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 the 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 up 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, quickly 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