Creating an In-House Vision Plan for My Patients Improved My Profitability

By dropping vision care plans and adopting a private pay in-house “club” for patients, Dr. Wesley has changed the scope of her practice, while still providing the highest quality care.

I opened my practice, Complete Eye Care of Medina, cold 15 years ago. I bought my own land and built my building about five years into the practice, and as we’ve continued to grow over the last 10 years, I started to notice a lot more issues with the one remaining vision care plan that we accepted. I had gradually cut back on the vision plans I had taken (only three total), cutting one out in 2011, and the second in 2015. It was around the beginning of COVID that I started to question the one remaining plan.

At the start of this year, I dropped that vision care plan, which comprised 35% of my patient base — it was my largest percentage of patients of any of my other vision plans previously taken. This wasn’t an easy decision, and I didn’t come to it quickly — it was thought about, researched, and analyzed for several years before eventually taking action. 

Over the last decade, I’ve worked with my leadership team to create a private, in-house vision care plan exclusive to our patients — the 20/20 Club. We’ve finetuned this system over the years into something that works for our practice and for our patients, all while maintaining the highest level of care. 

Should I Drop My Vision Care Plans?
The decision to drop vision care plans may not be the right one for your practice — now or in the future. In my case, there were a number of telltale signs that indicated that it was time to start considering other options. 

One of the things that pushed me to drop my first vision plan back in 2015 was the amount of administrative work that was involved with managing these plans — and yet there was no commensurate increase in revenue as a result. And while I was capturing revenue outside of what was reimbursed, when I saw the confusion from my patients about the details of their plan, and when I saw the confusion from my staff, I knew it was time to start rethinking how we did things. We received countless frustrated patient phone calls, which in turn frustrated my staff and me, and I didn’t want to let these plans dictate my credibility as a doctor and the integrity of my clinic. 

in-house vision plans
Since creating the 20/20 Club, Dr. Wesley’s staff has gotten comfortable talking to patients about everything regarding their care and payment options.

Ultimately, 10% of my patient base was enrolled in this first vision plan I dropped back in 2015, which wasn’t a huge number. When dropping my final vision care plan at the start of this year, the number of patients enrolled in that one was much larger, and I dove deep into tracking different metrics to see what this change would look like for our practice. I found that if we could keep four out of every 10 patients who had that plan and have them either pay out of pocket or use their major medical insurance (which we do still accept), then we would come out the same — if not ahead. 

After making the final decision, we started communicating with our patients to let them know that we’d not only be dropping their vision care plan, but we also educated them about our 20/20 Club. We packaged eye exams and benefits together at a price that would be attractive to people who still wanted to see us but were no longer in network with their insurance. Anytime we had patients visit us in the office, we would talk to them about the 20/20 Club, but everyone had plenty of warning with what we were doing and could make the decision to either keep seeing us or transition to a different provider who still accepted their vision care plan. 

Staffing Costs Affected My Decision
When I made the decision to drop my final vision care plan at the start of this year, one of the factors that heavily influenced my decision was staffing. Coming out of the pandemic, staffing — just like everywhere else — was difficult. My core staff, my leadership team, was hanging with me, but I was struggling to find my tertiary staff and to retain them. Wages have gone up so much, and to be able to have quality staff, I had to pay them adequately — but insurance companies weren’t upping their reimbursements. If anything, reimbursements have decreased in recent years. 

As a practitioner, you can’t continue to live on that model and deliver the same quality of care. In my office, patient care wasn’t differentiated based on what their vision care plan covered. Every single patient that came in for an eye exam received all of the attention, details, plan notes, technology, and the knowledge I have from my clinical research and consulting experience, as well as the products I have access to at early time points in release due to my work within the industry. When I broke it down, when a patient came in for an eye exam and we were able to capture a basic glasses sale, it wasn’t enough money to support the staffing I needed to deliver that exam and service. 

in-house vision plans
Dr. Wesley took the time to track important metrics in her practice before deciding to fully drop all of her accepted vision care plans.

It’s also important to note that I was profitable with my last remaining vision care plan, and I had to prepare myself and my team that at any point, we might have to go back and start accepting this vision care plan again if this didn’t go as planned. We thankfully have been able to meet all of our retention and financial goals, but these were all factors we had to consider when making these big decisions. 

Private Pay Helped Our Patients and Our Practice
Over the last seven years, my staff has gotten very comfortable talking to patients about our private pay plan, which has made all the difference when explaining it to patients. When patients enroll in our 20/20 Club and come into the office, we know exactly what they’re going to get in the exam, we know exactly what their benefits are, and we know exactly what their options are in the optical and the premium services they’re eligible for. There’s no submitting claims, there’s no worrying about a patient not paying enough, or having an outstanding balance. It’s all taken care of and our patients value that. 

We’ve also worked to educate our patients on what the 20/20 Club covers, providing them a side-by-side of what they were paying with their vision care plan and what they’re paying out of pocket. Not only do patients get an exam and a refraction, but they also get a percentage off in the optical, discounts on specific services, priority scheduling, an additional refraction during the year if they notice their vision has changed, extra testing when necessary, and more. We also do a great deal of dry eye treatments, and while those are paid for out of pocket, patients in the 20/20 Club can be “enhanced” members, which gives them additional benefits that go toward their dry eye treatments. Essentially, we’ve crafted this option to always give our 20/20 Club members the best in pricing and service compared to any other patient in the office, and they are continually educated on that point. 

in-house vision plans
At Complete Medina Eye Care, Dr. Wesley’s patients get a full side-by-side break down of their vision plan costs versus the costs of the 20/20 Club.

Making the Right Decisions for Your Practice
When talking to other practitioners about this model, I know it can be an emotionally charged decision to consider dropping all vision plans, but you shouldn’t let your emotions lead the way. Make sure that you’ve got practical information and you have a plan in place. My biggest piece of advice is to be fully prepared to understand all of the contingencies that may come. There are a lot of analytics, metrics, and numbers and understanding the average revenue — all of which can be stressful. Additionally, we have several specialty services that were already in place prior to dropping this plan, and those have continued to grow since the plan was dropped. I would advise having strong revenue streams that can stand on their own as you head into this potential change. Take a look at your patient numbers, understand how many of your patients participate in certain plans — and actually utilize those benefits, and make the right decision for your practice and your patients.

  • Gina Wesley, OD, MS, FAAO

    Dr. Wesley attended The Ohio State University, where she pursued concurrent degrees in both Clinical Optometry and Masters in Vision Science. Accolades for Dr. Wesley include: The Ohio State University College of Optometry Graduate of the Year and Fellowship within the American Academy of Optometry. She was also awarded Minnesota’s Young Optometrist of the Year for 2011 and the Early Professional Achievement Award in 2013 from Ohio State. She is a member of the Minnesota and American Optometric Associations. Dr. Wesley lectures, advises, conducts research, publishes on many aspects of the optometric industry, and has regular TV appearances discussing public health aspects of vision care. She enjoys all facets of primary care practice, including refractive surgery co-management, contact lenses, children and infant exams, vision therapy, orthokeratology, practice management, and advanced eyewear education.

Leave a Reply

Your email address will not be published. Required fields are marked *

Related Posts

Copyright © 2020 Jobson Medical Information LLC unless otherwise noted.
All rights reserved. Reproduction in whole or in part without permission is prohibited.