Obamacare — Good or Bad for Optometry?

Debate on national health care legislation has raged for the last several years and there are some critically important points that effect optometrists. Let’s skip Fox News, CNBC or wherever you turn for your daily dose of bad news and look closer to home. Setting aside political views, how would the implementation of national health care affect your patients and your ability to make a living?

I’ve been consulting professional practices since 1976 and have worked with thousands of doctors in specialties from eye doctors to foot doctors, alternative medical practices to leading MDs, national associations to hospital chains. So from the long-term view of what has happened to doctors and medical practices at the hands of federal health care systems, how would it affect your pocketbook and your ability to practice optometry to the best of your conscience and ability?

Will “Happy Patients & Prosperous Practices” - Vision Practice Management’s (www.vision-practice.com) slogan - be the end result? My answer comes from looking at what has happened to doctors, my clients, over the past 33 years at the hands of federal programs, fighting the “paper war” to get paid.

Let me remind you that the “broken system” the current proposal is designed to fix is not the bureaucracy that finds ways not to pay your legitimate claim. It expands that massive accumulation of civil servants and gives them and their politically-appointed bosses total power over what you can do and if you will be paid for it. It is not like a bad insurance program you can drop when its reimbursement gets awful or your staff quit rather than spend another hour on the phone waiting for some drone to explain why they won’t pay you.

Medicaid, Medicare and other government programs make changes without notice or appeal. For example take TriCare, the military insurance, where Bureaucrats recently decided that ODs when they detect glaucoma must refer patients back to their primary care physician, who then refers them to the ophthalmologist “specialist.” And just like that, your patient is gone. This was not legislated and there was no recourse, just some faceless person’s decision that lowers the income of thousands of ODs.

What is this proposed program likely to be like for you after the honeymoon; in 10 years; 25 years or more? Medicare and Medicaid have at various times been the poorest paying and least-preferred reimbursement programs. Many doctors won’t even take Medicaid. What if government programs were a virtual monopoly, with insurance companies in lock-step with them.

Maybe you are most familiar with how these programs effect optometrists, so let me expand your vision. A recent client was a 4-doctor colon and rectal surgical group in Beverly Hills. They were struggling to pay the payroll and rent in their stylish high-tech offices. Medicare had once been their cash cow, but in recent years “to reduce waste” had slashed reimbursement for all their procedures to below what it cost to deliver them! Their solution: hiring a $50/hour Medicare consultant to spend 30 hours/week in their practice to tweak every submission and spend endless hours on the phone to follow up in an effort to get paid. Still no profits. The good news was that I settled out the staff mutiny, dramatically increased efficiency and profits. The doctors were ecstatic. Effective practice management works, even in very challenging situations.

Then after I left, there was a computer glitch with Medicare and for 2 ½ months they did not receive a dime! Yikes! In another example, Medicare recently cut reimbursement to heart institutes by 20% two years in a row. Private insurance companies paying 110% of Medicare reimbursement also dramatically cut payouts without having to do anything.

Optometrists are politically active and the AOA has lobbyists in DC. Let me point out to you that in any fight for increasingly scarce funds, Big Pharma has us, the AMA and hospitals all outgunned. Do you know how the health-care pie is divided up among these players? Let me clue you in, doctors and private health care providers are on the very short end of the stick. Big Pharma has the lion’s share of the potential gain and with a former Eli Lilly attorney in the White House, is likely to retain their advantage.

As soon as the choice of medical practitioners moves from free market to smoke-filled rooms, every doctor is at risk. I have two strong recommendations:

1) Support and preserve free-market medicine.

2) “Flourish and prosper!”* Right now, this moment is the time to be successful. It is not an option to be down 10% or have little success. Your best protection is to create a booming practice with loyal patients. This is not the time to get out of optometry; this is the time to hit and maintain your highest level of success, to have “Happy Patients & Prosperous Practices.”

*”Flourish & Prosper” is taken from the common-sense moral code at www.thewaytohappiness.org.
David Sanders is a Certified Master Consultant with a 33-year successful track record. He is CEO and Senior Consultant of Vision Practice Management (www.vision-practice.com) specializing in optometry. He can be reached at (888)612-8884 or dsanders@vision-practice.com.