Experts spend hours looking at past trends to anticipate the future and recommend ways to exploit the changes that are predicted to occur. In the profession of optometry many are speculating on the change in the health care model and the impact the Affordable Care Organizations (ACO) will have on the reimbursement model for medicine. As optometrists we must preserve our current reimbursement model while anticipating the future payment model. One way to approach the future is to remain independent but act as a group when it comes to discussing payer models. The main focus is who will you team up with to present ACOs with a model that they can commit all their covered lives to that will represent all aspects of eye care.
- Large Eye Care Corporations – These are corporations that typically have 20-80 ODs that practice throughout the region and refer to the specialty ophthalmologists. They are under one name as they are a group that works to provide all levels and types of eye care to the general public. If a patient is referred into a practice like this they are typically referred internally. This model will have a competitive advantage when an ACO considers partnering with a group that can provide all the eye care needed for their covered lives.
- OD-OMD network – This is a corporation (group) of multiple independent practices that come together under one umbrella. They benefit by being a large group but remain independent in individual office decisions. This group is typically made up of 20-150 optometrists of multiple small independent practices, referral centers that represent retinology, glaucoma specialty and cataract surgeons. This model allows an optometry practice to remain independent but still compete with larger groups.
- Health Care Groups – This is a large regional multidisciplinary group that represents all and is positioned under one group name. It is different than the “large eye care corporations” since it is a multidisciplinary group. This type of group usually involves a hospital and has a competitive advantage with ACO alignment since it can offer all services to the ACO covered lives. Typically, the eye care is a carve out and the health care groups do not include all aspects of eye services.
If you are in a practice with one to five doctors that has always operated independently, please take notice that to not be a part of a larger body of providers may mean that in January 2016 when most health care plans change in industry, you may find you are no longer a provider for XYZ company. Assuming that you can continue to survive on only vision care plans is taking more risk than the average owner should be willing to take. Positioning yourself for the future includes being a part of an OD-OMD network. This will allow you to continue to remain independent but think and act as a group.
