what's your time worth?

Discussion in 'Optometry' started by HOLLYWOOD, Nov 26, 2005.

  1. HOLLYWOOD

    HOLLYWOOD Senior Member
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    I feel I should generate at least $200/ hr.(seeing 2 or 3 pts). I came up with that number by seeing what other people charge. ie. lawyer $200 to 450/hr. I feel I should make as much as a lawyer. Plummer $150 an hr. So what is your time worth ? then I'LL tell you what insurance companies pay.
     
  2. KHE

    KHE Senior Member
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    Are you talking gross or net?

    My lawyer charges $350 per hour, but its not as if he puts $350 into his pocket for that hour of work.
     
  3. Hines302

    Hines302 Senior Member
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    what is the point of this thread??
     
  4. prettygreeneyes

    Moderator Emeritus 5+ Year Member

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    This is merely speculation, but is the point of the thread to have everyone state that they think they are worth $x.xx amount of money/hour and then... surprise surprise... the insurance companies don't agree??? There's a shocker! EyeMed reimburses $39/exam plus pt. co-pays. Spectera is $25/exam if they ever actually pay you. VSP is $75 minus pt. co-pays. Medicaid pays (woo hoo!) $112. (Disclaimer, these are only the amounts the practice I work for gets reimbursed...your's may be different!) Of course we all think we are worth a lot more than we get paid. But, what are you going to do? Not accept a particular insurance? OK... but the insurance company is unlikely to care! Do the best you can do with what you got. In the end, that's all you can do.
     
  5. 3eb4me

    3eb4me Senior Member
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    NO!!!! You have to fight and resist those insurance companies.
     
  6. Ben Chudner

    Ben Chudner Senior Member
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    The real question you need to ask, is how much do I need to generate per hour to cover expenses. It makes no difference what you think you are worth, because in most practices, you have little control over that. Unless, of course, you are in an area that is cash only. Once you know how much it costs per hour to run your office, you can make educated decisions on whether or not to join a particular insurance panel. For example, if it costs you $100 per hour to run your office (staff salaries, rent, utilities, equipment loans, etc) and Davis Vision wants to pay you $25 for an exam, you would need to see 4 of those patients an hour just to break even. With Medicare, you would make money with just one patient. As you can see, it's not worth it to take a plan that pays so low.
     
  7. prettygreeneyes

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    I agree that you should fight... but how? Demand that they reimburse at higher levels? It seems that the only option is to not accept those insurances companies, but a good amount of optometrists would have to do that in order for the insurance company to really take notice. I think Ben Chudner is completely right... figure out how much money you need to make, and choose insurance plans accordingly. As a question to Ben, I curious to know if it makes a difference as to where you are at with your practice as to which insurances you should accept? Assuming that you could get on every insurance panel, is it better when you are first starting out with your practice to take every insurance under the sun to get the maximum number of patients into your office? And then as your patient base grows become increasingly more selective? Or, do you start out being selective to ensure you are getting the most out of your chair time? As a student who one day hopes to have a private practice, I would love to hear what you have to say.
     
  8. ucbsowarrior

    ucbsowarrior Senior Member
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    this man knows what he's talking about...chair time cost
     
  9. ucbsowarrior

    ucbsowarrior Senior Member
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    this strategy make good sense as you are trying to lessen your suffering during the initial stages of 'your new' practice. there's just one thing you should be concerned with. once you set the momentum or direction of your practice, it is often very difficult to change that when it matures and alienating a subsect of your patient population after you've initated service may not be all that easy. if you have 2000 spectera patients how are you going to change the direction of the practice? it's possible, but difficult. you'll be faced with tough choices....so in the end it depends what type of outfit you are trying to build. if it's a matter of survival than that's another story...but do your research and be realistic as to how things will play out when you build a practice. good luck :oops:
     
  10. ucbsowarrior

    ucbsowarrior Senior Member
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    lawyers may not have that many billable hours per week and if making money is one of your main motives (as this post depicts) you should probably not enter any career related to healthcare....i think you could make more money becoming a plumber (by the way i don't know what a PLUMMER is, but i assumed you meant 'plumber') or a 'pummper'....but if you want to be a pummper you'll have to move down to southern cali :smuggrin:


    if in the event you do become an od, pls let us know how much per hour you are making after you graduate. thanks! :thumbup:
     
  11. Opii

    Opii Senior Member
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    This thread reminds me that I am due for a hair trim and highlights.... which runs me about $130 and I do this about 4-5 times a year. :eek: I'm in the wrong profession.
     
  12. Ben Chudner

    Ben Chudner Senior Member
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    The answer to this question is very personal. As ucbsowarrior suggests, it is very difficult to change the direction of your practice so you must decide what type of practice you want to have. There are practices that do very well servicing low-paying patients/insurance companies because they make it up on volume. You cannot have a large overhead in this type of practice if you want to be profitable. That is why corporate docs can do very well. They can see 10 patients a day at $50 a patient ($500/day) with little overhead and clear well over $100K a year. This is only because their overhead is less than 10%. In a private practice the overhead is closer to 65%, so if you bring in $500/day, or roughly $130K per year at 5 days per week for 52 weeks per year, your take home is only $45K. So you must decide what type of practice you want, and make sure you are practicing in a state where you can achieve that. From what I have read on this forum, in some states it is very difficult to get on insurance panels. I don't know which states are better for this, but you better be sure you know before you decide where you want to practice.

    For me, I would not take any insurance plan that pays lower than VSP. Even in the beginning. I would not take VSP except that in my practice, it represents about 25% of my patients. Just to show you how hard it is to change direction in your practice, let me give you an example. In my area, VSP is being challenged by NorthWest Benefits. NWB is a discount eyecare plan, like Davis or Cole. A lot of the school districts in my area switched from VSP to NWB. For exams, the reimbursement is close, with VSP paying about $5 more. The problem is on the materials side. If the patient stays within their plan, we get reimbursed for the cost of the materials only. If they go above their plan, we get reimbursed for the cost of the materials plus $10. Once you factor in the time it takes my optician to process the order (frame select, write up, fax to lab, check in, call patient, dispense), it actually cost me money. I dropped the plan and offered those patients a 20% discount plus they could bill NWB for their exam and get some money back from them. We lost most of those patients. Was I upset? At first, but then we started filling those slots with patients that either paid cash, or had a better paying plan. In the end, I saw less patients, and made more money. Another thing to understand is that according to some consulting experts, a patient will change their doctor for as little as a $10 co-pay. Meaning, if they have to pay $10 to see you, but at the OMD office down the street it's free, they will change to that office regardless of how long they have seen you. Obviously, there are patients that are very loyal, but the point is you can't count on that. My neighbor, who I play poker with every month recently requested his and his wife's records because their insurance changed and I am not a provider. MY NEIGHBOR! But, when it comes down to paying me $151 for an exam or paying a $10 co-pay for an in network provider, can I really blame them?

    So what's my point? If you start out taking every insurance plan under then sun to get patients, you will have a very difficult time being profitable without having to see a ton of patients. When you want to start dropping plans once you have an established patient base, expect to lose those patients to your competitor that stays on as a provider. That's actually a good thing because he will be choked with a large influx of low-paying patients, but it doesn't guarantee you will have a large influx of better paying patients. You have to decide from the beginning what type of practice you want, and find the right place to do that. Good luck.
     
  13. prettygreeneyes

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    Thanks to Ben and UCBSOwarrior for their great replies. :D The more I thought about the question I asked, the more the answer should have been obvious to me. I realize that a major determining factor in the success of a practice is how much time one is willing to invest in it. If I did start out taking every insurance, sure, things could be great... but I'd have to see tons of low paying patients just to stay ahead. And, once I wanted to start changing the direction of the practice...trouble. But, start out with a solid group of decent-paying insurances, it will take longer to build a solid patient base, but, no fear of having to suddenly cut insurance plans down the road (unless they change reimbursments levels or get bought out by someone). I curious to know if VSP was Ben's cutoff point for insurances, are there a decent number of insurances that will pay better than VSP? I can think of a number of companies that pay worse than VSP, but not a whole lot that pay better. Obviously, there's Medicare/Medicaid. In Nevada, we have a select number of insurance companies that will give their members $250 for vision care. They spend it how they want to... exam, glasses, contacts, etc. Don't know if other states have those type of companies as well. Ben, I'm curious to know if cash paying patients make up a great deal of your patient base. You guys have given me some food for thought. I want to start thinking about all of this stuff now... maybe I'll stand in chance in about 5 years!
     
  14. Ben Chudner

    Ben Chudner Senior Member
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    Unfortunately, cash paying patients do not make up a large percentage of my practice. Then again, I do a lot of medical billing which still reimburses fairly well, so it's good my patients are insured for that. As for paying better than VSP, there are a lot of medical plans that allow for an annual exam and most, if not all, pay more than VSP. It only works if you can be a provider on those plans, however.
     
  15. drmhyde

    drmhyde Michael Hyde, O.D.
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    uhh well...it depends on what you do a 92004 is worth $125 bucks in my office> I could see 4 or 5 of those an hour. (that's not including a refraction fee or a CL fitting fee)
     

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