If your not in a group — you’re out!

Dissecting An Article Published by – United Hospital Fund

Following the passage of the Affordable Care Act, Medicare is sponsoring two accountable care initiatives. To date, 4/2013,   there are 17 Medicare accountable care organizations (ACOs) in New York, and a growing number of accountable care arrangements between provider groups and commercial payers.   If you are not part of a group  which is making these contracts for you,  then even if you are in Aetna, UHC, or B CBS,  it appears you are out! fixing healthcareCould you continue to run your practice if all you have is vision plans? 

A new Fund report provides a clear explanation of accountable care, this new approach to health care delivery and payment. Moving Toward Accountable Care explains how ACOs work, the kinds of groups that can enter into accountable care contracts, the challenges they face, and the ways in which they will be able to succeed. It also includes detailed profiles of 12 different Medicare ACOs in New York, showing the wide range of approaches around the state.  Notice that this has been achieved by 4/2013. That is 8 months ago.  Who is offering you a chance to be part of a group working with the ACOs  that have control of the lives?  If you are not part of an IPA,  as an optometrist,  the answer is no one!  This is why the NYIPA is here. 

 Simply put, an ACO is a group of health care providers that agrees to be held accountable for providing health care services to a defined population. In return, the payer agrees to allow providers to share in any savings that come from providing more efficient, high-quality care to that population. This builds on two trends in health care: the aggregation of providers into larger and more capable networks, and the movement of payers away from fee-for-service payment systems toward arrangements rewarding providers for performance.  Lets clarify this statement,  The system creates entities in control of lives,  which  push providers into IPAs  (large provider organizations) that can negotiate as ACOs.  The ACOs arrange  what is like the old HMO’s of Bill and Hillary’s era,  a capitated system that pays a fixed yearly sum  to large provider groups. The goal is to encourage them to minimize usage,  so that at the end of the year there is profit to share vs loss to absorb!  There is a new twist,  you are monitored by EMR and a system that tracks your patients care and referrals.    Entry into this system is potentially done by Gatekeeper physicians who may refer patients to their “buddies,” who send them patients,  and also keep you out of the loop unless you are in a powerful group!  This happened over and over during 1993 when Bill and Hillary ruled the world. 

If you are not in a powerful IPA (group) then  MDs who are organized by hospital affiliations,  or huge powerful groups like The MKMG that “owns”  almost all the docs in Westchester,  Rockland and Putnam counties will get the contracts and you will not. MDs have these organizations everywhere!   This is why we need an IPA. 

From the attached PDF,  file,  which I encourage you to download and read,  comes these statements one of MANY important statements:

Ultimately, the Medicare ACO program is designed to shift some or all of the financial risk (the difference between the actual costs of care and premiums paid) from the Centers for Medicare & Medicaid Services (CMS) to the participating provider groups.   This means that  the “insurance” companies will run around with potentially guaranteed profits and you as a provider take all the financial risk!   

Accountable care also depends on information systems to support the delivery of care, including EMR systems and regional clinical data exchanges that can enable effective communication among providers, and help coordinate patients’ care during referrals and care transitions. Updated information systems claims systems to identify and track discrete populations; to measure, analyze, and report on provider performance relative to the population covered by the accountable care contract; and to identify variances from quality, utilization, and cost benchmarks at the provider level and at the system level, in order to focus and support utilization management and quality improvement processes.   Insurance companies have controlled what drugs doctors can use for each patient’s care, based on their “formulary.”  Now we will be advised as to how to meet the goals of the ACO by what we do professionally.  Though I am not yet sure of this,  it looks like the basic concept is to provide the palliative drug  to create a record of a “good outcomes.”   This insures that there is profit for the IPA you belong to.    However what if you want to not drug the patient but instead work on preventive care through diet, lifestyle modification,  education,  counselling?    Will this be rewarded? Is this the kind of  care we all want?  Can we do better and is there an opportunity for creative solutions that really helps the patient? Only time will tell and groups with sufficient creativity and diversity may make “good outcomes” really become good care. 

For now we have no choice.  For now if we are not organized we have no really bright future.  For now you and I need and IPA,  the NYIPA….  Join now, if you qualify!  Help us become stronger to support your future!

Download the full PDF here From the United Hospital Fund Website.

Dr Joe Ross, President NY IPA  12/2014

footnote logo with border

Why We Must Differentiate OD’s From Eye Glass Pushers

From what I am reading (and I could be wrong) it appears that the forces that are shaping  up to be selling “lives” to us as OD’s view us as eye glass salesmen.  Let me share why and why this should be a concern we deal with.free eye exam with glasses

A couple years ago and OD came to me for a job.  I offered him a weeks trial.  We mutually parted ways a week later.  He did not think I did enough volume for him and I did not think he cared enough about patients to work in my office.  When I met him a month later he had signed a contract to work for the “Franchise Holder” of a big box optical store.  He explained to me that his contract said he had to see a minimum of about 35 patients a day to earn his keep and a maximum of 50 was expected.  He also had to promise to not do any medical eye care but to refer it out!

I said to him,  “that is going to burn you out in a short time!”   He said to me, “I am making the money I want and yes it will burn me out but I have a plan.  You see the leaseholder is probably going to lose the lease and they seem like they are willing to give it to me if I can do what they want.  When I have the lease I will hire other ODs to do the work and I will not be under such high pressure volume to make me sick.  With two our three OD’s in my employ in a few years I will be far more successful than I can ever be in your practice.  Your practice is a ‘dream practice’ but I need to make a lot of money and quickly. ”  I never saw him again or want to.

This has got to be happening all over the USA.   Now Luxotica was aware of the image issue of its “Sears optical and Pearl but they began trying to push for the LensCrafters docs to be more medical.”  They did not want to be left out.  That is why their plan is called “EyeMED”  So what should the world of MD’s and Insurance companies think of us when many ODs do factory work in big box stores?

Many years ago, when Bill and Hillary were around the HMO’s locked us out, as I have written elsewhere because the “gatekeeper  pcps”  felt we were “shoe salesman”  as one told me;  especially since the Sears Optical was near the shoe department.    It was also so the PCP could refer to his hospital buddy the OMD who referred back to him.  This is how they networked.  After a big struggle we got laws like “any willing provider”  and this nonsense stopped.  But it is not nonsense if the Big Box Volume store with OD’s appear to be practicing as we do or we appear as they do!

How do we differentiate ourselves from the eye glass pushers?  We don’t want to give up vision care and become OMDs.   We need to clearly place ourselves in a group that has been credentialed.  We have to prove we have been educated by regular CE courses. We have to have the right equipment,  we have to keep up our license and insurance coverage.  I am not one for board certification.  Any JC Penny OD could be board certified and what would that mean?   What we need is to be group that can provide medical as well as vision care and by our group credentialing process differentiate ourselves from what medical care justifiably views as “eyeglass salesmen.”

When you get a bad hair cut you do not stop going to hair cutters.  You find a different hair cutter.   It is the same with all professions.  Vision Source, is on the right track to create the image of a high quality team. VCD can however do it on the state wide basis with OD support and that is more important and something that VS has not done.  VCD, appears to be on the path to make OD’s much more profitable, than VS has done. Perhaps at some point we can work as a team for image and profitability.   There are good groups out there that represent good docs who can and will provide medical care not just eye glasses.  We also must not view VCD and state IPAs as the domain of  ODs.  We will and MUST team up with  OMDs so that we can provide for the absolute best care patients need.

The great thing is that with us doing the simpler medical services that do not require surgery  the ACO’s can have a much more profitable relationship with us than a team of MDs only!   It will be up to us to see the medical things we do best like Glaucoma, Cataracts, Diabetes, Pink Eye etc.  It will be up to us to quickly refer to our partner OMDs  the surgical needs, and some of the care that is highly related to complex general health issues.  This will meet the needs of reducing duplication of services by sharing electronic records and keep the services in the hands of the most efficient providers. Now it is up to us to organize and prove that we will be the most efficient care providers.  

At this point in the creation of this new health care paradigm,  I could certainly be wrong and this is just my opinion and not necessarily the opinion of the entire group.  We will all temper our ideas as ObamaCare of some sort takes form.   I don’t think anyone knows what the final structure of our healthcare system will look like. It is evolving and so our our thoughts.   One thing is CERTAIN,  we must be organized and we must be able to sell our selves.  So, no matter how you look at it, for now we are on the right path.

Dr Joseph Ross, President NYIPA

footnote logo with border

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!

footnote logo with border

The HOYA – NYIPA Collaboration

money-1428594_640The HOYA – NYIPA Collaboration is bringing you new financial 0pportunities!

Here are some of the exciting financial benefits!

■ HOYA / SEIKO’s  best quality lenses at Very Competitive Prices
■ HOYA pays for your dues with just 5K of orders
■ HOYA WILL Fund the IPA so that we can sell eye care contracts for you and add value to
your shares!
■ Numerous Marketing resources available to help you educate your patients

Special Collaboration:Benefits

  • Private Label Progressive Lenses
  • Dual Surface and Free Form Design
  • All Label lenses with national warranty
  • Programs to fund in-house edging technology
  • Underwriting Up to $10K I-Optics (Easy Scan!)
  • Innexus: web, patient marketing analytics
    • ○ Design practice websites and social media sites
    • ○ Run marketing campaigns
    • ○ Personalized promotions

Hoya

Who is HOYA?: – HOYA is a global technology company and the leading supplier of innovative and
indispensable high-tech products and services based on advanced optics technology.
HOYA accounts of over 20% of eyecare business or approx. $1.3 Billion in Eye Care seikoIndustry and includes Seiko Optics!!

more2Come.pngMORE TO COME! You will be invited to learn more at local meeting presentations and online presentations soon!

Who made this possible: Your Leadership Team: Dr Avi Zlatin has spearheaded a new empowerment for all IPA members creating a NYOIPA – HOYA collaboration!
Dr Ranani and Dr Rubinstein have also been key players in making this possible.

Did you miss our first presentation at Ruth’s Chris Steak house?  Sorry you missed us! However, you will still have an opportunity to benefit! Just contact Kimberly Stryker at the tel number or email below!  We will be contacting doctors little by little but why wait? Call now!   

HOYA Contact For More Information: Kimberly Stryker Territory Manager KStryker@Hoyavision.com  518-577-2275

The IPA Is Making Money For You!

money-1428594_640$$$ – THE IPA IS BRINGING YOU NEW FINANCIAL OPPORTUNITIES:

Dr Avi Zlatin has spearheaded a new empowerment for all IPA members through a NYOIPA – HOYA collaboration! Dr Ranani and Dr Rubinstein have been key players in making this possible. You will soon be hearing about the Collaboration which will:

  • Get you the best quality lenses anywhere at unbeatable prices
  • Pay for your dues, when you commit to using the services
  • Fund the IPA so that we can sell contracts for you and add value to your shares!
  • You WILL be hearing about this money making deal for you soon!

 

man-875702_640A Vision Care Contract is in the offing!

Dr Steve Rubinstein has spearheaded what looks like our first contract with a major vision care third party administrator.

Ami, Steve, Avi, myself and Reid Nelson have been working on this for nearly two months now.  A meeting to finalize a deal should be near.  We are anticipating news in the next 3-4 weeks!

………… more to come!

 

Why Not To Join VS Until Next Year!


Build.Your.Dreams

BECAUSE YOUR HARD EARNED EMPOWERMENT MAY VANISH!

MONEY GOES A LONG WAY:  As the New York IPA rose in visibility and significance over a year ago,  Vision Source sought to claim our network as its own. To do this they offered Vinny Calderon and myself Financial reimbursement in terms of lower dues and growing benefits for each of the  new members we signed up. Both Vinny and I refused despite the excellent personal Financial opportunity.  We chose to discuss VS with the board  instead.  The board decided that we would keep the door open for the future but not give up all you have worked for and paid for to VS). VS wants to  see itself as the next OD network in NY.  If we fail they may be. If we fail,  That should however be your last resort because if they are your only network (ipa) then you have NO CONTROL just like being a VSP or EYEMED  service provider!

HOW VISION SOURCE CREATES “ENTHUSIASM”  Vision Source grows by giving HIDDEN (Secret) benefits to those who will enthusiastically promote them. When I joined VS,  five years ago, it was because of the Overwhelming excitement shared by Dr Farkas’ office team. It was also NOT a franchise at that time. Had I known they were being paid (with a discounted fee and bonuses for signups) to be excited, I would not likely have joined even for the great camaraderie of Barry Farkas, Susan Resnick and their team.  I did not ever lose money  in VS and VS does have some good proprietary products to offer.  However, When a single doc is paying out the usual franchise fees they should not expect any big profits!  If you pay 3% of your gross and your gross is near $800,000   $24,000  is what you pay VS!  (A first year discount helps but you have likely traded $$ for lost empowerment).

DIVIDE AND CONQUER: The  VS new new strategy  (Sine your board chooses not to sell our network to them)  is to “encourage” your membership by giving you a first year discount (money). The downside is to your future. They get you into their network, when your board voted NOT to join VS at this time, because it potentially diminishes the NYIOPA’s power to work for you!

Why not come along for the ride this year and be a winner with us!  There is power in unity!

 

 

Reality Lesson – ACO Participation not promised!

aco-accesKey Statements from the AOA regarding what optometrist need to know to seek continued access to medical patients under medicare and medicare advantage (ACOs). 

  • Medicare ACOs are not required to include optometrists or ophthalmologists.
  • If you come across a closed panel serving Medicare patients, then you’re looking at a Medicare Advantage plan, the Medicare version of managed care organizations (MCOs).
  • ACOs might not realize the benefits optometrists provide, so optometrists will need to market their services and demonstrate their value to ACOs.
  • For Medicare, optometrists need to actively demonstrate value. This means participating in the Physician Quality Reporting System (PQRS), electronic prescribing, exchanging health information, implementing EHRs, exchanging health information with local optometrists, and tracking your results through clinical data registries.
  • Here are some suggested steps for optometrists to take to prepare for ACO participation:
    • Participate in PQRS.
    • Meaningfully use EHRs.
    • Use eRx.
    • Plan to join AOA clinical data registry under development.
    • Exchange health information with other practitioners <== For discussion at Boun Amici’s Wed June 15th 
    • Follow AOA Evidence-Based Clinical Guidelines.
    • Use other AOA Excel Tools to grow and enhance your practice.

     

Put The HealthCare Puzzle Together -See The Picture!

  • Optometric visits capture at risk patients between ages 15 –> 45 that PCPS do not see!  We see them for blurred vision. We are the Entry point to health care that is critical before it gets costly.
  • Optometric geographical distribution and office hours, makes us the ideal easy place for patients to come to, not a big central medical office that MD’s are forming for efficiency.
  • Optometric contact with leadership provides access to contacting ACO leadership for entry points.
  • Optometric technology – makes it easy to diagnose systemic disease via retina photography, cheaply, quickly and efficiently.
  • Primary Care Optometry — providing referrals to OMDs is the most efficient use of OMD surgical skills
  • Forming a Cooperative team and Branding ourselves in NY State would likely make us a sought out entry point  for MD / OD healthcare partnerships. Requiring a paradigm shift:
    • Retina Imaging Being Routine
    • Standardized reporting to pcps
    • Referring at risk patients to PCPS for consultation.
    • Taking the initiative by dispensing educational materials
    • Educating patients in our offices (as Dr Hom Suggested)
    • Connecting patients with online dietary advice such as health letters written by leading physicians who promote diet and lifestyle changes
The resultant picture:
profitable-healthcare-logo_med_hr

Gain Entry To Medical Eyecare & Earn $50,000 More!

profits10 Years ago I earned nearly $50,000 in one year by providing medical optometry to my patients and I did not have to submit one insurance claim!  After that year my income continued to increase every year. In several areas of the USA, optometric leaders are working on plans, similar to mine,  to prove it is profitable for OD’s and MDs in ACOs (accountable care organizations) to be working together!  Why wait for some outside agency to tell you what to do while stealing your profits! You can earn an extra $50,000 now while working on qualifying for the upcoming medical plans on your own! There is no reason we should not be  qualifying by proving it works now!

 

AN ACTION PLAN:  Here is my recommended NYOIPA plan for keeping ALL OF US  in medical eyecare (ACOS), helping you earn the respect of the local medical community, while making you a aco-acceslot more than $50,000!

I recommend every NYOIPA doctor commit  to offering a $45.00 Retina Photography Screening for every patient that comes into their office (even one time for children).  I can show you how to implement this program easily enough; I have done it.  Each doctor should also commit to providing a simple fast check box report to the patient’s PCP, if anything systemic was found (this is becoming the standard of care now).

Establishing A Brand Name – The NY Optometric IPA:  Every doctor in the IPA,  who reports findings to local MDs should use the report above or one like it of their own creation.  As part of your report letterhead, every report form should state your NYOIPA membership clearly and include a small copy of our logo:

 NYOIPA.-LEGAL-LOGO

A New York Optometric IPA Member  

  

 

This is all there is too it!