropriate as well:

new spherical = $179
new toric $187
new multi/mono $239
est spherical = $79
est toric = $87
est multi = $97
this is on top of exam fees. all of these are out of pocket. still look like a corporate office?
also, there is a CLEAR difference in our products. no lenses are dispensed/sold without antireflective (Zeiss Advantage or Crizal alize), all progressives are either Zeiss (Gradal, GT2, or Individual) or Varilux Physio. You dont get nickeled and dimed to "buy" a warranty. someone comes back and has scratched lenses, we remake them.
lastly, there is a CLEAR difference in our patients. we see patients who care about the health of their eyes. corporate ODs dont see alot of those patients, nor does the corporate environment spawn them.

 

[sco1styear]

also, there is a CLEAR difference in our products. no lenses are dispensed/sold without antireflective (Zeiss Advantage or Crizal alize)

What about when a patient's needs due to hobbies or occupation would be better met without AR? I know they've come a long ways but they still seem to get pretty dirty and smudged. I would think they would be less than beneficial for someone who does a lot of work outside - maybe you don't have those patients but I know in my area many farmers wouldn't be happy with AR on their lenses. I'm sure that there are other occupations and hobbies that also would fall into this category.

 

[KHE]

at the 80% vsp office, the remaining 20% is comprised of about 3-4% medicare/aid, and 15% medical insurers (which pay in full) and 1% cash payers.
at the 20% vsp office, another 20% is medicare, and another 30% is medical insurers, and the rest is private pay.

Drgregory,

Could you clarify what your current mode of practice is?

Are you a practice owner?
Partners with ophthalmologists in a predominantly ophthalmology or optometric practice?
Associate of ophthalmologists in an ophthalmology practice?
Employer/contractor of ophthalmologists to work in your optometric office?

I'm having a hard time understanding your situation.

I would also submit that your employment of certified personal is the exception rather than the rule in private OPTOMETRIC practices. Most "techs" and "opticians" in private optometric practices are usually the cute girl who received a few hours of on the job training toddling around after the other cute girl.

 

[drgregory]

Drgregory,

Could you clarify what your current mode of practice is?

Are you a practice owner?
Partners with ophthalmologists in a predominantly ophthalmology or optometric practice?
Associate of ophthalmologists in an ophthalmology practice?
Employer/contractor of ophthalmologists to work in your optometric office?

I'm having a hard time understanding your situation.

I would also submit that your employment of certified personal is the exception rather than the rule in private OPTOMETRIC practices. Most "techs" and "opticians" in private optometric practices are usually the cute girl who received a few hours of on the job training toddling around after the other cute girl.

i own the two practices. i have a third business whereby im partner with the ophthalmologists and that is the business we bill consults with in my optometric office. so basically, ophthalmologists get all of their surgical fees they perform at the hospital, but consulting and minor surgical fees performed in my office fall under our small parnership corporation. on non-consult days all revenue is to the optometric office.
my two closest neighboring private offices have all certified personel. it seems to me that in my area optometric practice is either top notch (private) or bottom barrel (corporate). i do know of a private office not too far from here that has an OD who graduated in the Nixon era that is a pure spectacle peddler who wouldnt know how to write a medical Rx to save his life.

 

[drgregory]

Sorry to go completely off subject...but why did you hate it?

becasue in most of our opinions, its basically only 80% as good as a DFE, and it costs an awful lot of money. everyone gets a DFE anyways, so why nickel and dime patients for the OPTOS just so we could make the lease payments on the thing

 

[drgregory]

What about when a patient's needs due to hobbies or occupation would be better met without AR? I know they've come a long ways but they still seem to get pretty dirty and smudged. I would think they would be less than beneficial for someone who does a lot of work outside - maybe you don't have those patients but I know in my area many farmers wouldn't be happy with AR on their lenses. I'm sure that there are other occupations and hobbies that also would fall into this category.

crizal alize is an improvement in this area. farmers, who traditionally carry "snot rags", are easily trained to carry lens cloths.

 

[Elfego Baca]

Anyone who pays $300 for an eye exam is either very rich, very stupid, or both. I suppose you could pull this off in Houston or Dallas.

 

[cpw]

Anyone who pays $300 for an eye exam is either very rich, very stupid, or both. I suppose you could pull this off in Houston or Dallas.

What are you implying ?? People in Texas are rich and stupid ?

 

[Ben Chudner]

at the 80% vsp office

$70-80

the remaining 20% is comprised of about 3-4% medicare/aid

$70 if you are lucky

15% medical insurers (which pay in full)

In order for an insurance company to pay over $300 for a comprehensive exam with refraction (92004 and 92105) the conversion factor would have to be about 65. If that is in fact the case, please let me know where you practice because I have never seen a conversion factor higher than 45 except for the Department of Labor and Industries which will not cover those codes. Even with E/M codes (99 codes) the conversion factor would be way above the norm for you to reach over $300 even with the addition amount for refraction.

1% cash payers

Therefore, only 1% of the patients in this office pay over $300 for a full exam.

at the 20% vsp office, another 20% is medicare

$60-70 plus refraction

another 30% is medical insurers

less than $300

and the rest is private pay

Therefore, only 30% of the patients at this office pay over $300.

a note on the vsp infected office - anything that is medical related is billed to medical insurance. none of this monitoring diabetic retinopathy et al for the measley vsp reimbursement.
another difference from private vs corp is that all of our opticians are CERTIFIED OPTICIANS, all of our techs are either LPNs or COMTs. not high school graduates that transferred from the shoe store three doors down. we also offer surgical treatment (via our ophthalmologists). our contact lens fitting fees are more appropriate as well:

new spherical = $179
new toric $187
new multi/mono $239
est spherical = $79
est toric = $87
est multi = $97
this is on top of exam fees. all of these are out of pocket. still look like a corporate office?
also, there is a CLEAR difference in our products. no lenses are dispensed/sold without antireflective (Zeiss Advantage or Crizal alize), all progressives are either Zeiss (Gradal, GT2, or Individual) or Varilux Physio. You dont get nickeled and dimed to "buy" a warranty. someone comes back and has scratched lenses, we remake them.
lastly, there is a CLEAR difference in our patients. we see patients who care about the health of their eyes. corporate ODs dont see alot of those patients, nor does the corporate environment spawn them.

You have missed the point. No one is doubting that your office is more professional than a corporate office. I was merely pointing out that one of your attacks on the corporate OD's was that they charge too little for an eye exam based on the amount of education. I agree with that, however, private docs are no better in that we accept too little for an eye exam. We can charge $1,000 for a comprehensive eye exam, but if we accept insurance we won't collect anywhere near that.

 

[iiiimonica]

crizal alize is an improvement in this area. farmers, who traditionally carry "snot rags", are easily trained to carry lens cloths.

sorry dr greagory (and i do plan to use your business model when i own my practice) but NO lens treatment is good for everyone. AR is great for 85% of people, but your opticians have to determine (with good ol' fashion life style dispensing questions) if an AR will be good choice for them.

i've been a abo/ncle certified optician for 10 years, so i do know what i am talking about here.

 

[Ben Chudner]

sorry dr greagory (and i do plan to use your business model when i own my practice) but NO lens treatment is good for everyone. AR is great for 85% of people, but your opticians have to determine (with good ol' fashion life style dispensing questions) if an AR will be good choice for them.

i've been a abo/ncle certified optician for 10 years, so i do know what i am talking about here.

I have been fortunate to lecture around the country so I have spoken to a lot of OD's in private practice. In my experience, OD's tend to believe they do more AR than they really do. This comes from hearing the numbers from the doctors and comparing them to the numbers from the reps that hire me to speak. I would be very skeptical of any optical, private or corporate, that says they do 100% AR.

 

[PBEA]

I have been fortunate to lecture around the country so I have spoken to a lot of OD's in private practice. In my experience, OD's tend to believe they do more AR than they really do. This comes from hearing the numbers from the doctors and comparing them to the numbers from the reps that hire me to speak. I would be very skeptical of any optical, private or corporate, that says they do 100% AR.

I agree, people who wear specs often understand the implications these coatings have on there usage (AR requires excellent care). I think gregory was exaggerating to prove a point, I do agree the AR (and other optical products) sold in private practice (depending on the practice) is of higher quality then the walmart (or other corporate) junk.

 

[Ben Chudner]

I agree, people who wear specs often understand the implications these coatings have on there usage (AR requires excellent care). I think gregory was exaggerating to prove a point, I do agree the AR (and other optical products) sold in private practice (depending on the practice) is of higher quality then the walmart (or other corporate) junk.

I don't think anyone is debating whether or not products sold in private practice are better than those sold in corporate locations. I agree that for the vast majority of private offices, the products are superior to corporate locations. The point I have been trying to make is that private OD's that take insurance (like myself) are just as willing to take lower payment for our services as corporate OD's no matter how much we say we charge. The issues our profession faces will not be solved by corporate docs raising their fees. It is the mentality of fast food eyecare where you can have an eye exam while you wait for your photos to be developed that has devalued the importance of ocular health exams.

 

[PBEA]

I don't think anyone is debating whether or not products sold in private practice are better than those sold in corporate locations. I agree that for the vast majority of private offices, the products are superior to corporate locations. The point I have been trying to make is that private OD's that take insurance (like myself) are just as willing to take lower payment for our services as corporate OD's no matter how much we say we charge. The issues our profession faces will not be solved by corporate docs raising their fees. It is the mentality of fast food eyecare where you can have an eye exam while you wait for your photos to be developed that has devalued the importance of ocular health exams.

I was just responding to your post regarding AR sales. And, yes I echo your sentiments about corporate. I don't blame corporate, though. The output of new grads far exceeds the demand (realistic demand, not actual need), and this is the core of the problem. Until we somehow control graduating numbers, then we can blame nothing else. I propose that a proper formula is reached that would estimate demand for our services (based on actual usage, not incidence data etc, which only artificially inflates need). Then shrink classes, or close schools, one or the other, I don't care which. And for pete's sake, let's not allow any other darn schools?!

 

[Ben Chudner]

I propose that a proper formula is reached that would estimate demand for our services (based on actual usage, not incidence data etc, which only artificially inflates need). Then shrink classes, or close schools, one or the other, I don't care which. And for pete's sake, let's not allow any other darn schools?!