The Managed Care Conundrum

Can you really profit with third-party plans? In this new column for 2019, we dig into the topic with expert optometrist Eric White, O.D.


the optical world is changing, and one of the biggest conundrums we are all dealing with is how to survive and even thrive with managed care being such a large part of our practices.

In this new column series for 2019, I plan on sharing the main ideas (and secrets) I use in my practice. These are common-sense concepts that do not take money to implement, but make a small shift in your—and your staff's—mindset.

2019: What We’ll Cover

In this series, we will cover many areas that will help you realize profitability within a managed care environment. Here’s a look at what we’ll cover this year:

How you and your staff can utilize Doctor-Driven Dispensing.

The importance of having a specific staff member who checks to make sure the insurance is filed and paid correctly. You cannot imagine how important this is. A few years ago, I went back through my records and discovered over $165K lost to incorrect filing and not billing the patient the correct deductibles. Boy, this can hurt a practice. This is a simple fact that many of us do not think about.

Specialty testing and how that can really build a practice.

Implementing specialty lenses in both the contact lens world and the ophthalmic world.

Finally, we will talk about doing some simple things on social media that will set your office apart from others and make it more attractive to new and previous patients without having to spend money to bring them in. Remember, a patient in the chair will mean revenue for the practice even with managed care.

First Up: Doctor-Driven Dispensing

So, let's get started with the first topic and what I feel is the most important concept for a practice: Doctor-Driven Dispensing.

I have lectured and written many times about this concept, and I feel this has helped me more than anything I have done in my practice. It does not cost me anything but a little more time per patient, but with it my per-patient revenue is averaging over $600/patient.

What is Doctor-Driven Dispensing? Let me explain it to you in simplistic terms. Doctor-Driven Dispensing is taking the time to listen and prescribe for your patient in the exam room.

After I do the refraction, I pull the phoropter away and prescribe the best option for my patient. The "power of the pen" is very strong and straightforward. In listening to what the patient’s lifestyle, work conditions, and needs are I am able to prescribe what is best. I also take the time—literally a few minutes—to explain why I am prescribing the highest quality products for them.

If they do have a managed care plan, then I explain why I am prescribing above the basics—and how it will benefit them. I tell them that their insurance will help pay for some of it but there will be deductibles and additional costs. And then I answer the patient’s concerns right there.

When I am done with the exam and hand off the patient to my optician, I again prescribe what I want them to have and my optician repeats it for a third time. The secret to making money with managed care is to make the patient realize why they need what I am prescribing. We will always find the money to purchase what we feel will help us live our lives better.

I will dive into this concept more in the next issue.

Eric White, O.D.