v.s.p. NO-CHOICE plan

[ak47]

WHOAH. so on the "patient record report" of federal high option patients, it says "Anti-reflective coatings covered."

This has always meant ANY v.s.p. approved coating was covered in full.

UNTIL NOW.

if i flip to the NEW "lens enhancement charges" tab, i see that i am supposed to collect an $85 copay for Crizal Avance, or a Unity coating is covered in full.

IT SURE WOULD BE NICE IF THAT WAS NOTED ON THE PATIENT RECORD REPORT, since that is what most dispensing opticians are referring to when quoting a price to a patient.

BE CAREFUL !

has anyone else seen DIFFERENT examples of this - where there are possibly HIDDEN COPAYS for some products that appear to be covered in full by looking at the PATIENT RECORD REPORT ?

[becc971]

Another part of the hidden co pay, if you sell them any of the crizal w/UV coats you now have to charge them an additional $10 for the backside UV. This was something that was just tacked on without us knowing about it which was awesome.

[racethe1320]

I agree VSP Columbus is pretty good, but nowhere near as good or as quick as Toledo Optical. It always takes longer due to shipping delays compared to our twice a day courier service for Toledo. Even though they do tons of jobs a day, their frame database is never a match for Toledo's and lens only jobs that are in their database seldom fit perfectly.Chemistrie Clips are not as perfect,either. PD's are always off and never perfectly straight.

Keep in mind Toledo does maybe 500 jobs per day where VSP Columbus last I was told is doing upwards of 4-5x that. I've toured both labs and it's evident. Courier services are nice, but VSP Has that too if you're within the service range. If not, just ask them for overnight labels. I've never had any lab refuse that.

I had several jobs in 4thQtr 2013 that took 4-6 weeks to get from VSP Columbus. Most averaged 2 weeks. What is even better is when they try to make it up to your patient by doing a freebie, but having that one take even longer to get back! 1 problem job, or even patient.. I get. Ran a lab for a while, you get those problem jobs. However this was several... Pretty soon you might as well state that VSP decided to change their model to Davis's. Since that is where it seems to be headed.

delays on what product? Hoya is about the only product that I have seen take that long but that's a Hoya issue IMO as they have to send it out to get done. Otherwise, we rarely have problems with their unity or big e products.

yup in a strange race to the bottom

you keep saying this but you do realize that the total earnings for doctors has gone up just about every year correct? combine their product rewards for unity and now their photochromatic with their lab incentives and it's huge. feel free to take it offline with me via PM and I'll gladly banter. I just this week sat down with our rep and feel I have a good understanding of their programs for 2014. an example for us is on photochromatics...VSP paid nothing on them for years, but at least I got a $5 bone from their lab if I used them. This year, they introduced their own version and on my payment from VSP i get $7 and if I use their lab I get an additional $5. That's big considering we're 30+% in terms of dispensing them.

[obxeyeguy]

Just love these VSP Rah Rah threads. Those $5 and $7 dollar bones really add up when I pay my Mctician $7.75 hr.

[optical24/7]

Keep in mind Toledo does maybe 500 jobs per day where VSP Columbus last I was told is doing upwards of 45x that. I've toured both labs and it's evident. Courier services are nice, but VSP Has that too if you're within the service range. If not, just ask them for overnight labels. I've never had any lab refuse that.
.

Doc, are you sure that you aren't inflating that number? 22,500 Rx's a day? Vision Monday reported the top labs of 2012. Walman (with all their locations) only does 6,800.

http://www.visionmonday.com/CMSDocum...y_VM092412.pdf

I don't think I'd like to use a lab cranking out that many Rx's daily.

[Stan Tabor]

I read all this stuff about VSP and how you have to work the system to be successful.

Can someone explain to me the difference between eyedocs getting comped to sell a particular lens versus surgeons being paid to use a particular hip or knee replacement? http://www.cbsnews.com/news/feds-mak...lacement-deal/ There are many articles about the sleaziness that has occurred in the past in the hip and knee business. It is easier to get away with in the eye business because patients do not understand what they are missing out on.

You can't have it both ways. If glasses truly are a medical device, then doctors should have some ethical standards and disclose to their patients the inducements they receive to push a particular lens product, insurance or not. This is a slippery slope folks. It starts out small. Then labs/"insurance" providers compete and engage in their race to the bottom. Then you end up with a corrupt "business model".

I would be particularly interested in hearing justification from those particularly adept at "working the system" with VSP.

Just because a patient has "insurance" with a managed care provider does not give the doctor the right to not provide options or disclose the financial incentives they receive to push a particular product via your prescription.

Paging Leslie Ann Stahl....paging Leslie Ann Stahl, we have another story brewing in the eyewear industry.

What am I missing here? Perhaps this topic should be its own thread?

[racethe1320]

Doc, are you sure that you aren't inflating that number? 22,500 Rx's a day? Vision Monday reported the top labs of 2012. Walman (with all their locations) only does 6,800.

Sorry...meant 4-5x. Will edit for clarity.

[racethe1320]

doctors should have some ethical standards and disclose to their patients the inducements they receive to push a particular lens product, insurance or not.

So do doctors have to disclose costs on all products? Do doctors have to disclose that Essilor funds acquisitions of other practices or dispensary make overs or covers the cost of a Visioffice or that they got an extra discount and extended terms for buying stock lenses in bulk or that they were provided x number of complimentary pairs to use?

Just because a patient has "insurance" with a managed care provider does not give the doctor the right to not provide options or disclose the financial incentives they receive to push a particular product via your prescription.

Who said the doctor isn't providing options? How many options should they present? I set my pricing, what if I price them all the same? Do I have to disclose that I make purchases on my Chase card and get a percentage kickback from them?

All rhetorical.

[Stan Tabor]

So do doctors have to disclose costs on all products? Do doctors have to disclose that Essilor funds acquisitions of other practices or dispensary make overs or covers the cost of a Visioffice or that they got an extra discount and extended terms for buying stock lenses in bulk or that they were provided x number of complimentary pairs to use?


Who said the doctor isn't providing options? How many options should they present? I set my pricing, what if I price them all the same? Do I have to disclose that I make purchases on my Chase card and get a percentage kickback from them?

All rhetorical.

Race- What does this have to do with disclosing costs of your products? I am talking about prescribing products to earn a spiff or some other prize that some people would equate to a kickback.

Regarding your comments about Essilor; they are not dealing directly with the patient. You are. Big difference. If you believe that it is ok for Essilor/VSP or anybody else to loan you money so they can dictate to you what products you prescribe or encourage your optician to sell, then this raises a whole other issue. There are people who post on this board who I respect for not taking the money from Essilor in order to maintain their independence.

Regarding your Chase Rewards, you get this regardless of whose bill you are paying. If you saying you recommend medical devices based upon your Chase rewards, then that is a whole other topic.

You're the doctor. You tell me if it is ethical to recommend a product to a patient because you get a spiff/kickback from the lab even though their may be a better option for the patient to consider? I am asking the question because I am trying to understand the issue.

Where do you draw the line? What do you think of doctors who take kickbacks from pharmaceuticals in return for prescribing their drugs? What is the difference between this and working the VSP system so you reach the "product of the month" quota so that you win a contest and get a bonus check or whatever they award you? Is this not a kickback? Maybe someone has information to convince that it is not.

I looked up the definition of rhetorical. Nobody has ever commended me in this way and for that I do thank you.

[racethe1320]

Race- What does this have to do with disclosing costs of your products? I am talking about prescribing products to earn a spiff or some other prize that some people would equate to a kickback.

I don't see how money coming back to me on my Explanation of Payment from an insurance provider can be considered a spiff or price or kickback. It's payment. They pay me more to have staff take measurements and even more if I use their products. That's great, and it's their way of controlling material costs. They, we the ECP nor the Patient can do that with Essilor products as easily.

Regarding your comments about Essilor; they are not dealing directly with the patient. You are. Big difference.

If an ECP is provided funding by Essilor to to the things i mentioned, how is that not as you described a kickback or spiff?

If you believe that it is ok for Essilor/VSP or anybody else to loan you money so they can dictate to you what products you prescribe or encourage your optician to sell, then this raises a whole other issue. There are people who post on this board who I respect for not taking the money from Essilor in order to maintain their independence.

If it's a loan that's one thing but in exchange to sell XX Essilor product or direct my work to them....I wouldn't do it. To earn higher earnings by being loyal to a managed care company for using their products, I have no problem with that.

You're the doctor. You tell me if it is ethical to recommend a product to a patient because you get a spiff/kickback from the lab even though their may be a better option for the patient to consider?

In the end, my patients rarely if ever come to us with a specific brand in mind unless it's from a Crizal or Transitions Commercial. They simply want to see better. I can dispense any number of products and choose to provide them top shelf products that also happen to earn me more money. No different than those out there who send all their lab work to Hoya in exchange for a deep discount on their work.

Where do you draw the line? What do you think of doctors who take kickbacks from pharmaceuticals in return for prescribing their drugs? What is the difference between this and working the VSP system so you reach the "product of the month" quota so that you win a contest and get a bonus check or whatever they award you? Is this not a kickback?

Haven't looked too deep into the above nor do I plan to. I see nothing wrong with an ECP earning more for dispensing specific products that their managed care co. provides. I see it much the same as another loyalty program. Everyone has one or comes up with one to compete.

[Judy Canty]

payola?

[Doctor Lucky]

I believe they are fully cover for Unity Ar, but can pay 20 for another brand.

Covered under Unity ARC which can only be put on Unity lenses. And it isn't 20 for another brand- it is $20 off the copay of another brand. So $65 instead of $85. I made that mistake too. That was a fun phone call.

[racethe1320]

Covered under Unity ARC which can only be put on Unity lenses. And it isn't 20 for another brand- it is $20 off the copay of another brand. So $65 instead of $85. I made that mistake too. That was a fun phone call.

The benefit on the high option covers ALL Unity AR Coatings. The columbus lab has even told us and we've upgraded our orders thus far for zero extra.

No unity is not an AR approved for essilor lenses but that's not a VSP thing.....they used to put it on Essilor products until Essilor told them no. It works, but it doesn't carry support by big E. I remember when the new compatibility charts were posted because I called my Essilor rep to discuss it. I know too as when unity was first launched we ordered it that way all the time. They even used their Crizal system to apply it up until they installed their own AR systems specifically for that product.

Co-Pay wise, there are actually four categories for each the low Standard and high option ranging from $21 to $85. The plan options are available online.

[racethe1320]

Another part of the hidden co pay, if you sell them any of the crizal w/UV coats you now have to charge them an additional $10 for the backside UV. This was something that was just tacked on without us knowing about it which was awesome.

Not true, there were SEVERAL communications about this to offices. It's was an ESSILOR doing too, not VSP. Essilor changed their formulation and increased prices to all labs due to UV Being a no-choice option on THEIR part. VSP never covered it as a benefit because as a managed care co. they didn't see validation to do so...and honestly, I don't think there's enough data to support it either. When Big E did this, VSP kept their unity UV as an OPTION. IMO it was nothing more than a reason for essilor to raise their prices.

It's all moot because as of December last year, VSP included UV standard and at NO CHARGE to the patient, so you no longer have to collect the $10 if you use their products.

[racethe1320]

Just love these VSP Rah Rah threads. Those $5 and $7 dollar bones really add up when I pay my Mctician $7.75 hr.

If you're trying to toss out sarcasm, I suggest you review your practice report and let their reps show you the actual figures. Yes, it does add up. If you're a decent office volume wise. 1000 claims, 25% penetration on Photochromatics, that's 250 x $12 is $3k or just under 20% of what your Mctician costs you.

If 60% of those claims are single vision, 35% progressives and your AR Rate is a typical 40% you stand a pretty strong chance of covering their salary in full 4x over. If you don't believe, PM me for details, I'll gladly break it down.

We're averaging $29 additional per job filed over the course of 2013 just by switching a couple products and focusing our lab choice to 1 or 2. For our volume the number was massive. Your mileage will vary but I would lay odds the dollars per job will be about the same.

[ak47]

Not true, there were SEVERAL communications about this to offices. It's was an ESSILOR doing too, not VSP. Essilor changed their formulation and increased prices to all labs due to UV Being a no-choice option on THEIR part. VSP never covered it as a benefit because as a managed care co. they didn't see validation to do so...and honestly, I don't think there's enough data to support it either. When Big E did this, VSP kept their unity UV as an OPTION. IMO it was nothing more than a reason for essilor to raise their prices.

It's all moot because as of December, VSP includes UV standard and at NO CHARGE to the patient, so you no longer have to collect the $10 if you use their products.

I try to be...fair and balanced...in these forums...so the following question is without finger pointing or accusation...but how has racethe1320 become such an expert in V.S.P.?...I don't recall them telling us ANYTHING about ANYTHING that was going to change so far into the future as he mentions UV will become standard to all V.S.P. patients come December...that is almost a year away.

I also don't recall being told anything by v.s.p. about the Unity AR being a requirement on so-called Choice plans. I learned it from this forum! It took me until 5 minutes ago to know that Unity AR is a no-go with Essilor lenses - I never chose to learn about Unity AR after seeing one sample of it which I could not get to look clean no matter how many times I tried. To be fair, that was a long time ago, and it may have improved significantly. I am not a huge Essilor fan by any stretch of the imagination, but Crizal lenses are very easy to clean and we all know there are many patients they should not be switched out of a Comfort unless you are looking for trouble and pre-mature balding. Plus, Varilux is one of the few brands patients ever request...

i come in peace and in search of understanding.

[racethe1320]

I try to be...fair and balanced...in these forums...so the following question is without finger pointing or accusation...but how has racethe1320 become such an expert in V.S.P.?...I don't recall them telling us ANYTHING about ANYTHING that was going to change so far into the future as he mentions UV will become standard to all V.S.P. patients come December...that is almost a year away.

I've gained my knowlege on VSP as I've been with them as OD for over 30 years. I pride myself in being very active with them as they have a huge share of the market and nearly 60% of our patient base. I meet with them regularly and stay involved in most of their lines of business and brands. It's paid off well for me and my practice. I'm sure others will quickly point out I tend to really only comment on managed care, but then I've been open about that being my focus here since day one of joining. The reason being there are enough lens gurus and optical experts but not enough Managed Care folks so it just makes sense.

In terms of AR and UV, I'm referencing LAST December...UV on their unity product has been included with their product since December of 2013. They sent out plenty of announcements on it.

I also don't recall being told anything by v.s.p. about the Unity AR being a requirement on so-called Choice plans. I learned it from this forum! It took me until 5 minutes ago to know that Unity AR is a no-go with Essilor lenses - I never chose to learn about Unity AR after seeing one sample of it which I could not get to look clean no matter how many times I tried.

Unity on the Federal Plan...that information is online and has been faxed or emailed to our office numerous times since October / November of 2013 when open enrollment began. Sounds like you need to touch base with VSP to insure you're actually getting any and all communications. You can have 1/2 of mine as they OVER COMMUNICATE with us. If I get one more thing on their Elements plan, I'm going to demand fees for disposing of it all.

If you weren't aware of the compatibility with unity ar and essilor, I'd one, talk your essilor reps because that's who hands us our compatibility charts. I'd also suggest you have a meeting with your vsp rep as ours comes to see us all the time. I don't care what others here say, they are the only reps I know are here to help drive profits into my offices and can actually show me how.

To be fair, that was a long time ago, and it may have improved significantly. I am not a huge Essilor fan by any stretch of the imagination, but Crizal lenses are very easy to clean and we all know there are many patients they should not be switched out of a Comfort unless you are looking for trouble and pre-mature balding. Plus, Varilux is one of the few brands patients ever request...

I'm not a fan of Big E but they have some good stuff. However in terms of Comfort, the 90's called and they want their lenses back.....time to upgrade dear sir. Seriously. It not only pays you less to dispense, it costs you more on non vsp patients and it's out dated in terms of performance compared to the newer lenses. That's my opinion.

i come in peace and in search of understanding.

Me too and I hope my approach here isn't coming across harsh. I'm opinionated, yes. :)

[Jamelina]

I LOVE VSP1 Olympia. I use them all the time, even for non-VSP orders. They are faster than Hoya, much more reliable, and everyone you talk to there is friendly. Not to mention, their products are great.

[ak47]

2015 update...more of our large employer groups have switched to the (no)CHOICE plan. where's my sharp stick?

[racethe1320]

2015 update...more of our large employer groups have switched to the (no)CHOICE plan. where's my sharp stick?

Choice 1: Poke your eye out with a sharp stick
Choice 2: Maximize your earnings and work the plan.

Hmmm...you're having a tough choice between the two? WOW!

[drk]

Dang it race, you're so upbeat about this.

I either love you or hate you. I'm not quite sure which.

[golfnut]

Choice 1: Poke your eye out with a sharp stick
Choice 2: Maximize your earnings and work the plan.

Hmmm...you're having a tough choice between the two? WOW!

You still seem to miss the point... the reason so many are disgruntled is even if you "work the system and maximize your profit" you are still going to lose more money. It would be like working at a job making $20/hr. new management come in and says now you have to find new ways to make your pay by playing their game, except at the end you still now only make $18/hr even after jumping through all their hoops. You CANNOT make as much with an insurance job as a private pay... I realize managed care is here to stay and we are all forced to "work the plan" to get our money. And for the record I work for an insurance heavy office that does a great deal of vsp. I know all the steps needed to get those elusive EXTRA dollars you speak of:)

[racethe1320]

You still seem to miss the point... the reason so many are disgruntled is even if you "work the system and maximize your profit" you are still going to lose more money.It would be like working at a job making $20/hr. new management come in and says now you have to find new ways to make your pay by playing their game, except at the end you still now only make $18/hr even after jumping through all their hoops. You CANNOT make as much with an insurance job as a private pay... I realize managed care is here to stay and we are all forced to "work the plan" to get our money. And for the record I work for an insurance heavy office that does a great deal of vsp. I know all the steps needed to get those elusive EXTRA dollars you speak of:)

First, for the most part, you all need to let the Private Pay talk go. That train has come and gone and while there will still be passengers, it's over. This isn't 1982. Horse is dead and the percentages overall are very low.

Next, in terms of losing money...you're a fool if you can't get rich running a business the right way. Yes, even an optical shop. Sorry to insult if I am, but seriously. I had lunch with my wife at a very nice place. $75 for great food, great company with a wonderful lady and owned by a friend of mine. Love the place and him.. However, if he really did it to get rich, he'd own a McDonalds which will bring in $2m per year per location and he'd build out more of them. I'm not saying run your place like a fast food joint, but don't run it like a miser in a one-hit wonder world of a single location or a starving artist that can't scratch a living because he's too blind to see the forest through the trees.

Now if you personally want to be the one practicing vs hiring others to work for you, then like my friend, you're pigeon holing yourself. That's on you, not VSP, managed care or anyone but you. The young docs that come work for us can hang a shingle out and get their business up to $650-800k fairly easily in a short few years and once "grounded" build out a real practice and open more. Some will, some won't they will stay small and many others will go work for others.

That's the goal really if you're in it to make money. Ive been doing this a long time and it's not rocket science. Build one successful practice and then move into managing more than one and eventually you'll be really just overseeing a small number of stores and a very lucrative business and enjoying a lot more time to yourself.

I know a lot here don't like to hear it, but Managed Care is like Cherry picking money off a tree. You just have to learn how to pick the fruit and in some cases yes, acquire a taste for it. If you really don't think you can get rich off managed care then you're hanging with the wrong crowed. Just visit some of the more successful practices and see. Every city has them.

[racethe1320]

Dang it race, you're so upbeat about this.

I either love you or hate you. I'm not quite sure which.

Been down the road of *****ing and complaining and found it's got a lot of company at the end but there were no pretty people or bottles of wine so I left and never looked back.

[golfnut]

You still seem to miss the point... the reason so many are disgruntled is even if you "work the system and maximize your profit" you are still going to lose more money.It would be like working at a job making $20/hr. new management come in and says now you have to find new ways to make your pay by playing their game, except at the end you still now only make $18/hr even after jumping through all their hoops. You CANNOT make as much with an insurance job as a private pay... I realize managed care is here to stay and we are all forced to "work the plan" to get our money. And for the record I work for an insurance heavy office that does a great deal of vsp. I know all the steps needed to get those elusive EXTRA dollars you speak of:)

First, for the most part, you all need to let the Private Pay talk go. That train has come and gone and while there will still be passengers, it's over. This isn't 1982. Horse is dead and the percentages overall are very low.

Next, in terms of losing money...you're a fool if you can't get rich running a business the right way. Yes, even an optical shop. Sorry to insult if I am, but seriously. I had lunch with my wife at a very nice place. $75 for great food, great company with a wonderful lady and owned by a friend of mine. Love the place and him.. However, if he really did it to get rich, he'd own a McDonalds which will bring in $2m per year per location and he'd build out more of them. I'm not saying run your place like a fast food joint, but don't run it like a miser in a one-hit wonder world of a single location or a starving artist that can't scratch a living because he's too blind to see the forest through the trees.

Now if you personally want to be the one practicing vs hiring others to work for you, then like my friend, you're pigeon holing yourself. That's on you, not VSP, managed care or anyone but you. The young docs that come work for us can hang a shingle out and get their business up to $650-800k fairly easily in a short few years and once "grounded" build out a real practice and open more. Some will, some won't they will stay small and many others will go work for others.

That's the goal really if you're in it to make money. Ive been doing this a long time and it's not rocket science. Build one successful practice and then move into managing more than one and eventually you'll be really just overseeing a small number of stores and a very lucrative business and enjoying a lot more time to yourself.

I know a lot here don't like to hear it, but Managed Care is like Cherry picking money off a tree. You just have to learn how to pick the fruit and in some cases yes, acquire a taste for it. If you really don't think you can get rich off managed care then you're hanging with the wrong crowed. Just visit some of the more successful practices and see. Every city has them.

You are too busy trying to throw around that you have some kind of Magic formula for working the managed care business to realize that ultimately they are working us! Sorry if I offend... If you read my post I too said managed care is here to stay and our business is quite prosperess in spite of. I was just trying to point out that you seem to rub people wrong by not acknowledging their beliefs, that are well founded, but probably pointless because like you said, managed care isn't going anywhere now for sure because its just too big, NOT because its fundamentally a better way to make a living with it! I have no problems either way:)