As you’re certainly aware, health care is undergoing a massive upheaval. Change is occurring in the medical fee-for-service system, in the upcoming (ongoing) adoption and rollout of accountable care organizations, in refractive carrier policies, in revised rules and regulations, and more—and all are valid reasons to seriously question how we’re doing what we’re doing.

So, how are you going to address these stresses, these changes, these current and nonstop issues that you now must deal with on a daily basis?

What You Think

Some say that this is just a natural evolution of America’s capitalistic health care system. Some would have you believe that it is unsustainable, while others tout our financially incentivized system as being the only sustainable model for delivering high-quality, professional services. Still others say that the Affordable Care Act is a revolution—a complete tipping of the cart toward socialized medicine.

No matter what camp you’re in, as health care providers, change is upon us. More importantly, though, is how you plan on responding to this change that is thrust upon you—because if you don’t respond to changes within the marketplace, you may not have the luxury of being around in future years.

Today’s system isn’t as flexible. And policy makers are taking a harder line, both in what they allow us to do professionally and in how we are compensated for it. So, pretending that change doesn’t affect your ability to provide appropriate clinical care to your patients is not a sound strategy in today’s world.

In eye care, we’re seeing change in separate areas. We have the area of prepaid managed vision care plan benefits (which include optical materials), and we have the world of medical eye care (which is limited to professional encounters, special ophthalmic procedures and surgical services). For the average optometrist’s practice, the bulk of patient encounters, and income, comes through managed vision care plans (MVCP).

Within the last year, these plans have proposed and implemented a significant number of changes, causing disruption within the average practice. To find out about the average practitioner’s perception of these changes, we recently conducted a brief survey to gauge optometrists’ perspectives on the recent changes that managed vision care plans have implemented within their networks. The survey went out to Review of Optometry’s entire readership, and some 350 optometrists responded.

The results found:
• 72% of the ODs who responded to the survey indicate that they are aware of the changes in the MVCP models and channeling of products.
• 90% of all respondents say that they are concerned—either “very concerned” (67%) or “somewhat concerned” (23%)—about these MVCP developments.
• 82% of ODs report that the changes would have a somewhat (45%) or very negative impact (37%) on their practices.
• 51% say that VSP is the MVCP that has the most impact on their practice, followed by EyeMed (31%), Davis Vision (9%) and Spectera (5%).
• 78% of ODs say that they would be changing their practice strategy either somewhat (51%) or significantly (27%) in response to MVCPs’ channeling of products.
• 89% of respondents indicated that they are looking for resources that would help to reduce their practices’ dependency on MVCPs.

How Will You Respond?

So, most of you indicated that you’re not happy with MVCPs’ changes, and that these changes affect your ability to provide the quality of care that you want to provide to your patients.

Additionally, we also know that reimbursements from managed vision care plans are on the decline, and the premium dollars for those plans continue to get challenged in the consumer marketplace. The question is, of course, how are you going to respond to those decreased reimbursements?

Let’s take a look at a classic profit triangle. If reimbursement per exam is decreasing and patient volume stays the same, then the only way that your profitability can move is down. Because you don’t have the power to increase your reimbursement, the only other variable that you can change in this system is the volume of patients per hour.

That means that the days of the 30-minute exam are over. If you want to keep your profitability intact, you’re going to have to look at alternative ways that you can still deliver quality care in 15 minutes or less per exam.

Of course, if this isn’t what you want to do, then you have another choice: quit the plan. While on the surface that may seem scary, our survey shows that many of you are contemplating this very action.

Personally, I’ve been first party to many practitioners who have done this, and done it successfully, by replacing their low-paying refractive examinations with higher-paying refractive and medical eye care visits.

Prepare to Adapt

Optometrists have long enjoyed a significant portion of their practices’ profitability from sales of retail products. While being able to sell and profit from what you prescribe is generally not allowed in medicine due to self-referral rules (the Stark laws), optometry and ophthalmology are currently exempt from these restrictions. That said, market forces today are dictating change in our retail strategies as well.

Refractive carriers that restrict practitioner choice in exchange for better pricing, or to simply participate in the plan, as well as greater challenges from other retail models (e.g., online sellers such as Warby Parker, Zenni Optical, etc.) are putting greater pressure on our traditional profit model.

And to top it off, our responsibility to provide and maintain the standard of care to our patients is increasing, which is putting our survival as an independent practice model in the crosshairs of sustainability.

As dire as all of this sounds, remember that these are all potential consequences if you ignore the changes in the health care landscape around you or if you delay taking action to these changes until it is far too late to respond.

Many practitioners are very successful in being proactive and keeping themselves and their staff on top of both federal and local issues that are affecting their chosen way of practice. These practitioners are the models for us to all follow; we know who they are in our communities, we wonder at their continued success and are often stumped at why they excel at something that we may struggle with. Like them, we have to be perpetual students, always learning, always adapting to the challenges that lie before us.

I have no doubt that 2014 will be a pivotal year for the profession of optometry and how eye care is delivered. I also have no doubt that we are and will continue to be the primary eye care providers in any health care system of the future. Is it a health care revolution or simply evolution? Adapting to change is required to be part of either.

Please send your questions and comments to