Obamacare and optometry

[mclem222]

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I was wondering what people thought obamacare will do for optometry.

I actually think it will hurt it. As an OD i see a large number of uninsured patients. These people come into my office. Pay an exam fee and are seen. Under obamacare the number of medicaid patients will expand greatly. Where i practice if someone has medicaid I am not allowed to bill them a refraction fee on top of the medicaid fee. The medicaid fee pays about 50 dollars for the exam. Also, these patients are not allowed to be upsold glasses etc.. So if they want medicaid glasses and to use their medicaid dollars for glasses there are only a few to choose from. If I want to sell them something expensive and charge them the difference it is not allowed under medicaid guidelines.

In our main office, I see patients with my brother who is an OMD. He sees and gets referred a lot of insured patients. I see some too but he gets the bulk of referrals.

From this I deduce that if more people are insured and more people have medicaid, my collections will go down because more people who now have insurance will get pushed to see OMDs from the primary docs and more uninsured people will have medicaid and will be a reduction of income per patient compared to pre-obamacare.

Note: This is no judgement on whether Obamacare is good or bad. It is strictly my opinion regarding whether my income will go up or down from obamacare. Thoughts anyone?

 

[q1we3]

But your practice will be busier, you and your brother will be seeing more patients. How many extra patients will you need to see per month to make up for the loss of revenue per patient
on current system? Any way to calculate that?

 

[mclem222]

my brother will be seeing more patients. ..I am maxed out and i see about 25 patients a day...All that would happen would be my collection per patient would go down...so instead of making $150 per patient it would go down to $50.

 

[Optomchick]

I was wondering what people thought obamacare will do for optometry.

I actually think it will hurt it. As an OD i see a large number of uninsured patients. These people come into my office. Pay an exam fee and are seen. Under obamacare the number of medicaid patients will expand greatly. Where i practice if someone has medicaid I am not allowed to bill them a refraction fee on top of the medicaid fee. The medicaid fee pays about 50 dollars for the exam. Also, these patients are not allowed to be upsold glasses etc.. So if they want medicaid glasses and to use their medicaid dollars for glasses there are only a few to choose from. If I want to sell them something expensive and charge them the difference it is not allowed under medicaid guidelines.

In our main office, I see patients with my brother who is an OMD. He sees and gets referred a lot of insured patients. I see some too but he gets the bulk of referrals.

From this I deduce that if more people are insured and more people have medicaid, my collections will go down because more people who now have insurance will get pushed to see OMDs from the primary docs and more uninsured people will have medicaid and will be a reduction of income per patient compared to pre-obamacare.

Note: This is no judgement on whether Obamacare is good or bad. It is strictly my opinion regarding whether my income will go up or down from obamacare. Thoughts anyone?

I love Obama. Also I now get to stay on my parents insurance till I'm 26, so it benefits me.

 

[q1we3]

my brother will be seeing more patients. ..I am maxed out and i see about 25 patients a day...All that would happen would be my collection per patient would go down...so instead of making $150 per patient it would go down to $50.

What percentage of your patient base will turn into medicaid?

 

[Shnurek]

I love Obama. Also I now get to stay on my parents insurance till I'm 26, so it benefits me.

You won't love him so much in 4 years 😀

 

[CL Doc]

I love Obama. Also I now get to stay on my parents insurance till I'm 26, so it benefits me.

What does your political opinion add to a discussion on the economics of socializing health care?

 

[mclem222]

I love Obama. Also I now get to stay on my parents insurance till I'm 26, so it benefits me.

That was just a political opinion...totally unneeded and irrelevent.

The percentage of my practice now that is medicaid is 10% and I have about 30-40% that is uninsured. These patients pay a flat fee right now $150 for an exam. If they have medicaid it will be replaced by $50 with a "collection rate" etc.. as some billings will get denied from medicaid. Curious what practicing ODs thought.

 

[KHE]

Leaving aside any political opinion and just thinking about it in terms of my office, In my state medicaid pays reasonably well for exams and office based tests and procedures. IF patients who are new to obamacare are medicaid patients and IF the fee structure remains the same as the current reimbursement, it would be a net positive for my office.

 

[Shnurek]

Leaving aside any political opinion and just thinking about it in terms of my office, In my state medicaid pays reasonably well for exams and office based tests and procedures. IF patients who are new to obamacare are medicaid patients and IF the fee structure remains the same as the current reimbursement, it would be a net positive for my office.

👍

 

[VA Hopeful Dr]

Leaving aside any political opinion and just thinking about it in terms of my office, In my state medicaid pays reasonably well for exams and office based tests and procedures. IF patients who are new to obamacare are medicaid patients and IF the fee structure remains the same as the current reimbursement, it would be a net positive for my office.

I think optometry has a different view of medicaid from medicine in general. From what I remember (granted its been a few years now), in SC medicaid paid better than even the best vision plan at the time (VSP).

Conversely, medicaid is almost always the lowest paying third-party in medicine.

 

[KHE]

I think optometry has a different view of medicaid from medicine in general. From what I remember (granted its been a few years now), in SC medicaid paid better than even the best vision plan at the time (VSP).

Conversely, medicaid is almost always the lowest paying third-party in medicine.

I'm speaking in generalities here but it seems that medicaid, like medicare pays reasonable well for office based things like visits and tests but it really screws over the surgeons and the hospitals.

Since optometry is pretty much exclusively office based, it's workable.

 

[VA Hopeful Dr]

I'm speaking in generalities here but it seems that medicaid, like medicare pays reasonable well for office based things like visits and tests but it really screws over the surgeons and the hospitals.

Since optometry is pretty much exclusively office based, it's workable.

I guess it depends on state. I know down here, I get around $47 for a standard medicaid office visit. Hell, that won't cover expenses and my resident salary much less real money.

 

[CL Doc]

I guess it depends on state. I know down here, I get around $47 for a standard medicaid office visit. Hell, that won't cover expenses and my resident salary much less real money.

I agree. Maybe in New England medicaid is the cat's meow but in the south you can't make a living from it.

 

[mclem222]

probably will be location dependent and how states reimburse for medicaid will decide if doctors accept it. If it is poor people won't accept it because they will be overrun with medicaid patients in their office.

 

[Tippytoe]

Yes, medicaid is state-run so payment will vary greatly. I know some states that pay around $40 for a routine eye exam and others that pay $110. Medical codes (99xxx) pay a little less than Medicare.

At $40, I would not see them. As a group they are the nastiest, most disruptive people you will see. They will run down your office in short order. Things will go missing. Things will be broken. Your parking lot will have McDonalds trash and dirty diapers in it at the end of the day. Plus, they have a 50% no-show rate.

(yes, I know I'm painting with a broad brush and there are some good welfare people.............but they are the exceptions. Many of my extended family members are on welfare and I will admit they are amoung the laziest people you will ever meet).

 

[Shnurek]

I heard blue states reimburse less for Medicaid patients. Is this true? I'm trying to google a state Medicaid reimbursement index for routine eye exams but all I found was a midwife pricing index that compares states by the percentage of the full physician reimbursement for their procedures.

 

[VA Hopeful Dr]

I heard blue states reimburse less for Medicaid patients. Is this true? I'm trying to google a state Medicaid reimbursement index for routine eye exams but all I found was a midwife pricing index that compares states by the percentage of the full physician reimbursement for their procedures.

You'll have to look it up state by state, generally.