Monthly Archives: July 2017

Do You Like IPAs? Here’s Why You Should

May 2 20017 ….. by Christopher Wolfe, OD, FAAO, Dipl. ABO  Read the full post here. 

Dr. Wolfe is the Chairman of the Board for EyeAssure, an Optometric Independent Physician Association and a wholly owned subsidiary of the Nebraska Optometric Association.

I used to think that IPAs were just an extremely hoppy brew originating from pale malts that I would drink last  (or give away… to others who liked them of course) when they were a part of a seasonal variety pack.  India Pale Ales are not something that my palate can tolerate.

 It wasn’t until about 3-4 years ago that I discovered IPA’s (Independent Physician Associations) were also a powerful tool that physicians can use to provide value to and collectively negotiate with, third party payers.  This is defiantly an IPA that I could love!

As a student and new graduate, I always asked (and heard others ask) why we couldn’t come together as a profession and negotiate collectively with insurance companies.  Every time this question was asked by me or someone else it was met with a quick “we can’t discuss those things within our associations, it is antitrust”.

While this answer was (and is) technically correct, it was never followed with the legally appropriate mechanisms that exist so that physicians CAN collectively negotiate.  I was never satisfied with the answer since I knew that there had to be some way that physicians who practice in large groups or within hospitals were negotiating their insurance contracts.  So, I continued to ask.

Fortunately, one day, I was discussing these frustrations with someone who had a lot of experience negotiating with insurance companies.  When I expressed to him that I had been informed that “we can’t discuss those things”, he simply smiled and said; “that is incorrect”.  “You just have to know HOW to legally come together as a profession so that you CAN negotiate collectively.” 

That day was the beginning of a long and exciting journey for our profession.  Someday I will describe the vision and process that the Nebraska Optometric Association went through in researching, developing and launching an Optometric IPA, but for now, I want to focus on the general functions of an IPA.

An IPA is a legal entity that unites physicians allowing them to negotiate insurance contracts.  IPAs do this by providing VALUE to those insurers which in turn will provide a reason for the payer to add beneficial provisions in the contract with the providers represented by the IPA. There are multiple types of IPAs and IPA classification determines what components of a contract can be negotiated (I will discuss this in Part 2 and 3).  

Part of the role that the IPA plays in controlling costs (for the payer) and improving the quality of care include:

  1. Deliver the contract to the provider once it has been negotiated

    • One of the costs of doing business for insurance companies is organizing a provider network.  This means that if there are 500 providers of one type (in this case ODs) then that insurance company has to disseminate contracts and communication to 500 different addresses, if an IPA acts as an intermediary then the insurance company can have 1 place to go for these types of contacts.

  2. Credentials providers

    • Similar to the above, if the IPA can credential providers in a manner that is acceptable to an insurance company then that is less work and cost that an insurance company has to spend on credentialing individual providers.

    • This is also a benefit for the physicians since every contract that is negotiated by the IPA would likely include the provision of accepting the IPAs credentialing, so there is no need to re-credential for every contract that is accepted by the physician.

    • Additionally, this allows a favorable intermediary (the IPA) to act on behalf of the providers in the case that there are questions that arise during credentialing.

  3. Implements utilization management (UM)

    • As I discussed in a prior post, payers look at a distribution of codes and procedures for outlier providers who utilize these codes at a level that deviates from the norm.  This can be a significant cost to the insurance company.  It can also be difficult for the insurance company to determine if the outlier is legitimate (as in the case of a provider who sees only complicated glaucoma patients compared to the general primary care optometrist) or an aggressive biller.

    • Since the IPA performs the UM they determine legitimate outliers versus aggressive billers.  I would much rather have an optometric committee evaluating my care than a professional auditor since other ODs will understand the care of patients better than non-clinicians.

The bottom line:……………….  read more here! 

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Cardboard Is God’s Prophet For Optometry

If you knew the future of your business was in jeopardy and how far away in time that change is, would you do something differently?

garbage-402295_640Last night I dreamed I had a temporary job working for a large optical store chain in NY City (I did when I graduated Optometry School).  When I got there all the equipment was so old it was useless.  The batteries in the instrument handles were rotting. The corporate staff who ran the labs was upstairs watching TV as they no longer made lenses in the USA. The lenses came from Alibaba Wholesale of China or were send as complete pairs to customers on line. No one really wasted time shopping in stores that were expensive, old fashioned, and filled with depressed employees.  I tried to get some equipment to do my exams with from some of the staff watching TV but they just laughed at me and said, just give them more plus, their old and that will work. Young people get eye exams on line, they never come here anymore.

This is not imagination. Nearly half the people in America are on some sort of government subsidy (welfare) because they no longer have jobs. Manufacturing Cities, IMG_8992.jpglike Detroit, Memphis, Milwaukee, etc., look like the dystopian nightmare scenes sci-fi paints on your TV screens!  Since it is not really Sci-fi, it has in truth become the neon light of the sounds of silence, that no one hears.  Is it the end of America?  I doubt it, but it is the beginning of a huge new revolution. A revolution where many things die and new ones are born, many win and many lose. Will you be a winner or loser? What have you planned and worked to become?  If the answer is, “I have no plan yet”  then you are planning on losing.

Where do you choose to be tomorrow?  Will you be one of the people that government is planning on giving a “standard basic salary to so that they may find some work to raise them up from that poverty level?  Or are you a disrupter who will use technology to make change, progress, money with pride?

You have a choice before you but not for long.  The choice is not too painful now but will be later. What takes out the pain now is that it is still time to have a fusion of technology and tradition. Later you will have to lose all you own as it will be worthless and then you must start from scratch.  Have you seen this? If you have not noticed it, is is all around you!

Notice the Malls that are closing, and department stores that are going out of business Debeverywhere!  Everything is moving online. You can now shop directly from China via Alibaba.  Cardboard recycling is the new prophet. It prophesies the death of traditional business. There is a torrent of cardboard needing recycling as packages become cheaper to deliver than driving to the store. Amazon is the new supply company that is taking over the world, just as a few companies did in the movie Rollerball.

Change is inevitable as stone and steel comes to life and human form turns to….. We shall see.  The robots are not coming they are here.  You still have time, though.

If you are an eye doctor you can be part of the transition not the destruction and recreation; it is lots less painful.  This requires the Fusion of online home technology and 

vinny

in office service technology.  If you combine your in office service with the online homebound service need and product delivery you can transition rather than die and find  job in rebirth, if you are lucky.

Right now there is one chance, work with Vinny Calderon, Aspire Health Solutions and deliver service no one else has been willing to do. If not you have one clear future, it is written on the subway walls and tenement halls……… and it echoes in the sounds of silence.

 

Note.... Vinny Calderon does not know I wrote this! ...

Janr Ssor, Author,  Founder MeetUps For Intellectual Discussion And Dreams (in progress)