This article is more than 5 years old. Information may no longer be current.
ODs looking for organization may turn to a 'practice without walls'
Click Here to Manage Email Alerts
SAN ANTONIO—As photorefractive keratectomy (PRK) builds momentum, private practice optometrists may feel lost entering the refractive surgery market, where surgeons and corporations seem to be calling the shots. However, Arthur A. Medina Jr., OD, said he has a way to help optometrists control their own future.
--- Arthur A. Medina Jr., OD.
Medina and other ODs here have organized their private practices into what he calls a "practice without walls," a professional limited liability corporation (PLLC) that gives them an optometric system of refractive surgery care. "The purpose of our PLLC is to inform, educate and train the optometric community about refractive surgery procedures," Medina said.
Included are preoperative consultation, assisting the surgeon during surgery and conducting all postoperative care and examinations.
Members of the group tell every patient there are three options for treating myopia: glasses, contact lenses and refractive surgery. Offering refractive surgery becomes "standard of care within these optometric facilities," Medina said.
Medina is emphatic that optometrists can organize themselves. He contends that ODs need to exert control in the refractive surgery market or risk losing patients. Refractive surgery companies and surgeons, he said, use marketing to offer an option that patients may not realize their local optometrists are also involved with. "If optometry doesn't organize and become proactive," he said, " patients will be marketed out of optometrists' practices and get information about refractive surgery elsewhere."
Medina's PLLC, Refractive Surgery Consultants, was created because ODs realized this danger when a local surgeon sent postcards to ODs after refractive procedures asking if they wanted to see the patient. "We thought the patients were not getting the procedures done," Medina said. "And patients said, 'Well, I didn't know you did that.' That's when the 2x4 hit me between the eyes: You can't tell just the people who ask. You've got to tell everybody, because not everyone realizes you have that information."
The ODs who founded the PLLC originally saw refractive surgery as a threat. But they found that informing patients actually created more primary care. "Eighty percent of post-refractive surgery patients continue to wear spectacles," Medina said.
The PLLC, which markets itself under the name NuVision, is supported by loans from corporation members, Medina said. All 30 members have equal shares of stock. Medina is one of a five-person managing board elected to oversee the corporation.
The corporation charter requires that each member provide a full range of optometric services, Medina said. All services the members provide through the group are billed under a billing number and accounts received are treated as receipts of the group. No group member may directly or indirectly receive compensation based on the volume or value of referrals, and group members must personally conduct no less than 75% of the physician-patient encounters of the group practice.
Liability decreased in the group
ODs are paid according to the work they perform. The remainder of the fees are for marketing and administration. Members need not change their practice and, when comanaging refractive surgery cases, can employ the advantages of the PLLC. "The idea is that you see your patient," Medina said.
The PLLC lessens members' liability when managing refractive cases, as well as providing a network of education through which they can develop internal marketing for refractive surgery. "
And there is power in numbers. The PLLC gives the ODs a bargaining position when dealing with laser companies, surgeons and managed care entities. "The economies of scale start to work on behalf of the individual optometrists participating," Medina said.
Wayne W. Wood, OD, a practice management lecturer from Jacksonville, Fla., said there are four basic advantages to organizing in this way: gaining clout with vendors, dealing with ophthalmology from a position of strength, gaining leverage in the managed care arena and developing interaction and expertise among members of the group. "This is a great way to have cross-pollination of ideas and strategies among ODs in the organization," he said.
Learning from mistakes
Medina said he is "evangelical" about the system because he does not want optometry to repeat the mistakes it made in dealing with optical retailers, where ODs relinquished control of the patient's entry into the optometric examination.
Medina said a PLLC can initially be expensive to start. But, a group of optometrists can still educate themselves and their staffs, and then move into negotiations with the local surgeon. "Then you can eventually go into the PLLC," he said.
While his PLLC originally was literally a practice without walls, it has leased office space where the outpatient surgical care can be performed. Non-members can use the space, and are charged facility fees.
The PLLC can also be used to negotiate eye care carve-outs with managed care companies, Medina said. "In our bylaws we have credentialing, academic and certification criteria. If a managed care entity/third-party entity wanted to look at this, they could look at the quality assurance aspect of this practice and the credentialing. It's all right there."