Al Cleinman's Blog

A Thanksgiving Message

OK, so your portfolio has shrunk by 40%, unemployment is jumping and you’re concerned about the future. 

Its times like this that keep me grounded.  And for my Thanksgiving message, I thought I’d share with you a poem that I wrote some ten years ago, during a particularly depressing time for me. 

 

Yes, this was the house to which I was born in 1956.  That’s a pigsty in the front yard and we had a two-holer outhouse. The house was actually a converted chicken coop.  There’s plenty of story here that I won’t bore you with, but you’ll get my point.  This photo sits by my desk and continually reminds me that, no matter what happens, I’m a pretty lucky guy. 

OK, so your portfolio has had a hiccup and you’ve got to work a bit harder then you'd like.  But think of from where you’ve come.  And think of all of those citizens who can’t afford to put food on their tables this Thanksgiving.  Sure, times are tough…or are they?

It’s all about perspective.

 

Happy Thanksgiving,

 

Al Cleinman

A Consumer's Perspective on Eyecare and VSP

I pulled the following off a consumer's blog.  It provides an interesting consumer's perspective on what they value from their VSP (or any plan) benefits.  Further, as you'll note, it's interesting that this consumer doesn't appear to have a clue as to the services that optometrists provide and why.  Indeed, you'll find an optician mentioned...and an ophthalmologist mentioned...but not word one about optometry.  And I thought VSP was optometry's friend?  I doubt that this individual went through the same detailed analysis when they purchased their car...or new TV.  All this analysis for a <$500 purchase.  Shows you what all of our industry's price positioning has done for our value proposition.  What a crime!

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It’s Benefit Enrollment Time - Seeing the Vision Plan Clearly. Finally.

November 12, 2008 — BeThisWay

This post is part of a series on choosing benefits.  Today I will look at the ins and outs of our choices for Vision Care.

Husband has worked for Large Conglomerate for nearly seven years, and 2009 will be only the third year they’ve offered vision coverage.  I wear contact lenses, and I am a very serious, naughty overwearer.  I believe I’m supposed to wear each daily lens for two weeks before discarding them and using fresh lenses.  For me it’s often more like two months.  Or more.

I was thrilled when they started offering this coverage, as it had been twelve years since I’d gotten new glasses.  Granted, I only wear them at night, but the prescription was just not getting the job done, and my frames were past the point of repair.   Can you say tape?

The offerings this year are the same as that first year, and it is through VSP.   They offer the VSP Core Plan and the VSP Core Plan with Buy-Up.

VSP Core Plan

• One eye exam every twelve months after $10 copayment.
• $A 200 allowance applies to the cost of my contacts and the contact lens exam.

OR

• One pair of lenses per year and one pair of frames every 24 months after $25 copayment.
• A $200 allowance applies to the cost of the frames.
• The cost of frames exceeding $200, additional prescription glasses and sunglasses all receive a 20% discount.

VSP Core Plan with Buy-Up is the same as the Core Plan except:

• Two separate $200 allowances applies to the cost of my contacts and the contact lens exam.

OR

• Two pair of lenses per year and two pairs of frames every 24 months after $25 copayment.
• Two separate $200 frame allowances.

Or, you can do what I did that first year and get one pair of glasses and one set of contacts.

Husband has never worn glasses, so until this year I was the only one using it.  I chose the VSP Core Plan with Buy-Up that first year because I needed new glasses and contacts, and actually broke even (other than the premiums) because there was a rebate on the contacts which covered my copayments.

Pitfalls and PITAs and Good News

I know I could get glasses and contacts much cheaper than I can through the opticians covered under the plan, through Costco or Walmart or any number of online purveyors.  A lot cheaper.  But I’d still have to pay for an exam and a contact lens prescription, and it’s been my experience that doctors actually charged me for an eyeglass prescription of I wasn’t getting my glasses there.  Which really, really peeves me.

The biggest pitfall to this program is that they do not have any accounts with any of the discount retailers, which you would think would save them money.   Our optician gave me the reason for that when she told me that they do all of their own lensmaking, so it saves them a fortune.  And I’m sure they only reimburse a fraction of the retail price on the frames, too.   I have gone over the coverage limit and had to pay out of pocket.

On the other hand, last year the optician price-matched the lowest price I found online for the contact lenses.   With the rebate I wound up making money on the deal.

Last year and this year we skipped the Buy-Up and just did the VSP Core Plan. I actually have my appointment for this year’s lenses tomorrow morning (after 20 months I’m getting low on lenses).  I was contemplating letting the coverage go next year, figuring that I could do just as well through a discounter and that I probably would not need to buy lenses next year at all.  But then we found out that Husband needed glasses, for the first time ever.  Getting old has it’s challenges!

Because he’s diabetic we wanted to go to our Opthamologist, who is not on the plan (though other Opthamologists are).  We walked in to the optician (one of those people who are really, really good at their job and just accentuate the crappy customer service you get everywhere else) with a prescription and walked out with a pair of really killer titanium lenses with polycarbonate scratch-resistant lenses, glare protection (pretty important here in the land of the sun),  and clip-on sunglasses for $75 out of pocket.  That’s a pretty good deal that I don’t think I could have matched online.  Fantastic Optician also commented that VSP is the best Vision plan she’s ever seen, so that was an interesting tidbit, too.

So, let’s look at the costs for 2009.

VSP Core Plan 2009 Annual Premium: $85.32 (Note: I do not get the family plan for this, I select the Employee + 1 pricing.  Son does not need Vision Care, so why pay extra?)

Copayments:  $20

VSP Core Plan with Buy-Up 2009 Annual Premium:  $113.40

Copayments:  $20

So, bottom line is that now that Husband and I are both visually challenged this becomes an even better deal for us.   And something else occurred to me just this very second.

I’m thinking that perhaps we’ll do the VSP Core Plan with Buy-Up this year.  For an addtiional $28.08 ( that’s only $1.17 per paycheck - and paid with pre-tax dollars!)  I can get twice the amount of contacts and Husband can pick up a pair of prescription sunglasses, and  we can likely skip the coverage for 2010, and maybe even 2011 and save those premiums.

Oh, yes.  We will definitely be doing the VSP Core Plan with the Buy-Up this year.

The Power of Power

-          Several weeks ago, a client in the southwest called me to thank me for our comments about VSP and informed me that his Marchon rep made some negative comments about the services that our firm provides.   I’ve never met this rep...but I bet I've made this rep money.

 

-          Just the other day, a client in the northwest called me to inform me that he was told by a “VSP manager” that it was likely another managed care provider was paying us to make disparaging comments about VSP.  I’ve never met this VSP manager...or any VSP manager for that matter.  Oh…and the client thanked me for saying what was on the minds of many of his colleagues…and asked that I keep it up.

 

First, let me set the record straight.  Neither I nor my firm, Cleinman Performance Partners, have been paid by anyone to say anything negative about anyone.  Indeed, that is simply not a service we provide at any price.  And this firm is not now engaged by anyone in the managed care segment of the industry and hasn’t been for almost a decade.  Yes, about ten years ago I was one of several consultants retained by the firm that is today EyeMed.  Our charge was to assist with designing their systems such that they’d be “provider friendly.”   I will not accept any blame for reimbursement levels as I had nothing to do with those.  What I can certainly lay claim to was helping to ensure that EyeMed had an “open lab” policy.  After all, the fact that VSP requires use of their labs for finishing is one of the “chief complaints” of VSP providers. 

 

I always find this corporate version of the kid’s game “telephone” humorous.    Here we are a small firm focused on helping our clients succeed, to buy more products and serve more patients. And to be better customers to our industry’s vendors.  How is it that we are such a threat to a $3 billion company such that they spread rumors about us?  Why doesn't VSP enter into a dialogue directly with me?  How sad...or funny.

 

Perhaps we’ve struck a chord?  VSP knows that its systems and methodologies are NOT provider friendly—perhaps it is time they take action.   Certainly, if they wish to dialogue about the efficacy of their methodologies, I look forward to their comments on this blog and to an open dialogue with our members. My readers should know that an attempt was made to have such a dialogue, but it was rebuked by VSP/Marchon leadership.  This is unfortunate.  What are they afraid of?  As a rising tide lifts all ships, I believe we are on the same coin in our efforts to bolster the health of private practice optometry...perhaps we're on different sides of the coin...but the same coin nonetheless.  Frankly, my mission is to make my clients aware...and to attempt to ensure that the managed care purveyors don't get too greedy with my clients margins...and make procedural changes that will allow improved margins.

 

Well, as the saying goes, I don’t care what you say about us, just spell our name correctly…

that’s “C-L-E-I-N-M-A-N P-E-R-F-O-R-M-A-N-C-E P-A-R-T-N-E-R-S.”   And we’ll keep pounding the managed care drum regardless of the rumor mongering. 

Wiring for Tomorrow...Today!

According to our Cleinman Performance Partners’ December 2007 study, about 22% of our clients are operating with Electronic Medical Records.  Our guess is that that number is growing, and that that our clients represent a penetration level higher than that of the national average. 

 

In our opinion, going EMR isn’t a choice…but a necessity.  The reasons for implementing EMR are many.  They include:

 

- Improved access to records

- Improved risk management

- Improved financial controls

- Improved patient perceptions

- Improve overall effeciency

 

Benefits aside, the reality is that EMR will be forced upon you sooner or later.  For example:

 

On October 24th, The Centers for Medicare and Medicaid Services

announced an incentive for physicians to trade in their Rx pads and improve efficiency and safety by prescribing drugs on-line for Medicare patients.  The incentive payment, coming in 2009, is 2 percent of the patient’s total Medicare allowed charges. 

Why the push?  Simply stated, the required reductions in health care costs are largely associated with providing the system with better information.  In this particular case, according to the Institute of Medicine, there are 1.5 million preventable Adverse Drug Events (ADE) in the U.S.  These events, often caused by physicians’ sloppy hand-writing, result in $3.5 billion in preventable costs.  Not inconsequentially, with 80% of our population taking a prescription drug each week, the potential health impact of eliminating ADE is substantial.  The Journal of the AMA reports that each year there results 2.1 million injuries from ADE and over 100,000 deaths! 

 

The best way to reduce ADE is to force every Rx through a system that checks for potential interaction problems.  The only way to do that is through EMR and direct electronic links to pharmacies.

 

The investment, both hard and soft, of going EMR is substantial.  However, in our opinion, the return on your investment is high.  So, why wait?  With the current economy in a trough for some, now’s the time to invest.  And the slower pace of your practice will reduce the costs and impact of implementation.     

 

Adam Parker, OD runs a website that compares OD EMR technology including costs.  You can visit the site at  odemrs.com.