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Thread: Medicaid only optical shop?

  1. #1
    Master OptiBoarder pseudonym's Avatar
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    Medicaid only optical shop?

    No one in this area fills outside medicaid prescriptions for glasses. Everyone does the exam, no one does the glasses. A friend has this crazy idea of starting an optical service that only provides medicaid glasses. Only his idea might not be so crazy. And I'm thinking if he doesn't actually do it, I may.

    An optical venture has all kinds of risk. You buy frames that may or may not sell. Your shop must be in an attractive location. You expend energy on advertising. You help the patient make decision on what lens best suits their needs, while trying to minimize non-adapt issues. All of these factors are narrowed down for medicaid patients. You have specific frames and lens material to dispense, and that's it.

    Other than the time-consuming billing and the paltry payments, is there any other reason I should dismiss this idea out of hand? If you have experience with medicaid, I'd like to hear your input.

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    If you have a "teaching institution" in your area they will eat your market up real quick. Not to mention you will be dealing with a bunch of deadbeats that won't pick up the merchandise (you can't bill til they leave your store with it).
    All will want upper tear frames, lenses, tints, scratch cotes, transitons, etc. None of which medicaid will pay for, so they will all hate you.
    It's hard enough to please real people who pay thier own bills, much less someone who wants a free ride.

    Chip

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    Master OptiBoarder OptiBoard Silver Supporter optical24/7's Avatar
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    It would be crazy to do medicaid only. (Like opening a PD kiosk :hammer:). Simply add medicaid to your existing location (if you need the 3 extra dollars that bad.)

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    Master OptiBoarder pseudonym's Avatar
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    @optical24/7: Adding medicaid to my present site is not an option but I DO need the 3 buck. A PD kiosk, eh?

    People in a shop where both high-end and medicaid frames are in view will naturally want the high end. They don't know the wretched frames they can get with medicaid are contracted to the lowest bidder. Since we're talking medicaid only, there won't be any beautiful well-crafted frames on display to confuse the issue.

    DTCC's dispensary doesn't take insurance at all. No competition there.

    Didn't know that you don't get paid until the person accepts the glasses. That could be a stopper. Even people who shop high-end have been known to order glasses, then fail to pick them up. It's the reason a lot of places get full payment up front- before the shop places the order with the lab.

    Speaking of the lab- if they send you something that's out of ANSI how much hassle is it to send it back and get it done right?

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    Master OptiBoarder OptiBoard Silver Supporter optical24/7's Avatar
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    Then open a budget optical that accepts medicaid also. I was just pointing out the folly of opening a "medicaid only" shop.

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    Quote Originally Posted by pseudonym View Post
    No one in this area fills outside medicaid prescriptions for glasses. Everyone does the exam, no one does the glasses. A friend has this crazy idea of starting an optical service that only provides medicaid glasses. Only his idea might not be so crazy. And I'm thinking if he doesn't actually do it, I may.

    An optical venture has all kinds of risk. You buy frames that may or may not sell. Your shop must be in an attractive location. You expend energy on advertising. You help the patient make decision on what lens best suits their needs, while trying to minimize non-adapt issues. All of these factors are narrowed down for medicaid patients. You have specific frames and lens material to dispense, and that's it.

    Other than the time-consuming billing and the paltry payments, is there any other reason I should dismiss this idea out of hand? If you have experience with medicaid, I'd like to hear your input.
    I think I knew a guy that did that in Durham. I will PM you his name.

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    OptiBoardaholic OptiBoard Silver Supporter
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    I think it's a great idea if the reimbursement makes sense in NC. The reimbursement schedule varies greatly from state to state. I used to work for optical an in Alabama that catered to the Medicaid community and we did extremely well. We carried -8 to +4 out to a 2cyl in SV poly and had their glasses ready in 20 minutes while keeping COG very low. There was practically no competition for this business and we advertised on the WB network and gospel radio stations. The store was located in a low rent area, where the target demographic was located. The no show rate was really high so we double booked to even it out. We would also confirm the day before and the day of to reduce the no show rate.

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    Master OptiBoarder pseudonym's Avatar
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    Reimbursement through any govt agency is bound to be problematic. You know going in to expect it. I know the amount they claim to pay in NC. The labwork is a concern because I've seen medcaid and Veteran's Administration glasses where the lenses were cut badly. I've used interliner on govt frames where you'd think whoever checked these things out would notice the lens was too small and reject it. Jobs like this lead me to believe remakes are frequent and difficult to get processed. Anyway, thanks for the info both on the board and by PM.

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    Bad idea; with the financial position of most states who knows when they either drastically cut benefits or eliminate them entirely. Look at what California did - totally cut benefits for eye exams. Not someone you really want to "partner" with.

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    OptiWizard
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    Wow. Not to stereotype, but most medicaid pts have multiple kids who terrorize your office. Ive had a Mom sit by while her kids literally fist fought in the exam room. I had to get in the kids face, and make him sit down. Then the little punk spun the davis rack like he was on wheel of fortune. The optician almost ripped his head off...

    Had another group ftom the "caid brigrade" who threw an action figure right at his brothers face during slit lamp. Not to mention hyperopia, astigmatism, and pds that are no where near the norm.

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    Master OptiBoarder OptiBoard Gold Supporter DragonLensmanWV's Avatar
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    Anyone have any theories about why so many of them have so much cylinder and high plus?
    DragonlensmanWV N.A.O.L.
    "There is nothing patriotic about hating your government or pretending you can hate your government but love your country."

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    OptiWizard
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    Quote Originally Posted by DragonLensmanWV View Post
    Anyone have any theories about why so many of them have so much cylinder and high plus?
    I think nutrition plays a huge part. Especially during fetal development.

    Also factor in genetics, too. I dont think the gentic pool is very big in rural communities. I have one patient whose parents are first cousins. I am in one of the poorest counties in NY, and typically kids who are on medicaid frequently have greater strabismus, and hyperopia ranging from +6 to +10 with about 3.50 of cyl seems to be the norm.

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    OptiWizard
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    Just 30 minutes ago I had a great caid example. Husband is a Od+7.00 with 3 cyl and os +7.75 with 4 cyl , with an alternating exotropia of about 17 diopters MARRIED to a woman with od -4.50 with 4 cyl and os -5 with 4.5 cyl, alt exotropia of 15 diopters, and a horizontal nystagmus to boot.

    Try to speculate the optical status of the offspring of this union...

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    Master OptiBoarder OptiBoard Silver Supporter optical24/7's Avatar
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    Quote Originally Posted by OHPNTZ View Post
    ..Try to speculate the optical status of the offspring of this union...

    Plano, Emmetropic! :bbg:

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    Don't know about the high cylinder and strabismus, but I used to work at Universal Contact Lens where the owners kept saying: "We'll always have a job as long as these myopes keep going to bed together."

    Chip

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    OptiWizard OptiBoard Silver Supporter
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    Pseudo,

    How does Medicaid in your state work? Do you get a set amount for frame and lenses then fabricate yourself, or do you measure then send to a state lab?

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    Master OptiBoarder pseudonym's Avatar
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    Quote Originally Posted by harry888 View Post
    Pseudo,

    How does Medicaid in your state work? Do you get a set amount for frame and lenses then fabricate yourself, or do you measure then send to a state lab?
    According to this, http://qa.dhhs.state.nc.us/dma/optical/4.pdf, the provider has to use an approved contract lab.

    The frames are warrantied for a YEAR? No way.

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    OHPNTZ, Had to get up to speed on what's happening in California. It looks to me as if Opthalmologists can still be providers, but optometrists were cut out. Since many California optometrists had a big part of their business in medicaid exams, they're are hurting if they can't get themselves reclassified. The same risks apply to a business that supplies only one client type, sure, but I think the government would have to get out of all optical for it to work against what I'm considering. I can't see that happening.

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    One of our MCD carriers just contracted with March Vision. Thus, now we get less for an exam, and can't make anything on the frames/lenses...In the past, you could make a little, and I stress little bit on stock lenses and Hart frames. Now, Fifteen bux for dispensing. (Sorry if I broke the rule of dollars) Waste of time. We have stopped taking new patients, BTW.

    If we got cut out of Medicaid, I would do the happy dance.

    We still see, and will continue to see the mentally/physically handicapped folks from the Group Homes in our area, even if they are new. They can be tough case sometimes, but very rewarding!

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    Great idea, but the execution and the business would have to be refined. Regardless if you're selling apples or eye services you have to have a profit margin to operate successfully. Due to the ridiculous low margins in medicaid reimbursements it is not typically financially feasible to accept medicaid (which is why private practices typically don't accept it). Number one issue is to avoid fixed costs which includes equipment, frame inventory and a monthly lease. If you can timeshare a lane and space for deep discounted prices and have a high volume of patients you may have a model that would work. Also, consider the cost opportunity of the doctor's billable time. Lastly, the numbers would need to support the model.

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    Bad, bad idea. First, you never know when they will cut or eliminate the benefits. Second, you won't make squat. Of course the good side is you really won't need to advertise IF you are the only one in the area that accepts medicaid, don't have to worry about "location, location, location"-- won't matter where you are. If your bend on doing so anyway, I'd do what someone else said and also include budget boards, offer some other kind of service.
    ~Follow Your Bliss~

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    Master OptiBoarder rbaker's Avatar
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    Quote Originally Posted by OHPNTZ View Post
    Just 30 minutes ago I had a great caid example. Husband is a Od+7.00 with 3 cyl and os +7.75 with 4 cyl , with an alternating exotropia of about 17 diopters MARRIED to a woman with od -4.50 with 4 cyl and os -5 with 4.5 cyl, alt exotropia of 15 diopters, and a horizontal nystagmus to boot.

    Try to speculate the optical status of the offspring of this union...
    Did not Margaret Sanger have the solution to this problem?

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    As of July 1st, Connecticut cut eyeglass benefits to adult medicaid patients to one pair of glasses every 2 years---no exceptions. Most of my medicaid patients are in group homes or have serious medical issues. Two years is a long time to go for raging diabetics or for someone who has seizures and breaks the frames. You will be performing lots of optical magic to keep their frames together and not get paid what your time is worth.

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    Blue Jumper That means if you prepare properly for it.............................

    Quote Originally Posted by pseudonym View Post

    All of these factors are narrowed down for medicaid patients. You have specific frames and lens material to dispense, and that's it.

    Other than the time-consuming billing and the paltry payments, is there any other reason I should dismiss this idea out of hand? If you have experience with medicaid, I'd like to hear your input.

    and the contra:


    Quote Originally Posted by chip anderson

    All will want upper tear frames, lenses, tints, scratch cotes, transitons, etc. None of which medicaid will pay for, so they will all hate you.
    It's hard enough to please real people who pay thier own bills, much less someone who wants a free ride.


    With all the negative answers, you would have to approach the idea fully knowing all the facts and it might just be a niche nobody else gives a damn about because it complicates live as I can read about it.

    That means if you prepare properly for it, it can also become easy and a breeze. If they want high teer, give it to them but in a Diso version, scratch resistant, do it yourself at a fraction of the cost and so the tints and all other extras that are available, instead of have them done and pay the lab prices and you could very well do good.
    Chris Ryser
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