I Hate Vision Plans


The following was written by Dr. Don Railsback who practiced optometry in Neodesha, Kansas (population 2,900). Currently, he manages Vision Care Direct sales full-time in Kansas.
“Put a vision plan in at Cobalt Boats! Are you crazy?” This was my thinking
process several years ago as I was forced to consider such a ridiculous idea. After all,
Cobalt was the largest employer in town. They had almost 900 people working there and
in my mind I was seeing a large majority of them and their families. The thought of
seeing all those patients at a discount gave me chills. Times were tough enough with new
competition in the form of the big box retailer, Wal-Mart opening just thirteen miles
away and a large optometric group buying and expanding a practice in another
neighboring community. “Why should I sell a plan that would make me take a discount
on patients I already had in my practice?” I kept asking myself.
Yes, it was true that I had been selling Vision Care Direct all over the state. And
yes, I had been telling doctors and staff people that VCD was different, that you could
actually make a decent margin with VCD and that it would tie patients to their practices
that might be going to Wal-Mart or Lenscrafters. But, this was my practice, my town, and
things were different in my situation. Sound familiar? It should because every day I run
into doctors who believe that their situation, their community, their patient base is
different somehow. That adding a vision plan, any vision plan is like joining forces with
Satan himself. I was that guy….
Then my conscience got the best of me. I had stalled long enough and the fact that
I was out selling VCD all over the place (except my own back yard) finally got to me. In
November of 2005, I went out to Cobalt, presented the plan, and much to my chagrin,
they bought it. Their effective date was January 1, 2006 and for a about a week after the
sign up I worried about what affect it was going to have on my practice. Then something
interesting started happening. The phones began to ring. Patient after patient starting
calling in to schedule appointments in January! The phones didn’t stop ringing over the
next month until our office had NO appointments available in January, February or
March! We had to reorganize our schedule and actually extend our days to add more
exam slots. This was a pleasant surprise in some ways, but my deeply ingrained
optometric doubt gene, kept me awake a few nights, wondering if these patients were
going to cost me more than I took in. I had spent my entire career believing that vision
plans, any vision plan, were bad for optometry. Those long held beliefs weren’t easy to
let go of.
What eventually changed my mind were the numbers. I had always been a
numbers guy and we tracked every facet of our practice very closely. I could see very
profit growthpositive numbers coming in very early. Gross sales were up, but more importantly the net was up! Not just the net, but the percentage of net to gross! “How could this be possible?” I asked. I dove into the numbers and found several interesting changes in my practice. For the three month period of January, February and March I saw more NEW
patients in the practice than the previous TWELVE months. Not only that, we saw more RETURNING patients in those three months than any quarter since we started tracking it.

We define returning patients as those that had left the practice to try somewhere else and
then came back to us. The vast majority of these patients had been to a WALMART
because they thought it would save them money. Many of them, I didn’t even know I had
lost, because they hadn’t admitted it on recall contacts. When we asked them why they
had come back, 100% said because the vision plan helped them afford to get the kind of
care they wanted anyway. Very few were happy with their Walmart experience but were
too embarrassed to come back on their own. Many of them had been long term patients
who I had taken care of since I started in practice, and I would have never believed they
would leave me, let alone go to WALMART!
Another interesting statistic was that the average patient expenditure was up.
More people were electing to add AR, high index, transition and upgrade their frame.
VCD was helping them save on their frame and lens purchase so they were able to
upgrade and still have a palatable bill when they were through. Patients were happier
because they could now afford to take my recommendation for these lens treatments.
They left feeling like they were following the doctors’ orders and weren’t ignoring my
I almost couldn’t believe that adding a vision plan to a company that didn’t
previously have one could do so much for my practice. Average per-patient sales were
up. Gross was up. Net was up. We saw more new patients per month, than ever. The
schedule was full and patients were actually happy with their vision plan and so was I.
More patients were seeing private practice docs and fewer were going to big box
retailers. The other doctors in my area were also seeing more Cobalt employees and were
seeing similar results. I learned that I wasn’t really seeing as many Cobalt employees as
I thought I was. The “conventional wisdom” was wrong.
It was working so well that I decided to try to present it to other industries in town
and sold it to two more companies and the city. I made a critical error with one
manufacturing plant, however. I decided not to try and sell it to that plant because they
had an indemnity plan that allowed me to get full fee from their employees. I thought I
should leave that one alone since their plan was so good. The next thing I knew, the
company changed plans to save money. That plan was set up so that selling additional
lens treatments actually increased the percentage write-off and forced me to take between
a 40% to 60% discount on jobs with additional treatments or upgraded frames. This
national plan also would force me use one of their labs and has a claims filing system that
is a nightmare for the staff. I wasn’t on that plan and the numbers just didn’t make sense,
so I did lose some of those patients. If I would have been smarter and presented the plan
to them early, VCD would have had a good shot of landing that one also.
Don’t get me wrong. I still don’t believe that every vision plan is good for
optometry or your practice. Vision Care Direct works because it is designed to be a WIN
for everyone. VCD member patients save money on their basic frame and lens package,
doctors can balance bill for add-ons and upgrades, and employers can save money by
offering the plan on a voluntary basis and running it through their pretax 125 plan. VCD
doesn’t have a profit motive for selling vision plans so can reimburse doctors at a higher
rate than other plans. VCD is doctor owned and actually wants those enrolled to use their
benefit! These are important differences between VCD and other plans.
magnifyingDoctors really do need to take a close look at the plans they are considering.
Taking a poor plan can actually drive down fees across the board. When doctors sign up or every plan on the market it confuses companies looking at the plans and they end up
choosing the lowest cost plan, not the one that may be best for their employees. VCD has resources that can help doctors evaluate plans, look at chair costs and understand the maze of plans that are on the market. Private practice optometry has to start taking care of private practice optometry. Every doctor needs to look at each plan based on not just the impact on their own practice but also on their profession.

It’s ok to hate vision plans. We’d probably all be better off it they didn’t exist, but
they do. The challenge is to find and support the plans that support doctors and build the
profession. Decent fees are important to patient care. If doctors aren’t profitable they
can’t invest in equipment, staff, training, education, and facilities. Eventually, the level of
patient care will suffer. It’s time for us to let go of “conventional wisdom” and embrace a
plan that can actually help us practice the way we want to, take care of patients the way
we want to, and protect our profession from big box retailers and the pirate vision plans
we all hate.


About janrssor

Author whose Nome De Plum and main character share the same name. I am a programmer, eye doctor, holistic practitioner, student of religion, student of mysticism, student of science, business net-worker and I strongly believe that life without a challenge and daily growth is not worth living. My motto is Live Outside The Box.

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