Monthly Archives: December 2013

Eye Care Industry Trends!

....this article is courtesy of VCD

Private Practice Eye Care Providers (PPECPs):

  • are LOSING 2 to 4% market share per year
  • provide 65% of the eye exams and only supply 39% of the eyewear
  • have more managed care patients each year
  • are losing locations (1000 per year nationwide)

Corporate optical retailers (Lenscrafters, Pearle, Wal-Mart, Costco, etc.):

  • are GAINING 2 to 4% market share per year
  • provide 33% of all eye exams and provide 60% of all eyewear dispensed
  • are gaining locations (1000 per year nationwide)

Vision Care Benefits:

  • Demand is INCREASING
  • Are the least expensive benefit of the big four benefits (medical, prescription card, dental, and vision.)
  • Demand is the same as dental and continues growing each year.
  • Help to ensure that patients purchase materials and services from PPECPs instead of corporate optical retailers

OD graduates:

  • Are choosing to work for corporate optical retail chains rather than in private practice
  • Are recruited by corporate optical retail chains at optometry schools
  • Are demographically more prone to favor retail chain occupations

The Bottom Line:

PPECPs are LOSING market share and money because:

  • They have lost private pay patients to corporate optical retail chains
  • Managed care (Spectera, Davis, Avesis) reimburses poorly
  • Patients are not covered with vision care benefits independently or through a collective organization (work)
  • They cannot capture new OD talent
* Based on Jobson Optical Research Reports
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A Battle For Professional Survival Begins – Jan 2014

Make no mistake about it, this IPA is being created because there is an ongoing battle for your professional survival!  One much more imminent than you might have imagined.  One that needs your ideas, your voice and your energy!  Why?  I am about to explain!   Once you have a clear picture then you will know why the NYIPA needs your creative thoughts! 
As I suspected,  Reid Nelson,  the founder of VCD,   clarified that the “NEW”  health care paradigm, is nothing more than no optometry crossed outthe rebirth  of HMO’s and Capitated health care with one new twist.  It is designed to reward frugality and penalize duplication.  Sounds good or patients but is it?  This twist is using EMR for a MUCH greater ability to penalize you for duplication of services.  For example: you see the patient,  the patient is referred to an ophthalmologist,  is then referred to a Retina Specialist. This will not be allowed!   With every challenge however, there is opportunity.  we just need to pick which side of the revolution we are fighting on.  The NYIPA wants and needs your input!  If we don’t choose well,  there may be little left of NY State private optometry next year! 
Mid state here, Putnam, Westchester, Duchess and Orange, we are seeing the power of organized commercial like medicine under the many HUNDREDS of doctors who have been put out of business and employed  by the MKMG (Mount Kisco Medical Group). Further north there is Crystal Run Healthcare,  In nearby Ct it is Western Ct. Medical Group, closer to NY it is WestMed and Montefiore,  in NYC there are many more!  You know the names!The MKMG for example,  is a formidable opponent.  It is a huge chain of employed MDs, much like Luxotica is for employed optometrists (some are called leaseholders but you know they are controlled if they want their lease renewed).  My personal experience being in the center if their territory is like being a chicken in coop surrounded by wolves. 
When HMOs first launched, many years ago,  with Clinton and Hillary,  I was denied access to patients by the MD Gatekeepers.  The MDs  sent referrals to  friends who they networked with at the hospital for referrals.  One unusually brassy  @##$% “gatekeeper”   took a patient I had seen on an emergency basis with Uveitis (now under my care) out of my office by refusing me referrals. I could not continue her care!  He TOOK her out of my office and sent her to a “buddy.”   Gatekeeper MDs  will likely be able to do this again! Thanks to Obamacare (which is now in play as of January).
When groups of MDs,  that are like the IPA we are forming,  are associated with hospitals or other regional centers which are  forming ACO’s  (accountable care organizations) they will be like insider market traders getting all the business.   IF they have too much power, you as an OD,  might be doing nothing more than refractions for EyeMed but not much else. Even if you are a BCBS provider, if you are not in a group the ACO is contracting with,  you will not see patients.  Possibly for the first 6 -12 months of Obama care this will not happen but as I understand it you can count on it for later.
We must be organized here and nation wide to become a formidable opponent.  Not because we can outgun them but because we can work with them. As our colleague,  Ami Ranani,  brought strength-inlineup last night,  MD’s are going to be graded by ACOs. They will be graded on things like how efficient they work with their Diabetic patients, etc.  What the industry calls “outcomes.” We can  help them succeed by monitoring and reporting on OUTCOMES of their care by retinal imaging  in their diabetic  eye exams.  In addition as Dr Hom (of Wellpoint) has suggested  one our key roles may be to monitor their BS by A1C testing and provide diabetic education to prevent continued degradation.  Dr Hom believes this will become a reality and have reasonable re-reimbursements to make it worth while.   But to do this, the ACO has to contract with us!  (This is why luxotica wants Perle and Lenscrafter docs to look like “professionals.”   luxotica wants the ACO contract! They cannot do this by providing mass refractions at JC Pennt!  This also why EyeMed includes private ODs in their plans!
The bottom line is,   we WILL and must form a powerful,  successful statewide group.  We will if you all can see the vision of the  Professional Precipice we are standing on!  We must empower ourselves not to fight the wrong battle but the right one.  WE need some 5 Star Generals (you board members are Generals in the battle, you soon to be members will be battalion leaders!)  in the NYIPA  to become visionaries.  We need to choose a direction for our nascent organization.  If we choose like the RedCoats did we will loose.
One thought to be entertained is we must plan on  working with larger medical groups like MKMG rather than against and the same for all the ACOs like Montifiore!  If we can get big fast,  which we  intend with your help and VCD,   we can possibly consider working WITH the MKMG by allowing some of their ophthalmologists to join our network, as tertiary care participating providing, not owners, and as such get the referrals they want from our network and give them the services they need!  So far In MKMG’s case they  do not want to or sell glasses though likely they have a backdoor arrangement with Raymond’s Optical. However, Raymond’s is an eyeglass pushing entity and not a medical eye care provider as 99% of us are!  They know how this power strategy game is played. They got big by freezing doctors out of the referral network and  them and then absorbing them,  much like the BORG on Star Trek.   As much as I do not love how they formed,  I can admire their success and I have and will work with the doctors, many who are excellent!  The issue for  me and you is keeping the wolves out of the chicken coop!   If we can provide better outcomes for their PCP’s by our retinal exams,  they will benefit;  if we can work with their ophthalmologists, they will benefit.   I am not sure if this is a good idea or even the right direction but I throw it out to you to get you thinking.  WE NEED A STRATEGY AND A DIRECTION.  No one knows how the game will yet be played.  As Vision Monday said,  “If you have seen one aco……. you have seen one aco!”
We must know our enemies and our friends and choose sides in the battle to come and it began this Janruary!    The MDs are organized by hospital membership,  in NY  near me by the MKMG and  in nearby Ct. by  the Western CT Medical group, which competes with MKMG on the NY boarder!   It is happening NATURALLY for them everywhere.  They are networkers.   We too must learn to work together, to be organized, love your enemies - feed your enemyquickly and we too must choose a direction.  I ask you to read and understand what is happening and help share your vision for the direction your organization,  the NY IPA,   must take in the next year.   Share this article with you colleagues as this will happen everywhere across NY State and we who can qualify as private practitioners, must ALL join and support the NYIPA.  Dr. Ami Ranani and I will be talking with leaders in other states.  Dr Vincent Calderon had brought back news from the front line, a meeting of national leadership in Arizona!  Make no mistake, your are fighting for your survival.
Think creatively,  share suggestions by email,  take the initiative to talk to anyone in the leadership of other states, share ideas.  My goal as NYIPA president is to expedite the organization’s rapid formation,  to organize our team and communicate,  the vision is yours!  Share your vision,  Share your needs,  Share your support,  Join The NYIPA,  it is your best hope for prosperity in the new health care paradigm.  Most of all it is YOURS!  Become an owner we need to hear your voice!   What is the sound of one hand clapping?  Failure! 
Dr. Joseph Ross,  NYIPA President 

PEERING OVER THE PROFESSIONAL PRECIPICE

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 Teamworktheir 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 Precipicedon’t mobilize right now, we may be left to reminisce fondly about the Golden Age of optometry that ended in 2012.

THE DETAILS

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 Moving_Fast-300x223are 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:

  1. Show your interest by adding your name to our list of potential members! Apply now!  Click Here
  2. Subscribing to this newsletter NOW!  See the top right link of our homepage!
  3. Tell all your colleagues on Facebook, Twitter,  Linked-IN and more to do the same.
  4. If you have experience in organizational leadership and are willing to donate your time and efforts,  email our President,  Dr Joe Ross.  Screenshot from 2013-12-20 08:25:06 We want you on our team!

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Doctors Driven Into Bankruptcy!

doctor morgan moor

Dr. Morgan Moor, an internist, narrowly escaped filing for bankruptcy in 2011.

As many doctors struggle to keep their practices financially sound,some are buckling under money woes and being pushed into bankruptcy.

It’s a trend that’s accelerated in recent years, industry experts say, with potentially serious consequences for doctors and patients. Some physicians are still able to keep practicing after bankruptcy, but for others, it’s a career-ending event. And when a practice shuts its doors, patients can find it harder to get the health care they need nearby. Read more……..

New Leadership Joins The NYIPA

The NYIPA welcomes Dan Kirchheimer to the board of the NYIPA. ​

Dan is part of the great team up in Vestal NY at the Sacco Eye Group.  Dan is past president of the SUNY College of Optometry Student Society of the New York State Optometric Association, and was one of the youngest serving members of the Executive Board of the New York State Optometric Association.  He is currently the President Of the South Central Optometric Society and our 5th Society president to join the NYIPA.  Dan has kindly offered to help the NYIPA  upstate by attending our Sunday Night Board Meetings and work with Andy to help forge better communications. Andy will continue to communicate by email as his previous commitments made Sunday night meetings almost impossible.

 
Thank you for your interest in supporting Private Practice Optometry in NY State, Dan!  And Welcome to our leadership team.

leadership-team 5-12-14

 

The NY IPA was founded today 12-14-2013

The NY IPA  was founded today by a meeting of past Vision Resources leadership and lots Business success growth chartof new great doctors from across NY State.  On start up we have a board that includes members in Orange, Dutchess,  Putnam and The Bronx Counties of NY State!

Our goal is to duplicate the success that other IPA’s across the US have had with developing, marketing and selling better quality plans to local and national buyers. In addition we anticipate being the NY State voice of optometry in negotiating with ACOs (Accountable Care Organizations) created by  The Affordable Care Act (Obama Care).  These ACO’s will be parceling out lives to groups of providers and we anticipate being one of them to keep your offices busy!

The NY IPA,  is a group of independent  practitioners and will not include commercial doctors as our goals are to provide the level of care that we believe is not consistent with the goals of mass eyeglass merchandisers who lease out these facilities and as such have a strong influence upon how their leaseholder doctors may practice.

We have lots of other goals in mind to make your practices much more profitable through the rapidly growing size of our national organization,  IECP,  which is owned by the local IPA’s.   As our buying power grows, so will yours and so will your profitability.  This means that soon our member doctors can compete and win contracts that might otherwise end up in the hands of big chains.