MANAGED CARE UPDATE
Gone Fishin’ After This
Randolph Brooks, O.D., F.A.A.O.
An avid bass fisherman—I happen to be one—will tell you there’s more to success than you might think. As you get started, you must learn everything you can about the bass—their migrating habits and habitat—and plan for the best times to catch them. You must choose the best equipment, discover what bait works best, and even keep detailed records about the best fishing conditions. Above all, you need a lot of patience. One Internet site devoted to bass fishing perhaps put it best: “The more you understand the bass along with the many different circumstances and conditions you run across, the more successful you will be at catching them.”
A similar principle applies to managed care. The more you understand how it works and the more you plan, the more likely you are to succeed and grow your practice. Over the past six years, I’ve tried to emphasize the importance of carefully researching and selecting plans, keeping meticulous records, accurately coding claims and equipping your practice for success. And, these are some of the lessons I hope to leave you with in this last “Managed Care Update” column.
When we first started this column, the Clinton administration’s health-care reform plan failed, but managed care continued to grow as employers and patients looked to reduce health-care costs. Plans lured us to their panels with the promise of more patients. But once we took the bait, we found ourselves fishing for answers about how to succeed in an environment of discounted fees, complex rules and oceans of paperwork.
One of the biggest challenges we faced was in educating the medical community, managed-care plans and our patients that optometrists provide much more than so-called “routine” vision services. This remains a major challenge. We’ve also had to become more efficient to see more patients in less time without sacrificing the quality of care we provide. The use of optometric assistants and trained paraoptometrics became—and remains—critical. Finding and training qualified staff remains a top priority; don’t let a good employee be “the one that got away.”
Finally, we must remain selective about the plans themselves. So, we’ve learned to carefully evaluate each plan before joining, and drop those plans that no longer make sense for our practices. Once we joined those plans that do make sense, we’ve had to learn the intricacies of coding accurately.
While we got onto the right course, rough waters remain ahead. Some challenges:
- Increased level of optometric practice and a more uniform scope across state boundaries. This, perhaps, remains the single most important challenge that optometry faces. The patchwork of optometry laws among the states has created a massive amount of confusion as to what services optometrists can provide. As health plans continue to provide both regional and national coverage, a more uniform scope is essential to optometry’s ability to continue services in a managed-care environment.
- Participation in postoperative care. Proper coding and billing arrangements for the division of services when we provide comanagement under managed-care plans remains a continued challenge. As optometrists, sometimes find we cannot provide post-operative services under managed care.
- Providing more sophisticated diagnostic and treatment services. This is for such procedures as punctal plugs for dry eye, and new technologies such as the scanning laser ophthalmoscope.
Hopefully, I’ve left you with this important lesson: To succeed with managed care, you must learn everything you can, equip your practice for success and become more efficient.
I’ll continue to comment on important managed care and practice-management topics in future issues of Review of Optometry. I’ll also continue to respond to your e-mails. Unless, of course, I’m out fishing. u
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December 15, 2000