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Thread: Affordable Care Act and your optical: What's going to happen?

  1. #76
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    Quote Originally Posted by Johns View Post
    Yes, I am passionate about this, and I have been working with some of the larger insurance companies, as well as trying to get a seat at the big table, but at the end of the day, politicians want to know how many of their constituents (opticians) will be affected, and when they see that most won't even join a local trade association, they can smell the apathy miles away, and turn their ear towards the groups that will at least show up.
    I have long thought we need a new Optician organization with a wider scope of service than the ABO, and with more flexible membership requirements than the Society to Advance Opticianry. I would nominate you president!

  2. #77
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    Quote Originally Posted by sharpstick777 View Post
    I have long thought we need a new Optician organization with a wider scope of service than the ABO, and with more flexible membership requirements than the Society to Advance Opticianry. I would nominate you president!
    Thanks, but what we need is a lobbying organization, and that would be dead in the water because it requires money. I've heard opticians complain about how much it costs them to pay for the gas to drive to free CEU's...heaven forbid if they were asked to contribute to a group formed to help them improve their standard of living,

    I can't speak for the ABO, but the SAO was not designed to be that type of organization, rather it was formed to encourage opticians to further their education, and to recognize those who have.
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  3. #78
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    Quote Originally Posted by sharpstick777 View Post
    I would disagree, I have helped a lot of ODs kick the insurance habit, it can be done. 4 of my practices dropped VSP last year. I have been working with one single location practice, 7 years old now, that will break the $3 mil year mark this year with zero insurance, in a depressed middle class area.
    As I've stated, my practice is by no way addicted to insurance, and we don't take VSP. I know what kind of income good offices can generate. The offices I take insurances at are well equipped, but have low rents, smaller staff, and hours that are specific to the clients.
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    Quote Originally Posted by Johns View Post
    Thanks, but what we need is a lobbying organization, and that would be dead in the water because it requires money. I've heard opticians complain about how much it costs them to pay for the gas to drive to free CEU's...heaven forbid if they were asked to contribute to a group formed to help them improve their standard of living,
    I can't speak for the ABO, but the SAO was not designed to be that type of organization, rather it was formed to encourage opticians to further their education, and to recognize those who have.
    We can't have a lobbying organization first, it has to start with a wider goal, and lobbying would be secondary role. Although you are right that Opticians complain about $6 for gas , those many of us there who are CE adicts don't complain. There are many opticians that invest both time and money into improving their skills and many are here for that reason. There is no national organization for them, and as you stated the scope of the SAO is limited too.

    We will never get everyone to join, or contribute or participate, but you can't wash everyone out with the bad bath water. It all needs to start with a national organization with a wider scope than the ABO or SAO ever intend to offer, where lobbying is not prohibited. There are some that would join, some that would help, and some that do care. If we can't start that, here, then we can't complain what other opticians do and don't do. I am made this case before, are you willing to join me? Your a very smart guy, a great business man, who is both knowledgeable and wise. Any organization would benefit from your participation.

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    Nice to see some honest discussion going on about this. ACA definitely should be a concern for anyone in the field. Sharpstick - I see you think its a possibility for VSP and others may end up getting dropped by employers plans since eyecare will be on medical anyway. Is this known at this point, eyecare will be on medical that is, or is it just a hunch?

    Another question that has come to mind is if someone does not purchase insurance, the government will do this for them. (the basic gist of it anyway) I tend to think of this as some sort of medicaid replacement. If one wants to accept these plans, do they have to get on the panel, like they would with medicaid?

  6. #81
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    Quote Originally Posted by AustinEyewear View Post
    Nice to see some honest discussion going on about this. ACA definitely should be a concern for anyone in the field. Sharpstick - I see you think its a possibility for VSP and others may end up getting dropped by employers plans since eyecare will be on medical anyway. Is this known at this point, eyecare will be on medical that is, or is it just a hunch?
    From what people at VSP told me (casual conversation, 3 weeks ago), they are handling the exchanges on a state-by-state basis.

    They came very close to losing California,

    http://www.bizjournals.com/sacrament....html?page=all

    and managed to salvage it only by promising to keep some 1500 jobs in the state...

    http://www.bizjournals.com/sacrament....html?page=all

    Now...that is just one state, and it's going to be interesting to see how many rabbits they'll have to pull out of their hat in each state to maintain their status.

    Here's another article that talks about the effect this will have on optometry. (the comments following, although merely one person's opinion, are interesting as well)

    http://www.healio.com/optometry/regu...public-meeting

    Did any Optiboard ODs attend this meeting? Anything you can tell us?
    I know there is one in my area, and I plan on being there.
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    Quote Originally Posted by AustinEyewear View Post
    Sharpstick - I see you think its a possibility for VSP and others may end up getting dropped by employers plans since eyecare will be on medical anyway. Is this known at this point, eyecare will be on medical that is, or is it just a hunch?
    Its a Hunch AustinEyewear, I have not seen the projections that VSP has done, but you can see the results and I have chatter from friends at VSP. VSP is frantically trying to maximize their short term revenue and diversify their income streams. Raise in Patient OOP Costs, New VSP Lab Network, Unity Lens, Marchon Frames, International Business. And VSP is threatening layoffs in certain markets if they don't get on State Exchanges.

    An audit by the WA state department of insurance showed the VSP was the single least efficient provider doing business in here, in Net they returned less value to the patients and providers vs. what they took in over every single insurance carrier. The goal of Obamacare is returning value and thus insure more patients for less money. So VSP will inherantly be at odds with Obamacare. Insurance companies add enormous expense to overall healthcare costs, but provide no real medical benefit to patients, and VSP is simply the worst offender of that.

    VSP rose up because medical providers refused to contract with ODs, so medical insurance had to outsource Vision Insurance to secondary networks when the employers asked for it, then VSP bypassed the insurance companies and went direct with the employers. Now ODs are on most medical panels, the need for 2nd party insurances has diminished greatly. Its simply more cost effective for medical providers to offer exam benfits directly. Hardware is another issue, so VSP will retain some advantage there. But as everyone seeks to reduce costs, some efficiency will return, and that efficiency for exams favors medical providers. They don't have to create a new department to process claims.
    Last edited by sharpstick777; 03-27-2013 at 01:58 PM.

  8. #83
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    VSP only has that leverage in California where their headquarters are, and there are a few states that will look at VSP's blackmail unkindly. They will have a much harder time in most other states.

    Quote Originally Posted by Johns View Post
    From what people at VSP told me (casual conversation, 3 weeks ago), they are handling the exchanges on a state-by-state basis.
    They came very close to losing California,

    http://www.bizjournals.com/sacrament....html?page=all

    and managed to salvage it only by promising to keep some 1500 jobs in the state...

    http://www.bizjournals.com/sacrament....html?page=all

    Now...that is just one state, and it's going to be interesting to see how many rabbits they'll have to pull out of their hat in each state to maintain their status.

  9. #84
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    Quote Originally Posted by AustinEyewear View Post
    Another question that has come to mind is if someone does not purchase insurance, the government will do this for them. (the basic gist of it anyway) I tend to think of this as some sort of medicaid replacement. If one wants to accept these plans, do they have to get on the panel, like they would with medicaid?
    The current plan as it stands now, people are NOT required to get insurance, but if they don't, they will still be paying some through a higher sur-tax. Compliance is encouraged but not forced. They can either pay that money to insurance or the government.

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    Quote Originally Posted by sharpstick777 View Post
    An audit by the WA state department of insurance showed the VSP was the single least efficient provider doing business in here, in Net they returned less value to the patients and providers vs. what they took in over every single insurance carrier.
    Thanks for response SS777. Now I'm curious what factors made them inefficient? From a provider standpoint, they are pretty good, and from what I can see better than most. Eyemed has so many plans that it makes it difficult. In my mind though, they are all inefficient. W/O them, we could probably lower costs to all patients across the board. However, would those patients still seek regular care, as it seems most don't unless something is wrong - and then you end up losing the cost benefits of catching problems early (diabetes, etc) Just food for thought.

    But what factors went into measuring efficiency really intrigues me.

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    Washington state added the average patient out of pocket, plus ins. premiums paid by employers, then subtracted payments made to providers and suppliers. VSP charged the most, and returned the least. Per patient VSP was keeping the most money for themselves of any insurance carrier who did business here.

    Quote Originally Posted by AustinEyewear View Post
    Thanks for response SS777. Now I'm curious what factors made them inefficient? From a provider standpoint, they are pretty good, and from what I can see better than most. Eyemed has so many plans that it makes it difficult. In my mind though, they are all inefficient. W/O them, we could probably lower costs to all patients across the board. However, would those patients still seek regular care. Just food for thought, what factors went into measuring efficiency really intrigues me.

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    Quote Originally Posted by sharpstick777 View Post
    Washington state added the average patient out of pocket, plus ins. premiums paid by employers, then subtracted payments made to providers and suppliers. VSP charged the most, and returned the least. Per patient VSP was keeping the most money for themselves of any insurance carrier who did business here.
    Interesting, given their strong hold on lenses, and some low ball diag testing reimbursements, I could see how that could occur.

    So as of now, the only way to get insurance is thru private companies? There are no government plans - they ended up doing away with these? If so, I seems difficult for these to really work, because people (supposedly) couldn't afford insurance before. So what are the theories on how this will now be affordable to people it was not previously?

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    Quote Originally Posted by AustinEyewear View Post
    So as of now, the only way to get insurance is thru private companies? There are no government plans - they ended up doing away with these? If so, I seems difficult for these to really work, because people (supposedly) couldn't afford insurance before. So what are the theories on how this will now be affordable to people it was not previously?
    There will still be government plans, but the goal is to keep more people on private insurance partially subsidized, so the plans would move to a partial capitated /PPO combination.

    The key affordability comes from the fact that over 60 million Americans depend on the Emergency room for their primary health care, because an Emergency room cant by law turn any patient away. Because the cost of care is about 50 X higher for Emergency room care than a simple doctors visit, by moving these patients to primary care (a regular scheduled Drs visit) the entire system will be more cost effective. The system can see more patients for less money. We are all subsidizing these patients through our premiums now, those extra costs are passed to all of us. Not mention the wait in Emergency (when we really need it) will save lives and treatments costs because patients will be treated sooner.

    That's the theory at least.

    The other key is now that many of these patients have primary care, their treatment costs will drop because they will see the Dr sooner. Delayed care is a huge cost increase in the system.

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    Here is the other diabolical effect that VSP and other managed vision care has on the market. Since many managed care plans pay so little, most Drs raise their U&C fees to compensate. Which means cash and PP0 patients are subsidizing VSP patients to some degree. Very few offices can survive on managed care alone.

    So as the U&C fees rise (which is VSPs fault) VSP now goes to providers to show how "much" VSP can save them on an eye exam and glasses. So VSP by artificially inflating optical prices has also improved their sales pitch. Crappy, eh?

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    Quote Originally Posted by sharpstick777 View Post
    There will still be government plans, but the goal is to keep more people on private insurance partially subsidized, so the plans would move to a partial capitated /PPO combination.
    Here is where the actuaries and our good friend Johns goes nuts. A combination of capitated and /PPO insurance plan will have an uncertain effect on the market, the numbers will all change, because insurance now is either ALL capitated (like and HMO, the provider gets paid whether you use them or not) or ALL PPO, where the provider gets paid for every visit or service only. Because the government will basically subsidize some policies, these plans become partially capitated. No one knows how THAT will exactly pay out, because its never been done before. We will have an adjustment period as those actuaries calculators are put to work in new ways.

    A simple example, if the price of Milk stays the same, you can have some reasonable exception of what people will buy because sales will also stay the same, you have market equilibrium. If its free, everyone will buy it of course, so again, you can predict, just count the number of people. But if I drop the price in half, what will the market response be? Will 2 or 3 times the number of people now buy Milk. Its un-predictable, that's why we don't know EXACTLY what will happen, no one does.

    When we reduce the over cost basis of healthcare, demand will increase, but no one knows by how much.. or what then new cost basis will be. That's why details are fuzzy, no one wants to commit to numbers they can't operate with. We will find a new equilibrium someday, but we will have a less efficient market until we do.

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    Quote Originally Posted by sharpstick777 View Post
    Here is the other diabolical effect that VSP and other managed vision care has on the market. Since many managed care plans pay so little, most Drs raise their U&C fees to compensate. Which means cash and PP0 patients are subsidizing VSP patients to some degree. Very few offices can survive on managed care alone.
    Agreed with caveat, this can be said across the entire ins. spectrum. med, vis, dental, ect. can't really single out a single ins company that this would not hold.

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    Quote Originally Posted by sharpstick777 View Post
    There will still be government plans
    If these start springing up in early 2014, how does one become a provider?

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    Quote Originally Posted by AustinEyewear View Post
    Agreed with caveat, this can be said across the entire ins. spectrum. med, vis, dental, ect. can't really single out a single ins company that this would not hold.
    Most primary care medical practices in this area are 95% insurance, and do quite well. Most medical insurances here pay decently. Many Dentists here accept ZERO insurance, so its where I think Optical is heading.

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    Quote Originally Posted by AustinEyewear View Post
    If these start springing up in early 2014, how does one become a provider?
    Some of it will be determined by the State Exchanges, some providers will just add special plans to their existing offerings. That is why there is so much uncertainty, no one knows for sure what the state exchanges can and will require. In general, most insurance providers will enter the exchanges, so if Blue Cross creates an Exchange plan, and you take Blue Cross, you will probably already be a provider. The patient my have a different copay, benefits etc, but that is how it is now already.

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    As a side note, to demonstrate how inefficient the Medical/Insurance system in the US consider the Mayo Clinic. They have one of the highest brand recognition on the entire planet. In 13 of 16 medical categories they are in the top 5 in the world for treatment and of care. Many of the MDs are considered tops in the field worldwide. And they usually see only the worst patients, after they have locally tried everything else over many years. Their patient referral level is astonishing because their "customer service" is so high. All of that seems a recipe for financial disaster.

    You would think that care at the Mayo Clinic is expensive, wouldn't you? The Mayo Clinic charges about 46% LESS on average than other providers. Almost half, for much better care. They made billions in profit too, which is then poured into their own research foundation.

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    I may be wrong but I believe that the Mayo specializes primarily in diagnostices and not long term treatment or care. The patient comes in on Monday and walks out on Wednesday with a diagnosis which will be managed back home by their local health care system.

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    Mayo is a full treatment facility, multiple hospitals, surgery centers, etc. and many of their treatments are unique. They are fast, so its not uncommon for someone to arrive on Monday, be treated on Tues, and leave on Wednesday. They know that many of their patients travel long distances for both diagnosis and treatment. And that delays in care increase both expense for the patient and their family, and decrease the success. Speed is one of their mantras.

    There is a great book about the Mayo Clinic, Management Lessons from the "Mayo Clinic" that is intended to be a business book about one of the most successful businesses in history, but it offers great insight into what is wrong with our healthcare system.



    Quote Originally Posted by rbaker View Post
    I may be wrong but I believe that the Mayo specializes primarily in diagnostices and not long term treatment or care. The patient comes in on Monday and walks out on Wednesday with a diagnosis which will be managed back home by their local health care system.

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    Quote Originally Posted by sharpstick777 View Post
    Some of it will be determined by the State Exchanges, some providers will just add special plans to their existing offerings. That is why there is so much uncertainty, no one knows for sure what the state exchanges can and will require.
    Well, most folks weed out low reimbursement rates, because they can't afford to pay staff on them. Ins. co's know this, and so does the government. Hopefully this fear won't come to fruition but there sure is a lot of chatter about it. It makes me wonder if they will tie these government run health plans to medicare or something, forcing people to take what ever it is they end up offering, or dropping medicare if they don't want to deal with it. I'm assuming there will be government run health plans, or is that not the case?

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    Quote Originally Posted by AustinEyewear View Post
    I'm assuming there will be government run health plans, or is that not the case?
    I believe that is the administrations ultimate goal - everyone, no exceptions, under a single Federal Government health insurance plan.

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    It all boils down to Americans sitting back, doing nothing, and deciding that anything is better than what we have.


    Well guess what? "Anything" is not always better.
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