THIS ARTICLE IS AN ADAPTATION OF ONE WRITTEN FOR THE SUCCESSFULLY GROWING CT IPA. This was initially published 12/19/2013 by the NYOIPA founders.
It was a year and a half ago when a group of Connecticut optometrists got together to form their own IPA, a group that would be owned and controlled by local optometrists for optometrists, not owned by large corporations who could care less about private ODs. They would determine their own fees, how the plan would function and finally have more control of our profession and our future.
Strategic planning depends on anticipating changes well in advance of their occurrences and being prepared for them. They hired consultants who had a proven record of establishing optometric IPAs throughout the country to guide them through the process. They then developed a statewide panel of providers to offer to prospective plan buyers. Their IPA could always use more providers to beef up the panel, but they thought, as they got started to get interest in our IPA from brokers and buyers, that they were moving forward nicely. They thought that they had time to grow.
They were wrong. Very wrong. The stakes have just been raised significantly.
You’ve heard of the “fiscal cliff”? We are rapidly approaching a “professional precipice”, a moment in time when OTHERS can effectively eliminate optometry from the professional landscape. The timetable is in place. The mechanics are being devised as we speak. If we don’t mobilize right now, we may be left to reminisce fondly about the Golden Age of optometry that ended in 2012.
Previously, to access patients, we have been concerned about being participating providers for various health plans. As the healthcare landscape has been morphing into unknown frontiers, we wanted to be included in the Healthcare Exchanges, where individuals and businesses can buy health insurance. We were in the wrong place. Without an IPA in any U.S. state we are definitely in the wrong place!
Under the Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare , local healthcare will be managed and coordinated by ACOs, or Accountable Care and Medical Home Organizations. The ACOs will generally be local hospitals overseeing networks of providers handling many tens of thousands of lives. It won’t be insurance companies or vision plans (the payors). The ACOs will want to put together panels of high quality, experienced providers who have a proven record that they can diagnose and treat conditions quickly and efficiently. They will be looking for offices with the best instrumentation and credentialed providers having PQRI, NCQA or maybe even Board Certification, who can deliver excellent quality care while effectively managing fees. The ACOs are critically looking at the bottom line and understand that there is economy of scale. They will want to cherry pick the best practices, but not negotiate with individual practices; they want an entity to represent those quality practices. Having an established panel of credentialed optometrists in place that has good statewide coverage and is large enough to handle their patient volume is critical.
The Connecticut leadership was determined that this panel clearly should be the Connecticut Eyecare Alliance. It would be in place before January 2014. They have done this! NY Is way behind, but not in energy, enthusiasm, leadership and commitment! Your opportunity is about to happen! The NY IPA has been formed and it has not only the same support that Connecticut had but a panel of seasoned leaders who have done this before in an organization call Vision Resources (Founded by Dr Gary Weiner). Vision Resources organized a network of statewide doctors, mostly upstate, and successful sold plans without any of the great infrastructure that our brothers and sister OD’s in Ct. have so successfully utilized! This team is back together with new young leadership here and in NYC as represented by Dr Vinny Calderon who will be flying out to Arizona as your representative to our national meeting. This is not just a NY state group but a Nation Group which, unlike VSP, is owned by the IPAs, of each state, You and me! No one in this group will ever dictate your fees. It will be your group when you join locally! It is a cooperative on a nationwide level.
THE BOTTOM LINE
We all must move fast, very fast. The Ct IPA knew it would have have to double its provider network in the next 90 days for its IPA network to be considered by ACOs. Since all ACOs are local, in areas where there is a strong panel, they should be a competitive force. In areas with poor representation, the ACOs may look elsewhere if there are better options. Unaffiliated providers in those areas may be left out completely.
This is as urgent a situation as we have ever faced. If optometry is excluded from an ACO in your area, it won’t matter what insurances you accept, you won’t be in the loop. You won’t be at the table and you won’t even be on the menu. You may participate with their insurance plans, but if your patients are being managed by a “gatekeeper” ACO that you are not affiliated with, they cannot see you. Period.
Our NYIPA board, with help from our colleagues in Ct, are consulting with experts across the state and country. The timetable is very short and implementation dates are around the corner. Complacency is not an option. There is no more “business as usual”.
Our IPA is no longer concerned about just competing with the commercial vision plans. We must become a major statewide player to be attractive to ACOs for the quality managed care of their (our) patients. That is the prime purpose for our organisation and beginning membership drive.
As with all panels, we will eventually have to limit membership/ownership to effectively control costs, so please join us today and forward this to your colleagues who might be interested. Until further notification, the only current requirements are, that ODs who join us a owners own/control their dispensary, as the vision plan component may include eyeglasses, be available for 24 hour medical access for emergency medical care, be the majority owner of the practice (these qualifications may change without notice as determined by the IPA leadership). Commercial practices that may not qualify as such, however they will be included as non-preferred providers whenever it serves the contracting entity and the boards assessment of value to the IPA.
Concerning the difference between ownership and non-ownership status in the IPA, non-owners have no say in the direction or management of the IPA while owners do have a say and a vote. Non-owners will only receive their contracted fees. In some states, some non-owners may be reimbursed at a lower rate than owners. Owners collectively control all of these details. Additionally, once the panel is closed, the owner share will appreciate in value. If someone wants to buy in to the IPA, they will have to buy someone’s share. In some states, shares go for upwards of $10,000. Conceivably, owners could reap a dividend if and when the IPA becomes profitable…. but that is probably a distant goal for now.
Connecticut had no parent organization to finance the development and growth of their organization. The NY IPA has been granted some funding by the Board Of Vision Resources whose president Todd Punim is also our Vice President and a man with a clear vision on our future. Beyond this fantastic gift of start up help we must self-fund this initiative by assessing a monthly fee to all members. We plan to have a number of vendors in and out of the eyecare industry, who will and have stepped up to help fund organization like ours, across the usa. Nevertheless we will only grow quickly through member support. The action step is to grow the IPA right now. You have put years of effort into creating your practice. Don’t let that be taken from you!
Get started with protecting your future by:
- Show your interest by adding your name to our list of potential members! Apply now! Click Here
- Subscribing to this newsletter NOW! See the top right link of our homepage!
- Tell all your colleagues on Facebook, Twitter, Linked-IN and more to do the same.
- If you have experience in organizational leadership and are willing to donate your time and efforts, email our President, Dr Joe Ross. We want you on our team!