Vsp…..

[JDH]

I just heard about yet another new plan from VSP called Essentials.

From what I was told they reimburse 40.00 for exam, small dispense fee and no add-ons.
I have been out of the dispensing side of this industry for about 16 years, but I had to chime in:

OD's are well educated and pay an expensive price to get that education.
I would like to point out, however, that my mechanic gets about 70.00 per hour. Hmmmm,,, what is wrong with this picture? (No offense, mechanics)
I know, let's see 4 patients an hour,,, that would be providing high quality patient care. (Sarcastic tone)
When will this all end? As a patient, not the kind of eye care I would want to receive!
I am glad I am on the other side of the counter and don't have to worry (as much) about what these guys are going to do this industry next.
Best of luck to you all.
JDH

[drk]

They're ObamaGlasses.

[racethe1320]

I just heard about yet another new plan from VSP called Essentials.

The Essencials plan is ACA aka Obamacare's pediatric portion of the plan. If you're just now hearing about this, then you need to insure you're getting your communications from VSP as this has been rolling out in droves since last October.

OD's are well educated and pay an expensive price to get that education.

and many but not all doctors understand the importance and good will at providing the less privileged eye care as well.

As a patient, not the kind of eye care I would want to receive!

Are you stating that the kind of care you would provide would be different for a cash-pay well of patient vs someone from the pool of American children that have never been able to receive proper eye care/exams?, I would bet many of them would disagree and actually be grateful for finally having the option.

I am glad I am on the other side of the counter and don't have to worry (as much) about what these guys are going to do this industry next.

I retract my first point as I see you're not a panel provider but am leaving it as a reminder for everyone who is to insure they are getting their communications. I had lunch with a fellow provider who was still unaware of the dispensing fees for their various plans! He runs his business completely through his staff which IMO is a mistake, but ultimately that's his call.

[Judy Canty]

No, they're VSPMakingaRidiculousProfitWhileScrewingECPsGlasses.

[Slim]

Wow... do you have to accept that certain plan? Medicaid pays double that...

[drk]

It's the new morality. I live in a well-enough-to-do area. All kids will be covered, not just the huddled masses yearning to be free. They are probably better covered through Medicaid.

Nope, this will be for all kids in the USA. Everyone must buy health insurance, now. If you're 25 without kids, boom, you buy vision care for kiddos. All health insurance has to cover kids' eye exams, and sometimes glasses. First time ever. Can't wait.

(Hope this is not too political.)

[racethe1320]

No, they're VSPMakingaRidiculousProfitWhileScrewingECPsGlasses.

You really don't understand managed care/costs involved, especially this plan. They aren't making any money at it. They took it to secure their position within the FedVIP Plan. You work for Lucerne right? Ask your VSP Rep, he'll tell you the details. Their labs are more costly to run than yours.

[drk]

Race, I know you support VSP.

How do you envision future vision plan sales at the corporate and individual plan level?

[Uilleann]

...Are you stating that the kind of care you would provide would be different for a cash-pay well off patient vs someone from the pool of American children that have never been able to receive proper eye care/exams?...

This is rich! HAHAHA You make it sound as though VSP would provide comparable products on an equal basis to people who pay little (or even nothing) into their cash cow machine, as they would to those who are gouged the most both on premiums and co-pays through their ECP. All under the guise of managed care "quality" of course.

Were this ridiculous company ever to be the least bit concerned about the actual visual experience of their clients, every patient they cover would be given free Trivex through 1.74 HI and 2 year scratch protected A/R, using labs that were at the bleeding edge of current ophthalmic technology at no extra cost & with no additional co-pay to the patient. But of course, it's much harder to get (and stay) rich that way.

Of course, we all know in the real world that someone who cuts out the managed care provider has far greater choices, far superior quality, enjoys far faster turn times, and far more reliable back-end support for their eyewear...and all can often be had for a lower cost to the patient, (and much better business conditions for the provider) all else being equal.

[racethe1320]

How do you envision future vision plan sales at the corporate and individual plan level?

I think the indivual plan was recently "pushed" closer to the front burner in the public eyes to help capture those individuals that will perhaps be droppped by their employer or lose their current plan.....those that are implacted by Obamafail and were told they can keep their plans....yeah...right......my gut tells me it will continue to stay front page but I don't see any further push for it to be promoted over and above the corporate plans.

In the corporate word, I see them reacting with plans like Choice and Advantage more and more. Employers all over are driving towards those plans to reduce costs on their end. In VSP's eyes, they are reacting to better support the growth there by building more labs, increasing capacity and even leveraging their own products/materials to win contracts and control costs. Very good business and so long as they continue to drive revenue my way, I'm good with that. Again, work their programs and the dollars are very lucrative.

That's my quick take on it.

[racethe1320]

This is rich! HAHAHA You make it sound as though VSP would provide comparable products on an equal basis to people who pay little (or even nothing) into their cash cow machine, as they would to those who are gouged the most both on premiums and co-pays through their ECP. All under the guise of managed care "quality" of course.

So you think VSP / Managed Care chooses the Products covered? The products provided aren't chosen by the managed care company. The client chooses which products are going to be covered and how the plans are structured. In the case of ACA, the Fed Gov't program managers worked with VSP to buy-down the costs of the pediatric plan and structure how it works. VSP is simply administering the plan and leveraging their labs to do the work as who controls costs better than those that produce the work AND administer the plans. Heck, ECP's here are complaining about the plans so it's not like other labs are going to want that work....Besides, it doesn't take much to see that by stepping up and taking on ACA's plan that they put themselves in the forefront to win the FED VIP program.

Were this ridiculous company ever to be the least bit concerned about the actual visual experience of their clients, every patient they cover would be given free Trivex through 1.74 HI and 2 year scratch protected A/R, using labs that were at the bleeding edge of current ophthalmic technology at no extra cost & with no additional co-pay to the patient. But of course, it's much harder to get (and stay) rich that way.

Again, it's very clear you don't understand how managed care works. Come back when you have a better understanding of how managed care works.

[Uilleann]

So you think VSP / Managed Care chooses the Products covered? The products provided aren't chosen by the managed care company. The client chooses which products are going to be covered and how the plans are structured. In the case of ACA, the Fed Gov't program managers worked with VSP to buy-down the costs of the pediatric plan and structure how it works. VSP is simply administering the plan and leveraging their labs to do the work as who controls costs better than those that produce the work AND administer the plans. Heck, ECP's here are complaining about the plans so it's not like other labs are going to want that work....Besides, it doesn't take much to see that by stepping up and taking on ACA's plan that they put themselves in the forefront to win the FED VIP program.

Again, it's very clear you don't understand how managed care works. Come back when you have a better understanding of how managed care works.

Nice try. Thankfully, I and the majority of u$ here are more than intelligent enough, and have decades of experience with this type of provider to well under$tand the mechanic$ of who V$P look$ out for fir$t, not to mention the other managed care companie$ a$ well.

[racethe1320]

Nice try. Thankfully, I and the majority of u$ here are more than intelligent enough, and have decades of experience with this type of provider to well under$tand the mechanic$ of who V$P look$ out for fir$t, not to mention the other managed care companie$ a$ well.

I'd be willing to take you on toe to toe that you don't know nearly as much about managed care or VSP as you lead on. Let me know where and when you wish to debate. Until then, keep pretending....

[Uilleann]

Again - nice try. No matter how you try to spin it here, seeking to extol the altruistic virtues of VSP and their ilk, a spade is still a spade. Or in the case of ophthalmic patient care, a massive, greedy, outdated and inefficient impediment to the ability of ECPs to provide the highest level of quality for the lowest cost to the patient.

Those who choose to continue to feed the VSP beast are certainly welcome to do so. Just count your fingers when you're done. It bites.

[racethe1320]

Again - nice try. No matter how you try to spin it here

Come on Brian, who's spinning anything? I'm calling you out on facts and am awaiting any and all discussions if you will actually participate beyond a quick one-liner.

Or in the case of ophthalmic patient care, a massive, greedy, outdated and inefficient impediment to the ability of ECPs to provide the highest level of quality for the lowest cost to the patient.

Looking forward to you pointing out specifics regarding inefficiencies
Looking forward to discussing how VSP is impeding an ECP on providing the highest level of quality to their patients
Looking to see where ECP's weren't made clear that Managed Care in general is to afford lower costs to their clients

Just count your fingers when you're done. It bites.

Please engage with details to further this discussion.

[OHPNTZ]

and many but not all doctors understand the importance and good will at providing the less privileged eye care as well.

The pride of providing the less privileged wears off rather quickly as the strains on covering chair cost are difficult to maintain with such low reimbursements. Factor in the challenge that most within this demographic will present with high prescriptions, latent hyperopia, amblyopia, etc. compounds the time necessary to spend dealing with these patients. Throw in that most of the parents will be non-compliant with follow-up, trash your office, let their kids run wild around and cause disturbances...

So what happens in the end? VSP champions itself as providing for the "less fortunate", while the strain on yourself and staff continues...

[racethe1320]

The pride of providing the less privileged wears off rather quickly as the strains on covering chair cost are difficult to maintain with such low reimbursements. Factor in the challenge that most within this demographic will present with high prescriptions, latent hyperopia, amblyopia, etc. compounds the time necessary to spend dealing with these patients. Throw in that most of the parents will be non-compliant with follow-up, trash your office, let their kids run wild around and cause disturbances...So what happens in the end? VSP champions itself as providing for the "less fortunate", while the strain on yourself and staff continues...

I suppose you're right. To heck with the children of the poor. Here I thought we lived in a world with compassion. What was I thinking.

[OHPNTZ]

I suppose you're right. To heck with the children of the poor. Here I thought we lived in a world with compassion. What was I thinking.

I deal with this day in and day out. It gets old real fast. The worst part is dealing with the kids with amblyopia. I really care about the kids. It's dealing with the idiotic parents who unfortunately brought these kids into the world. The number of no-shows on the schedule, compliance rate for occlusion therapy, maintaining proper follow-ups, refusal to pay for new lenses if the power of the rx needs to be increased (latent hyperopes), refusal to embrace home vision therapy programs, etc. It just wears on you after awhile...

If you care, you are much better off providing to families who care about their children, and who value your education and training...where you can make a difference.

[drk]

That's my quick take on it.

I appreciate your insight.

[drk]

20/15 line, you are laboring under a misconception.

This isn't a welfare program, it's the "new normal" for all American children's vision care.

Remember, amblyopia is a medical problem. Vision therapy is a non-covered service. VSP and the pediatric vision essential benefit have nothing to do with either.

[OHPNTZ]

20/15 line, you are laboring under a misconception.


Remember, amblyopia is a medical problem. Vision therapy is a non-covered service. VSP and the pediatric vision essential benefit have nothing to do with either.

I am referring to the conundrum of "medical" and billing with VSP's manual. I know vision therapy is not covered, but simply implementing a home therapy through HTs home program, parents balk all the time...

[JDH]

The Essencials plan is ACA aka Obamacare's pediatric portion of the plan. If you're just now hearing about this, then you need to insure you're getting your communications from VSP as this has been rolling out in droves since last October.

So this only applies to underprivileged children? This won't be rolled out to the large corps etc? I'll be curious to see how these plans all "develop" in the future.



and many but not all doctors understand the importance and good will at providing the less privileged eye care as well.
I believe that as well.


Are you stating that the kind of care you would provide would be different for a cash-pay well of patient vs someone from the pool of American children that have never been able to receive proper eye care/exams?, I would bet many of them would disagree and actually be grateful for finally having the option.

Not sure why how that was taken so out of context? I believe I said that patient care/quality eye exams is important, not that children shouldn't have good care.... Seeing 4 or 5 kids in an hour is not my idea of receiving proper eye exams, to use your words. Keep in mind that I am not a provider, but I am a patient and a father of kids getting proper eye exams; and have spent 20+ years in this industry seeing what it has become due to managed care, consolidation etc. I have countless friends, clients and colleagues that have to deal with this day in and day out. As you can see by my history, I don't usually post, and I am more of a casual observer of the forum. However, when I see 40.00 eye exams being paid for professional services to doctors, that doesn't seem right to me. But for you, as a provider, if that is acceptable to you, then I guess that's okay for your practice.




I retract my first point as I see you're not a panel provider but am leaving it as a reminder for everyone who is to insure they are getting their communications. I had lunch with a fellow provider who was still unaware of the dispensing fees for their various plans! He runs his business completely through his staff which IMO is a mistake, but ultimately that's his call.

I still believe the professional fee's, (exam fee's) need to be in-line with your title/education. Dispensing fee's coincide with the other profit centers of your practice such as contact lens fee's. (I'm pretty sure my dentist would agree with me:)
best of luck to you all
JDH

[JDH]

Told you I don't do this often, I can't even get my response properly formatted. Part of its in the above "quote box."
Rookie, signing off.

[racethe1320]

I still believe the professional fee's, (exam fee's) need to be in-line with your title/education. Dispensing fee's coincide with the other profit centers of your practice such as contact lens fee's. (I'm pretty sure my dentist would agree with me:)
best of luck to you all
JDH

Careful what you wish for...if VSP raises exam fees which in many cases are already higher than the competition, that is only going to sway their clients the other way even more. It's an all-in business for many. If you're not going to put an emphasis on the dispensary and it as a profit center then you're likely at a disadvantage. In my business, it's nearly 65% of the revenue and the profits are very high. I wouldn't give it up for the world.