METAMORPHASIS
Who Are We? What Are We Providing To The Patient?
Coming from an Optometric background, it is understandable to think that we are an optometry office, and that our optometrists are only providing an "eye examination and glasses". However, we have "morphed" into a new optometric subspecialty - we are nowNeuroVisual optometrists, and we are much closer in scope of practice to a medical specialist than a standard optometrist.
So from the Medical Specialist point of view, we are providingtwoexams with additional procedures [an optometric exam (about 20-30 mins), and a NeuroVisual exam (about 60-70 mins), which contains certain procedures like sensorimotor testing AND Gait and Balance assessment (walking down the hallway)], and fitting and dispensing a medical device called a "Visual Orthotic Device" (trial framing; optician's time to fit the device (glasses) properly to the patient's face [above and beyond standard fitting time and skill]). What we do is so far removed from a standard vision exam as to be almost unrecognizable. The Medical Specialist model is what our practice model has "morphed" into, and when assessed from that perspective, our charges can be better understood.
Many of the medical professionals in our community relate to us as a medical specialist, not as an optometrist. This is particularly noticeable in the way patients are referred to us, and in the method that professional communication takes place between us (the sending and receiving of progress and referral notes as an example).
We need to explain all of this to our patients before they come in to see us for the first time
One of ourchallenges is that we need to provide a more thorough and detailed description to the patient of how unique we are. They may think that they are coming to an "optometrist" for an "eye exam". But they are not. We need to adjust our verbiage, starting with patients making their first call for an appointment. We need to educate patients to know that we are specialized optometrists - we are "binocular vision optometric specialists called NeuroVisual optometrists"; and that the standard eye exam only occupies a small portion of our very long and detailed NeuroVisual evaluation in our office; and that the majority of the time is spent trying to determine the exact prescription for a very special pair of glasses that are really a Visual Orthotic Devicedesigned to help eliminate their medical symptoms.
We do charge a lot for our services. Is it worth it?
The average Cash Pay patient will spend about $1750 for a course of care which includes an Initial Visit, 2 Follow Up visits, one frame, and 2 sets of lenses. This will take close to 4 hours (90 / 70 / 70 mins) of provider and scribe time, and a large amount of ancillary time (scheduler taking insurance information and checking eligibility, opticians signing patient in, performing 5 separate screening tests, downloading WebReg, frame selection, bench optician grinding the lenses to fit into frame, optician fitting the frame for VH patient, a specialized biller to billthe exam). What else can you get for that kind of money?
An MRI is about $3500.
A CT of the head is about $1500.
A day in the hospital (just the room charge) is $1000 - $2000.
A course of Vision Therapy is $5,000-$10,000.
Medications are not one-time charges - they usually occur monthly. They can be in thehundreds of dollars every month just for 1 prescription.
So in reality, $1750 is a very reasonable price for a service that consumes a lot of provider and ancillary time and delivers an orthotic device that brings the patient such effective relief from their symptoms that it reduces future expenditures on behalf of the patient(such as decreased medication use, decreased testing and decreased provider visits). To quote Dr. Jennifer Doble, "It's the least expensive service that is provided for a TBI patient", and if I may say so, one of the most valuable, given it's effectiveness.
How do other physicians and physician specialists bill for their services?
It is uncommon for physicians to bill on their time. For the most part, they bill on the complexity of the issues presented to them. It is common for a Level 4 or 5 visit for the provider to spend only 15 - 20 mins with the patient. This allows that provider to see 3-4 pts in an hour.Extended face-to-face time almost never occurs - almost nowhere in the American medical culture is time like that spent with a single patient. It is no wonder that patients feel as if no one hears or understands their complaint.
What is it worth to find a provider that takes the time to actually listen and examine their patient thoroughly? - PRICELESS. What is the value of a visit with a provider that results in the patientactually experiencing significant improvement in their condition?-PRICELESS. What is the value if that patient had been everywhere, seen everyone else, had every test and treatment and never got better before the visit with today's provider?-BEYOND PRICELESS.
Since we spend so much time with our patients, we see very few in a day (maybe 8 / day) compared to a standard optometric practice (upwards of 20 per day). The current medical billing system has created a code we can use to help compensate us for all the time we took with the patient, and for all of the business we "didn't have" because of being occupied with the other patient in such a prolonged manner. It is calledExtended Face to Face Time.
Medical specialists bill not only for their examination, but for all "procedures" that are performed. As an example, acardiologist willcharge for a stress test, both the professional and facility charges if it is done at his facility. Same for the pulmonologist that does pulmonary function testing in his office. An ENT will charge for the exam as well as a sleep study. So, the bill on any given day can be quite high if anything in addition to a standard office visit occurs.In our case, we do the following "procedures":
-Sensorimotor testing
-Refraction
We also perform additional services such as Orthoptic training (trial framing).
Is our pricing fair? Reasonable? Do we help those who cannot afford our care?
By the very nature of it, some people who really need this care will not be able to afford it, but if priced correctly, there will be enough people who can afford it to fill up the schedule. Is this unfair? - ABSOLUTELY.If we really price it correctly, most people will be able to afford the care, and at this time, I think we have priced it correctly.
Can we provide assistance to those that cannot afford the care?The answer is we already do. In many instances VSofMhas lowered prices to help patients afford care. Also, we have "gently used frames" as well as $5 frames, and the patients can use lined bifocals without all of the bells and whistles for the lenses to significantly decrease costs. We have payment plans, which is almost unheard of in the vision industry. Sometimes care has even been given pro-bono (without any charge).
Can we help out those who are paying Cash? The answer is that we already do. Cash Pay patients get discounts off of the exam, and they receive a special pricing plan for lenses.
Rationale for how we charge Cash Pay patients
There is a large discrepancy between what you can charge the insurance companies and what you can collect fromthem. Arguably, it should be the same, but the reality is that the insurance companies discount all of our charges, so that we get paid only a percentage of our charges. It only seems fair for those who are paying out-of-pocket to pay what the average insurance company pays us for our care.
Given this rationale, it is kind and fair to reduce the amount collected from a Cash Pay patient to that of what the insurance companies would pay. However, it does not make good business sense to reduce the amount collected from a Cash Pay patient to BELOW that of what the insurance companies would pay.
We provide an excellent service, and really help patients feel better, and it takes a lot of time and resources to do this - time that almost all other providers are unwilling to take (and even if they did, they would not obtain the really excellent results we do).
Rationale for charging what we do to insurance companies
I personally feel that, as a business person, it is wrong not to collect for the work you are doing. As explained above, given the service we provide, and the excellent response the patient has to our services and devices, I feel completely justified in the amount we are charging. Once again, I am approaching all of this from the"Medical Specialist" (not Optometrist) point of view, where what we are billingis not only acceptable, but standard practice.
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