Medicaid only optical shop?

[pseudonym]

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.

[chip anderson]

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

[optical24/7]

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.)

[pseudonym]

@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?

[optical24/7]

Then open a budget optical that accepts medicaid also. I was just pointing out the folly of opening a "medicaid only" shop.

[Speed]

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.

[Ocular Dexter]

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.

[pseudonym]

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.

[Oedema]

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.

[OHPNTZ]

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.

[DragonLensmanWV]

Anyone have any theories about why so many of them have so much cylinder and high plus?

[OHPNTZ]

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.

[OHPNTZ]

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...

[optical24/7]

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

Plano, Emmetropic! :bbg:

[chip anderson]

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