Private versus Commercial?

[fedor]

Reading through this forum I kept running into Private versus Commercial. How does one know which is which? For the large commercial chains such as Costco, Walmart, and Lenscrafters, it's pretty easy since they have brand recognition and are known chains. However, if a doctor sets up his own store and calls it, for example, "Eye Expertise", would that be private or commercial? Many of the one doctor shops I have been in look no different from a Lenscrafters.

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[Ben Chudner]

Reading through this forum I kept running into Private versus Commercial. How does one know which is which? For the large commercial chains such as Costco, Walmart, and Lenscrafters, it's pretty easy since they have brand recognition and are known chains. However, if a doctor sets up his own store and calls it, for example, "Eye Expertise", would that be private or commercial? Many of the one doctor shops I have been in look no different from a Lenscrafters.

The main difference between commercial practice and private practice is who owns the optical. Most, if not all, OD's in corporate locations are not paid by the corporation so they are actually independent. Technically they are in a private practice that operates out of a retail chain, even though we consider them in corporate practice. A doctor that sets up a store and calls it "Eye Expertise" is in private practice if he/she owns it all. For a lot of OD's, the money is made in the optical, so they tend to emphasize that aspect of their office. This makes it look very similar to a place like Lenscrafters.

 

[fedor]

The main difference between commercial practice and private practice is who owns the optical. Most, if not all, OD's in corporate locations are not paid by the corporation so they are actually independent. Technically they are in a private practice that operates out of a retail chain, even though we consider them in corporate practice. A doctor that sets up a store and calls it "Eye Expertise" is in private practice if he/she owns it all. For a lot of OD's, the money is made in the optical, so they tend to emphasize that aspect of their office. This makes it look very similar to a place like Lenscrafters.

Would you say that, on average, the doctors at a commercial practice have less experience or ability than those in provate practice? My former optometrist maintained that those doctors at Lenscrafters and similar outlets were 1) young -- just out of OD school and gaining experience 2) low ability -- aren't good enough to work in PP 3) are there only for a year or two and move on to a new place, where they get fired and start over. I find his claims lack credibility, but I would like to hear your comments on them. No offense intended to those in commericial practices.

 

[rpames]

Would you say that, on average, the doctors at a commercial practice have less experience or ability than those in provate practice? My former optometrist maintained that those doctors at Lenscrafters and similar outlets were 1) young -- just out of OD school and gaining experience 2) low ability -- aren't good enough to work in PP 3) are there only for a year or two and move on to a new place, where they get fired and start over. I find his claims lack credibility, but I would like to hear your comments on them. No offense intended to those in commericial practices.

Often times the chain locations are filled by new grads. Many times new grads use the chain locations for and instant income and after a few years, move out to private practice. On the other hand, there are many ODs who make Lenscrafters home. I know an OD who worked for a chain for 30 yrs. He now has his own practice b/c they tried to screw him on his salary. Sometimes the ODs in chains do seem to be less capable. That is often b/c they don't have time to treat every disease, so they refer out. Sometimes they only have time to refract and move on. This is not the case everywhere, there is an extern site here that is at a Lenscrafters. The doc there is suppose to be really good.

 

[Ben Chudner]

Would you say that, on average, the doctors at a commercial practice have less experience or ability than those in provate practice? My former optometrist maintained that those doctors at Lenscrafters and similar outlets were 1) young -- just out of OD school and gaining experience 2) low ability -- aren't good enough to work in PP 3) are there only for a year or two and move on to a new place, where they get fired and start over. I find his claims lack credibility, but I would like to hear your comments on them. No offense intended to those in commericial practices.

I've always believed it's not where you practice, but how you practice. I would bet that the average years in practice for commercial docs is less than those in private practice, for the reasons that rpames suggests. As for ability, I don't think you can say they are less capable doctors. I would agree with rpames again that corporate docs may not choose to treat ocular disease because of the setting. It may be due to lack of time to deal with following disease, or lack of equipment, or it may be because medical eye problems are typically covered by insurance. Corporate docs typically are not on many insuarnce panels. That would mean it would be more cost effective for the patient to see a doc that can take their insurance.

 

[Tasteestuff]

Also,

Don't forget that in private practice, you select the insurance that you want to accept (there are exceptions) therefore, doctors that I know select insurances that reimburse you fairly well (ie. VSP, United Health Care etc..)

For ICD code 92004 (comprehensive new patient), I was paid $120 and did Contact lens fitting 92310 $65. Total $185 for new CL patient from United Health Care Vision

However, Colevision or I guess it is EyeMed now, pays you whopping $35 for most 92004 exams ($10 copay, $25 reimbursement)
There is another insurance that EyeMed accepts. NVA vision. Pays you exactly $25 for 92004 exam. WTF

That is why I had mentioned previously that working for chains is like PROSTITUTING yourself.

Chains need to sell glasses (as well as private docs) however, they have the control to accept/offer crappy insurances to companies so that we as doctors get completed Fu%$#d up in the A$$

there are good doctors in Private and commercial practices but if we keep working for chains (since the purchase of colevision by Luxxotica) They will control us (doctors).. Keep offering Colevision/EyeMed insurances to companies and they will change from VSP to Colevision because it is cheaper. We will start to get reimbursed less and less until we become F%$#ing 'SuperCuts'.

That is why I support private doctors 100% no matter what. because at the end, if we want to control the eye care industry, we need to go into private practices.

Damnn. People, don't you understand that??

Imagine, if 95% of ODs practiced privately, where do you think patients are going to go to receive eye care? We can decide to get reimbursed what we deserve (at least what medicare states we should receive) EyeMed/Colevision could not survive if we did not work at those ***** houses anymore

But if more and more ODs start becoming Luxxotica's puppets, they are going to lower our fees more and more because that benefits them.

I AM JUST SICK AND TIRED OF FELLOW ODs stating that it is OK to work for Chains.. Shiiiiat..

 

[Chr147]

I am a front desk person for an OD at a Walmart in South Orange County. The area is very competitive, there are 5 optometrist offices (1 walmart, 1 costco, and 3 private) in our block alone. Luckily for my doc, he's been there for over 10 years cause of the crazy traffic he gets. He see's about 20 patients a day.

Damnn. People, don't you understand that??

Imagine, if 95% of ODs practiced privately, where do you think patients are going to go to receive eye care? We can decide to get reimbursed what we deserve (at least what medicare states we should receive) EyeMed/Colevision could not survive if we did not work at those ***** houses anymore

But if more and more ODs start becoming Luxxotica's puppets, they are going to lower our fees more and more because that benefits them.

I AM JUST SICK AND TIRED OF FELLOW ODs stating that it is OK to work for Chains.. Shiiiiat..

Don't be so simple minded. Don't get me wrong, cause I am all for the revival of private practices, but we all know that it is not going to happen. Let's say that you get 95% of every OD in the US to just practice privately (haha). Within a matter of weeks, Opticians will be given the right to refract. That will mark the end of optometry.

 

[Tasteestuff]

I am a front desk person for an OD at a Walmart in South Orange County. The area is very competitive, there are 5 optometrist offices (1 walmart, 1 costco, and 3 private) in our block alone. Luckily for my doc, he's been there for over 10 years cause of the crazy traffic he gets. He see's about 20 patients a day.


Don't be so simple minded. Don't get me wrong, cause I am all for the revival of private practices, but we all know that it is not going to happen. Let's say that you get 95% of every OD in the US to just practice privately (haha). Within a matter of weeks, Opticians will be given the right to refract. That will mark the end of optometry.

Sure.. so continue to accept EyeMed vision... $25/eye exam. while Medicare states that we should be receiving around $130.

Let's continue to help Luxxotica become bigger and bigger while VSP (at least an insurance that pays a decent amount [not great] ) get weaker and weaker.

At the end, EyeMed will control the eyecare industry and they will force us to charge $9.99 for eye exams.

Ask doctors who work for chains one thing. "Did you notice that Colevision/EyeMed vision is becoming larger vision insurance than before? I am seeing a significant increase of companies moving from VSP to Cole/EyeMed vision to their employees.

If I was John Doe (CEO of certain company).. Why would I choose UHC or VSP to give vision insurance to my employees over EyeMed? I wouldn't... VSP has to pay their doctors higher fees which in turn needs to charge companies higher premium, while EyeMed pays their doctors $25 so they can charge much less premium to companies..

Ahhhh.... WTF is going on with our profession... Once upon a time, I used to be a nerd/excited Optometry student. Now, all I see is ... Dark and Doom....Very depressing

 

[Ben Chudner]

Sure.. so continue to accept EyeMed vision... $25/eye exam. while Medicare states that we should be receiving around $130.

Let's continue to help Luxxotica become bigger and bigger while VSP (at least an insurance that pays a decent amount [not great] ) get weaker and weaker.

At the end, EyeMed will control the eyecare industry and they will force us to charge $9.99 for eye exams.

Ask doctors who work for chains one thing. "Did you notice that Colevision/EyeMed vision is becoming larger vision insurance than before? I am seeing a significant increase of companies moving from VSP to Cole/EyeMed vision to their employees.

If I was John Doe (CEO of certain company).. Why would I choose UHC or VSP to give vision insurance to my employees over EyeMed? I wouldn't... VSP has to pay their doctors higher fees which in turn needs to charge companies higher premium, while EyeMed pays their doctors $25 so they can charge much less premium to companies..

Ahhhh.... WTF is going on with our profession... Once upon a time, I used to be a nerd/excited Optometry student. Now, all I see is ... Dark and Doom....Very depressing

I don't disagree with you that EyeMed and all the other discount insurance companies are a big issue for us. And it is true that Medicare says we should receive around $130 (and by the way, Medicare reimbursement ranges from $109.10 in Puerto Rico to $215.81 in Alaska for 92004). Did you know that Medicare has one of the lowest conversion factors of all the major insurance companies? VSP is even worse with the average reimbursement being between $70 and $90 for a complete eye exam. If you want to attack the corporate docs for staying in a situation that forces them to take lower reimbursement plans that's your choice, but I would make the same arguement about you. By continuing to be on VSP's leash you are helping that company take profits away from private practice OD's. Low reimbursment for complete eye exams, essentially no profit on frames, and poor dispensing fees on lenses. With the overhead of a private practice, VSP is essentially EyeMed to us.

I know several docs that have dropped VSP in the past two years. They have seen their gross production drop, but a lot of them have seen their gross collection increase or only drop an insignicant amount. That means they were working harder for the same or less money by taking VSP.

 

[fedor]

You guys are complaining about VSP being 70-90$ but I just called a few OD's yesterday and asked how much a comprehensive exam costs and I was quoted $50 to $60. That is with no specials, coupons, or insurance. How is that possible? Would insurance reimburse the amount of the exam up to the maximum (ie, VSP 70 to 90) or would the insurance reimburse the set fee no matter what the cash fee was?

 

[Ben Chudner]

You guys are complaining about VSP being 70-90$ but I just called a few OD's yesterday and asked how much a comprehensive exam costs and I was quoted $50 to $60. That is with no specials, coupons, or insurance. How is that possible? Would insurance reimburse the amount of the exam up to the maximum (ie, VSP 70 to 90) or would the insurance reimburse the set fee no matter what the cash fee was?

Insurance companies will reimburse what you charge up to their maximum allowable. So, if a doc charges $50 for an exam and the insurance company allows $100, then they will pay the $50 and no more. That doc just lost $50. If the doc charges $110, the insurance company would pay $100 and the doc would have to write off the $10. VSP is different in that they do not use conversion factors to calculate what they will pay for each code. What VSP does is uses the average fees in your area to determine what they will pay. So if you charge $150, but all of the docs in your area only charge $80, then you will not get any where close to what you charge. This is another big problem with VSP because there are a lot of OD's that have no idea how to charge appropriately and therefore keep the reimbursement lower than it should be. If those docs are private practice OD's that you got the quotes from, they are prime examples of the problem. To give you an idea, in my office a new patient exam is $185. Add another $40 if that patient wears contacts. Now, I don't get that, except on cash paying patients, and I give them a break for paying in full on the day of service. But by charging that much, I am sure that I get every penny that I can from all of the insurance plans that I take.

 

[fedor]

What discount do you give for patients paying in full in cash? Are you in a rural area? Because in the large metro area I am in, $50 to $60 is standard. (In fact, I used to pay $59 for the exam and two pairs of glasses before I switched to the OD I have now which is $60 just for a non-contact eye exam). The only reason I go to the PP OD I go to is because 1) he did a very thorough eye exam 2) he patiently answered all the medical questions I had. I think the majority of patients consider eye exams as a commodity so they differentiate solely by price. They do the same for pretty much everything, including plastic surgery, LASIK, etc.

I think in many ways you guys are fighting a losing battle and eventually you will have to conform to the commercial OD business model of cheap eye exams and expensive lenses. The reason for this is that as a commodity, all goods are standard. Thus they think the eye exam at one location is of the same quality as that in another location. The only way you can somehow get around this is by advertising to your patient base that your eye exams are superior to those of your competitors. For example, this practice is trying to do just that.

http://www.eyeworks.com/eye_health_exams.htm

Now I am not sure if what they are offering is really above and beyond a normal eye exam, but to a non-OD like myself, it certainly looks like it. If you can't differentiate your eye exams to the public somehow, you're bound to be outpriced by the commercial stores.

Insurance companies will reimburse what you charge up to their maximum allowable. So, if a doc charges $50 for an exam and the insurance company allows $100, then they will pay the $50 and no more. That doc just lost $50. If the doc charges $110, the insurance company would pay $100 and the doc would have to write off the $10. VSP is different in that they do not use conversion factors to calculate what they will pay for each code. What VSP does is uses the average fees in your area to determine what they will pay. So if you charge $150, but all of the docs in your area only charge $80, then you will not get any where close to what you charge. This is another big problem with VSP because there are a lot of OD's that have no idea how to charge appropriately and therefore keep the reimbursement lower than it should be. If those docs are private practice OD's that you got the quotes from, they are prime examples of the problem. To give you an idea, in my office a new patient exam is $185. Add another $40 if that patient wears contacts. Now, I don't get that, except on cash paying patients, and I give them a break for paying in full on the day of service. But by charging that much, I am sure that I get every penny that I can from all of the insurance plans that I take.

 

[Ben Chudner]

I am in a suburb of Seattle, not quite rural. There are about 12 offices within fairly close proximity, including a LensCrafters, Wal-Mart, Sears, Pearle, and JC Penny's. I give a 25% reduced fee for day of service payment. In my state, there are plenty of insurance companies that pay well over $100 for an eye exam, so I would be leaving money on the table if I charged only $60. The doom and gloom prediction that the "doc in a box" locations will take over private practice has been around for awhile. I think the offices that differentiate themselves will always do well. We provide a thorough eye exam with the latest technology. We have several patients that have EyeMed that still chose to see us because the level of service we provide. They can then bill their insurance company on their own and I get paid the appropriate amount for the type of exam I provide.

 

[kiwipotato]

Often times the chain locations are filled by new grads. Many times new grads use the chain locations for and instant income and after a few years, move out to private practice. On the other hand, there are many ODs who make Lenscrafters home. I know an OD who worked for a chain for 30 yrs. He now has his own practice b/c they tried to screw him on his salary. Sometimes the ODs in chains do seem to be less capable. That is often b/c they don't have time to treat every disease, so they refer out. Sometimes they only have time to refract and move on. This is not the case everywhere, there is an extern site here that is at a Lenscrafters. The doc there is suppose to be really good.

I'm new here, still learning about all of this. If you are working for a corporation or commercial, i.e. lens crafters, do you get paid on salary? otherwise, what incentive are you being offered to accept cheaper eye exams? is it that you do higher volume? please explain someone. thanks!

 

[generallyspeaking]

It depends on state laws if they are one-door or two-door states. Meaning, some states it is illegal for the doctor to be employed by an optical so doctors lease nearby to collect exam fee, and some states doctors can be employed by an optical so they are paid a salary.

Usually the incentive is that your start up costs and overhead are lower, and yea volume.

I won't return to commercial optometry, mainly because I dislike working with the clientele.

 

[SunA21]

I won't return to commercial optometry, mainly because I dislike working with the clientele.

In your experience, how has the clientele in commercial differed from the clientele in private practice?

 

[generallyspeaking]

I don't work in private practice, I work in a hospital/MOB HMO with one of the highest premiums. My clientele contains people with money, employment, and education. These people come to their appointment on time, know their medical history, are sober, get regular health care, etc. They also tend to stay established patients so their repeat visits were easier in nature.

Whenever I worked in commercial, I tended to encounter lower-income patients that carried their socioeconomic woes into my office - single moms bringing in huge strollers, people with lots of diseases because they get an eye exam once a decade, larger refractive errors, contact lens abusers, people who complained a lot about costs, people coming in late or not at all, everybody was new so I always had to start from scratch. It just wasn't fun working with patients, and every so often I would get crazy/hostile people which I greatly hated.

It just wasn't for me. It's analogous to being a disneyland employee and working with their guests versus being a six flags employee and working with their attendance. Or teaching at a private school versus inner city chicago. Since working at the hospital, I've not had any confrontations, bad attitudes (I'm not your buddy, I'm your friggen doctor), nor anyone coming in my exam while under the influence of substances. I can just do my job without any drama.

TL;DR : there's less bullsh*t

 

[OpticalBlackOut]

I don't work in private practice, I work in a hospital/MOB HMO with one of the highest premiums. My clientele contains people with money, employment, and education. These people come to their appointment on time, know their medical history, are sober, get regular health care, etc. They also tend to stay established patients so their repeat visits were easier in nature.

Ah, the dream.

Comment #2- here's another realization while looking at the insurance info from a 2005 thread. Our reimbursements have gone DOWN...way down, and VSP is one of the biggest culprits of killing our profession. (The CVS fiasco is just a giant knife to our backs). EyeMed has indeed grown into a giant low-paying practice killer, and offices are quickly opting out of these plans because the exam fees are not worth it for the hassle. Truly a disservice to patient care

 

[Nimsss]

I don't work in private practice, I work in a hospital/MOB HMO with one of the highest premiums. My clientele contains people with money, employment, and education. These people come to their appointment on time, know their medical history, are sober, get regular health care, etc. They also tend to stay established patients so their repeat visits were easier in nature.

Whenever I worked in commercial, I tended to encounter lower-income patients that carried their socioeconomic woes into my office - single moms bringing in huge strollers, people with lots of diseases because they get an eye exam once a decade, larger refractive errors, contact lens abusers, people who complained a lot about costs, people coming in late or not at all, everybody was new so I always had to start from scratch. It just wasn't fun working with patients, and every so often I would get crazy/hostile people which I greatly hated.

It just wasn't for me. It's analogous to being a disneyland employee and working with their guests versus being a six flags employee and working with their attendance. Or teaching at a private school versus inner city chicago. Since working at the hospital, I've not had any confrontations, bad attitudes (I'm not your buddy, I'm your friggen doctor), nor anyone coming in my exam while under the influence of substances. I can just do my job without any drama.

TL;DR : there's less bullsh*t

Are you a physician or an optometrist working in a Hospital??

 

[Optogal]

Like generallyspeaking said above, patient clienteles in well-to-do neighborhoods are by far an easier group to do eye exams on. You hardly encounter any disease. The converse is true for low-income neighborhoods.

Health and wealth are definitely highly positively correlated. Being a health care practitioner will clearly show that to you.

 

[generallyspeaking]

The more stressful factors that made it unbearable to me were related to things that didn't involve the actual case and my job responsibilities. Things like creepy men hitting on me, higher unpredictability of patients actually showing up on time, disrespectful patients with attitudes, poor hygienic patients. It's nice not having so many chain-smoking patients or the super body-odor dude where you have to breathe through your mouth all the time and then hose the office down with de-odorizer. All of this is also probably correlated with wealth, as they are socioeconomic problems. THIS is the stuff that gets me and makes my exam harder than it needs to be.

 

[Singuy]

You guys are complaining about making 35 dollars for an eye exam with the potential to make 100 if it's a contact lens fit? Have you seen what they do at America's Best? I see ODs seeing 30-35 pts a day making a 500 dollar salary. If you do the math, we are talking about close to 15 dollars/pt.

Cut down on the BS and tell these kids who are entering the profession how much you guys gross at a LC vs a private practice. Luxottica may be the devil, but I know a lot of ODs grossing 250k/year without the need to buy any equipments/paying a start up fee...my wife included.

 

[drjecod]

So, what I am gathering from this thread is that, as an Optometrist, I am supposed to A) hate capitalism, and B) hate poor people.

Otherwise, I won't make as much as my over-inflated ego tells me I should...