The sight of network freedom: Eye care providers embrace out-of-network
This past 4th of July, in cities across the country, fireworks complaints are skyrocketed.
There are plenty of theories, but we think we it figured out. More and more eye care providers are celebrating the freedom they feel out-of-network.
Eye care providers embrace network freedom
Increasingly, ECPs are dropping managed care and embracing network freedom. As this trend picks up momentum it makes sense to ask why. And, it can’t hurt to look into whether it’s right for your own office.
There are a few advantages to this sort of practice, Dr. Anthony Diecidue wrote in Review of Optometric Business. It should hardly be a surprise that freedom is among them. Additionally, ECPs also point to benefits including improved patient care and more revenue per patient.
Opening up a path to success
The freedom to operate your practice your way while providing better patient care and earning more per patient is a great recipe for practice success. And unlike other some simple recipes like Fourth of July jello shots, these ingredients make for a substantial return.
Eventually, direct patient care can pave the path to practice success. For example, we took a look at the average annual claimed revenue from out-of-network appointments for offices that submit at least one out-of-network claim per week. We found these practices were raking in on average an additional $97,000 from these patients each year.
No more forcing patients into pre-approved frames that don't quite work for them.
Freedom means flexibility for you and for your patients
Why are practices that leave managed care enjoying success to the tune of an additional $97,000 per year?
There are a variety of reasons. For instance, it offers ECPs the flexibility to substantially improve patients’ general experience and quality of care. From the first touchpoint through the payment process, many ECPs find each patient interaction easier after exiting managed care.
“I didn’t feel like were able to give our patients the best service that we could,” Dr. Kara Ramsey of EyeCare for You, explained. “It felt more like nickel and diming, the way we would sell. You get this photo or you could do this testing - that’s just the way the industry works.”
Now, Dr. Ramsey’s Apex, N.C. practice offers reasonably priced frame packages with transparent pricing listed on her website. When you’re not contracted with a specific insurer you simply have more to offer. You’re no longer required to provide certain frame brands. Nor do you have to cycle through patients faster than you can learn their names just to pay for your valuable time.
Instead, you can dedicate time to personalized treatments for patients, and focus as much on relationships as you do on reimbursements—or better yet even more!
“It’s just so confusing with the plans and trying to understand them,” Dr. Ramsey explained. “And then it ends up being the same price as what our packages are and we can offer a better quality product.”
Be the boss of your own billing cycle
As Dr. Ramsey noted, fee schedules and low reimbursement rates can hurt the quality of care. But that’s not all; they can also frustrate your billing cycle and complicate your accounts receivable.
“Just trying to get reimbursements back - it’s so confusing, you have to submit so many times,” she explained. “I remember specifically, we submitted for a contact lens fitting. They had a $25 co-pay, we were charging around $129 for them. I think we got $3 back. They sent us a check for $3. How can I continue to spend this amount of time, which people need, but still get these terrible reimbursements back?”
Having your staff submit the same claim over and over only to get $3 back is going to disrupt your billing cycle. And it’s going to squeeze your practice margins tighter at a time when most practices cannot afford to lose a dime.
It’s why so many ECPs feel restricted by reimbursements. The potential for practice growth is restrained when you’re not getting paid properly for your time.
It’s something Dr. Joseph Day, the owner of East Main Vision Clinic in Puyallup, Wash., can attest to, as well. In 2017, his practice wrote off nearly $700,000 in lost revenue. He noted was working so hard to provide the best care, only to write off 50% of what he was charging. It made him feel like a gerbil; racing on a wheel and unable to get off.
“We knew we were working very hard for very little revenue,” Dr. Day explained. “It just wasn’t the mode of practice we were going to continue. Unfortunately, it’s a race to the bottom.”
Out-of-network practices have the freedom to do thing their way.
Out-of-network and in control: Your practice, your way
We all want freedom in our professional lives. It opens up opportunities for ECPs and ensures patients receive the best care possible.
Leaving managed care presents ECPs with a chance to embrace this sort of control. After all, for some providers, the alternative certainly isn’t the freedom to run your business how you see fit. For example, Dr. Ramsey was facing the prospect of hiring more staff simply to work on claims and reimbursements.
“It’s not enjoyable to rush around and not see patients and fight for reimbursements or hire more people,” she pointed out, “when I could just spend more time with people and have a smaller, happier team.”
If you have to hire more employees to abide by a third-party’s set of rules, are you really in control of your own business? Or how about if you can't choose the lab you use?
And that freedom translates into results for ECPs and patients alike.
“On average, a physician can see about one-third or fewer the number of patients in a direct patient care practice vs. one that relies primarily on third-party payers,” Dr. Diecidue wrote. “This leaves more time for doctor-patient interaction and less time filling out forms and “chasing the money.”
Practice freedom funds practice growth
Of course, something stands out about that quote: If you’re seeing one-third or fewer patients how are you going to grow practice revenue?
ECPs who drop off insurers’ panels often end up earning more per patient. This can more than make up for any drop off in appointments.
For example, East Main Vision Clinic revenue per exam increased by around 20% in the years after leaving managed care. And for Dr. Ramsey, the result was similar.
“We used to be at $120 per patient encounter,” she wrote in Review of Optometric Business. “And now we are at $235 per patient encounter. We are a five-year-old cold-start practice, we don’t take insurance at all, and we continue to grow at 20% annually.”
These practices are making up for lost patients and more by substantially increasing revenue per patient. Plus, the additional time freed up for each appointment contributes to strong relationships and better care.
Sit back and relax: An out-of-network solution
The cost of freedom in this case? Going out-of-network means you lose access to vision insurers’ friendly portals for eligibility verification and claim submission. Instead, many providers who leave managed care have to spend significantly more time on these processes.
With that being the case, how do practices like East Main Vision Clinic and Eyecare for You generate increased revenue per patient while dealing with out-of-network verification and claim filing?
The answer is they don’t.
Instead, they rely on Anagram to help unlock patients’ out-of-network benefits. Anagram is a web application that allows ECPs to instantly verify out-of-network patients’ benefits and calculate service costs. And afterward, the same solution helps ECPs file out-of-network claims online.
That way out-of-network ECPs can focus on the positives of leaving managed care without having to worry about the negatives. And that’s something we like to call freedom.