Cash only - Does it exist in optometry?

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Shnurek

Shnurek

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Are there optometrists out there that go cash only? If so what is the % of OD's that are cash only compared to every other way of getting reimbursement?

Just came upon this while reading some Medical Student SDN threads.

Here's an interesting article:
http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=652945
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Good article, although, I don't think its fair to compare two professions.

I have noticed that Medicine, among other health care professions, are procedure driven (i.e., you must physically do something), whereas, optometry is more so service driven (i.e., examination). Therefore, you can't really expect to build a lucrative cash only accepting practice, since your services, by nature, pay quite low. You would need to see many more patients a day, and quite possible sell glasses to them, if you would like to make as much as the physician in the article, since he probably grosses more per patient, whereas the OD grosses less per patient.

That isn't a knock on the OD, it is just the nature of the work! (procedure vs service, for the lack of terminology)
 
I've worked at an OD office that is cash only and takes no ins. I think the key to it is to occupy a top of the line niche. The place I worked for sold VERY expensive and rare types of frames from overseas. This brought in people that were willing to spend money and didn't mind paying out of pocket.
 
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Wow, that was a really interesting article, thanks for posting.

I see that as a genius path for the family practitioner. Everybody has multiple issues at times and lots of questions; so more time with the doctor is golden.

I imagine there really does need to be a niche.
 
I know of one practice in the city of Chicago that does not take any insurance. It is in a desirable location with a focus towards higher end eyewear. The practice also does a lot of complex contact lens fittings.

The physician (Dr. Forrest) mentioned in the article seems to take home plenty with low overhead and moderate fees ($45 for a office visit). The other doctor with the $2 a minute stopwatch (Dr. Grigg). The former can bring in $90 cash from two exams per hour, while the latter can bring in $120 in an hour. I would posit that an optometrist could just as likely bring in that type of money. At $80 for an eye exam and even more for a comprehensive+CL fit, and 2 exams per hour, an optometrist could set up a similar practice. They could bill cash for medically necessary tests as well (fundus photos, fields, etc). Although a majority of the exams are comprehensive eye exams, even those exam fees can be profitable.

What seems to be the problem is filling up a schedule with all cash pay patients. With the prevalence of vision plans, I think it would be very hard to grow a cash pay private practice. It seems like much of the advice I've been given is to start a practice and sign on multiple insurance panels to bring patients in the door, then drop the ones that don't work out for you. No one seems to advocate a cash plan

An aside: the more I think about it, a corporate lease sounds very similar to this plan. Low overhead, a small staff, and plenty of cash pay patients (well, before VSP hopped in bed with Costco).


Anyway, do any practicing optometrists have any thoughts on the matter? Have you ever thought of or tried to go cash only and how has it worked out for you?

Thanks,
Jeff
 
I don't see the appeal of cash only, other than the reduction in paperwork.

My typical day generates $300-350/hour in professional fees and then whatever gets generated by CL's/glasses on top of that. In general, health insurance pays well for optometric services, it's vision plans that pay poorly, which is why I don't accept any.

Appeal of cash only: not so much
Appeal of no vision plans accepted: very much!
 
The optometrist down the road from the one I worked with in college is cash-only. I don't know anything about her practice except that she does very well and sells higher end materials. Not sure about her fees, patient flow, etc.
 
That's cool that it exists. I guess you have to be a superstar OD to have a practice like that. I'm sure it will get more popular as insurance reimbursements go down.
 
optsuker said:
I don't see the appeal of cash only, other than the reduction in paperwork.

My typical day generates $300-350/hour in professional fees and then whatever gets generated by CL's/glasses on top of that. In general, health insurance pays well for optometric services, it's vision plans that pay poorly, which is why I don't accept any.

Appeal of cash only: not so much
Appeal of no vision plans accepted: very much!
Click to expand...

If you don't mind, what are your fees?

I have not heard anyone making that much with just their fees....unless you charge a premium or I guess if you have multiple Od's working for you.
 
The only practices that I've ever seen that are cash only (and I've seen scant few) are practices that sell super ultra high end materials and charge a nominal fee for their exam or they sell super low end, ultra high volume and charge a nominal fee for their exam.

I've never seen any practice where any sort of disease management takes place that is cash only. Patients aren't going to pay hundreds of dollars out of pocket for advanced testing.
 
imemily said:
If you don't mind, what are your fees?

I have not heard anyone making that much with just their fees....unless you charge a premium or I guess if you have multiple Od's working for you.
Click to expand...
I schedule 3 20 min slots/hour. Try to make 2 comp exams & one office call/postop/other. Often the OC will include other procedures (OCT/VF/photo) so it's very easy to ave more than $100 per patient.
The comp exams will generate more besides if they order glasses/CL.

Private practice is not the easy road, but its the more lucurative one.
 
I've always thought the trouble with pp is not being able to attract enough patients, even if your prices are competitive.


People just don't value a visit to their od like they do with an Md. Breaking 20 pts is pretty much impossible to achieve!
 
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KHE said:
What do you base that on?
Click to expand...

Well there's a lot of things. For one, the tendency of people to not put a high priority on eye care. Medical visits or visits to a dentist or a vet just seem like more of a priority.
 
imemily said:
Well there's a lot of things. For one, the tendency of people to not put a high priority on eye care. Medical visits or visits to a dentist or a vet just seem like more of a priority.
Click to expand...

I routinely see more than 20 patients a day. So your assertion that it's "pretty much impossible to achieve" is a non starter.

You're right in one sense though. People may not consciously put a high value on eye care but every single survey shows that blindness is rated very highly as something people are afraid of when it comes to their health.

So where's the disconnect? How do you make someone "value" you or your practice or your services?

Think about that.
 
I think the disconnect is that people are intuitive enough to know that blindness is not that prevalent; "I wouldn't want it, but my chances are not that high".

I'm also of the opinion that people don't behave particularly rationally, but emotionally. Think of STDs, teen pregnancy, motorcyle use, smoking, etc.

The most effective "approach" would be to have a testimonial from some poor soul that lost vision: "Yup, I didn't take it none too serious, and now I'm a blind guy. It could happen to you tomorrow!" (Hey, that toothless idiot reminds me of myself...I'd better motor off to Lenscrafters after this NASCAR race ends.)
 
I'm schedule with 21 patients every day (plus 4-8 unscheduled emergencies).
 
KHE said:
I routinely see more than 20 patients a day. So your assertion that it's "pretty much impossible to achieve" is a non starter.

You're right in one sense though. People may not consciously put a high value on eye care but every single survey shows that blindness is rated very highly as something people are afraid of when it comes to their health.

So where's the disconnect? How do you make someone "value" you or your practice or your services?

Think about that.
Click to expand...

Sorry, what I meant to say was that the practices around here, (Seattle) are hard pressed for patients. I've shadowed many practices, and the max patients seen was around 17-18, which was on a busy Saturday!

Hypothetically, a practice having 20+ patients on average, with the optical, should be able to gross close to or above the 1 million dollar figure. This is another reason why I believe 20 pts/day is hard to achieve as you just don't find too many practices breaking that mark. Most practices see between 8-10 patients a day, sadly.

I think you can make a couple of people value your practice by providing caring, intelligent and useful service, but you cannot hope to do that with your entire patient base. Most people just want to get in and out asap. Improving office aesthetics and offering patients more than just an eye exam would probably set a good impression on patients. Other than that, I am not really sure what an OD can do, other than to slash prices by 50%!
 
I see 8-10 patients/day, and I'm approaching the half-mil mark, and I'm not sad at all.

If I wanted to see double the patients, I'd sign up for low-reimbursing vision plans and Medicaid. Then I could brag how much throughput I have.

Or, I could just see forty patients in one day and close the rest of the week...
 
imemily said:
Sorry, what I meant to say was that the practices around here, (Seattle) are hard pressed for patients. I've shadowed many practices, and the max patients seen was around 17-18, which was on a busy Saturday!

Hypothetically, a practice having 20+ patients on average, with the optical, should be able to gross close to or above the 1 million dollar figure. This is another reason why I believe 20 pts/day is hard to achieve as you just don't find too many practices breaking that mark. Most practices see between 8-10 patients a day, sadly.
Click to expand...

That's because those practices have done a terrible job of marketing to people.

Again....Seatle might be the best example of this. Seatle is a very tech heavy place. The same people who are not getting eye exams, or updating their eyewear, or want the cheapest stuff possible are just DYING to get their hands on the next ipad, or playstation, or whatever.

Why?

You'll say because they value the ipad more than their eyewear. Yes....but why? Because their current glasses work fine? Ok. BUt their current cell phone works fine too.

Think about it some more.

imemily said:
I think you can make a couple of people value your practice by providing caring, intelligent and useful service, but you cannot hope to do that with your entire patient base. Most people just want to get in and out asap. Improving office aesthetics and offering patients more than just an eye exam would probably set a good impression on patients. Other than that, I am not really sure what an OD can do, other than to slash prices by 50%!
Click to expand...

You can do it with your entire patient base. You can't do it with the entire population. But that's ok. You shouldn't want to. If you think most people want to get in and out ASAP, them I would respectfully submit that you have not visited any practices worth visiting.
 
People don't want to pay for healthcare period I think. People view it as an entitlement in the US...this should be free..I am supposed to life a happy healthy life. Xboxes and Lexuses are considered luxuries.
 
optomistristeye said:
I would agree to the idea so that health insurance should be free because there are many countries that have excellent health care system which is free. Once it is not free, it means that health is simply evaluated in terms of money. On this issue, we had a good conversation with Christopher Reynolds. If somebody have an opportunity meeting him, you can visit his blog Christopher Reynolds
Click to expand...

spam
 
lol that's worse than me putting up the SUNY brochure. There is nothing about healthcare policies in that link. It just shows the accomplishments of some meatball 😛
 
Shnurek said:
lol that's worse than me putting up the SUNY brochure. There is nothing about healthcare policies in that link. It just shows the accomplishments of some meatball 😛
Click to expand...

Douuuuuuuuuuche. lol.
 
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