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Your choices now will set your course for 2008
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We are in the last month of the year 2007. If we are to make the changes that we have talked about since January, we had better get at it.
There is still time to sign up at the fitness center and lose those excess pounds. There is still time to throw away last year’s holiday fruitcake before this year’s stock arrives. There is even still time to look at your fee schedule and implement the increases you decided on in February but just have not gotten around to. There may even be time to pull out all the contracts that you have with various major medical insurers and vision plans to decide which you intend to renew, which you intend to cancel and those with which you intend to open negotiations.
While I cannot help you call the fitness center or dispose of your bricks of fruitcake, I can help with the fee schedule consideration and with third-party contracts. These should not be difficult; it is more about getting enough energy and commitment to make some changes. You will have to actually do it, but maybe I can motivate you a little.
Consider your fee schedule
First, consider your fee schedule. Some of you may remember this publication provided a fee survey 2 years ago ("Survey results show wide spread in ODs’ fees,” October 2005). I prepared the survey and reported the results, and I remember it very well. I conduct fee analyses for hundreds of eye doctors a year, so it was no surprise to me that the survey indicated that ODs’ average fees are well below the 50th percentile of MDs’ fees for identical services. The fees were 35.7% below the findings of a 2005 survey of MDs’ fees.
What this might indicate is that the services provided by ODs are somehow less valuable or are measured on a different scale than services provided by MDs. Doctors of optometry should know that is simply not true. The only real tests of such things are patient satisfaction, the effectiveness of the care provided and, although frequently overlooked, the frequency and outcome of professional liability suits against ODs and MDs.
Satisfaction high, liability low
ODs’ patients are very satisfied, as patients’ continued selection of ODs for eye care supports. ODs’ care of refractive and medical conditions seems efficient and effective, although there may be no definitive measures of such things.
Professional liability suits against ODs are rare and comparatively less costly than suits against MDs, as indicated by the very low premiums that ODs continue to enjoy for professional liability insurance. If suits were frequently brought and lost or if losses in the suits were high, insurance companies could not continue to charge low rates to optometrists. Furthermore, we know that the same expert witnesses come to testify against ODs as against MDs, certainly enthusiastically applying the same “standards of care” and raising the same expectations of the quality of care, regardless of the doctor’s license.
Be proud of your services
By the only objective measures that exist, ODs do a better job than MDs where their respective scopes of practice overlap. None of that could possibly explain why ODs’ fees are lower. So, as you consider the value of your services for the remainder of 2007 and into 2008, let your chest swell a little with pride.
Be realistic about the value of your services to your patients and to the health care system, remember the gratitude your patients express to you every day, be proud of your wonderful education, the state-of-the-art diagnostic equipment that you utilize, your well-trained staff and your comfortable, efficient office. Then, pull out all the data you can from surveys, payers’ fee schedules, the Medicare relative values, computer software such as Reimbursement Plus (www.reimbursementplus.com) or AccuFee (www.accufee.com) and reformulate your fees.
Consider medical services first
I suggest that you first do the fees for all services that you usually provide for patients with medical reasons for visits. Those would include the 99000 office visit codes, the special ophthalmological services, the surgical services, nursing home and rest home codes and the lacrimal services. Suspend your consideration of anything you have traditionally thought of as “routine eye exams,” “annual eye exams” or “contact lens rechecks” and concentrate just on the medical services. Consider the definitions from Current Procedural Terminology and decide what you believe the services are actually worth.
By evaluating these services separately from the nonmedical eye care you also provide, you will be more free to establish values for the services that are closer to the fees believed appropriate by other health care providers and insurers.
Disregard Medicare fees for now
Do not consider Medicare fees in this process. Medicare is scrambling to save itself from bankruptcy and is not concerned with making sure you receive fair reimbursement. Think of Medicare and Medicaid as being charity programs in your practice. Their fees are set at levels that keep them solvent a little longer while maintaining adequate numbers of providers willing to assist covered patients and accept lower fees for their services.
At the same time, be aware that nearly all major medical insurers have fees considerably higher than Medicare. They must, as providers are not interested in providing the same deep discounts to high-profit insurers as they are to governmental programs in crisis.
In spite of this logic, data from our 2005 survey indicates that the average of ODs’ fees were 7.4% above Medicare’s allowable fees that year, while 50th percentile fees for MDs’ were 67.3% above Medicare. Remember, these figures are for the same services, the same CPT definitions, the same insurer requirements, the same patient expectations and the same standard of care testimony in courts of law.
Do your homework
In closing, let me try to inspire you to take action with the insurers with whom you are currently contracted and with whom you may consider contracting in the future.
It is not necessary, nor is it fiscally sound, to accept what insurers offer you for your services unless you first do some homework. First, you must have a fee schedule that you are confident truly reflects the values of your services. Second, you must have some idea how many of your current patients will be covered by the plan in question and how many people covered by the plan honestly represent potential patients. Third, you must be brave enough to ask questions of the insurer, even such far out inquiries as “What will you pay me for my services?” and “What are your policies with respect to ‘reasonable and necessary?’” and “Which diagnosis codes support my billing for this list of commonly provided CPT codes?”
In short, it is critical that you no longer feel rushed or pushed into signing insurance contracts. Get some backbone, ask the questions, and make decisions based on facts, data and what is good for your patients and your practice. Throughout this process, you can be confident that the insurance companies will be able to take care of themselves, with minimal concern or assistance on your part.
So, there is your prescription for taking action during what is left of this year, to be sure that you do even better next year. I know these are revolutionary thoughts, but give them a shot. You may be surprised with the results you achieve.
For more information:
- Charles B. Brownlow, OD, FAAO, is a member of the Primary Care Optometry News Editorial Board, executive vice president of the Wisconsin Optometric Association and a health care consultant. He can be reached at PMI, LLC, 321 W. Fulton St., PO Box 608, Waupaca, WI 54981; (715) 942-0410; fax: (715) 942-0412; e-mail: Brownlowod@aol.com.