The state of optometry: 3 tips for shifting payment sources

Each week, AOA News is offering a new entry in a series based on "The State of the Optometric Profession: 2013." This report and summit from Optometry's Meeting® 2013 included analysis on key industry influencers. 

Up this week: the shifting sources of payment.

"The power of your pen has never meant more."

Payers and reimbursement are changing

Third-party reimbursement accounts continue to grow as revenue sources for optometrists.

Optometrists reported that two-thirds of revenue in 2011 came from third-party sources, according to the report. Only one-third of revenue came directly from patients.

The shift in revenue sources should continue with health care reform.

"The Affordable Care Act of 2010 is likely to precipitate further shifts in reimbursement for services received by ODs," according to the report. "The new federal law will expand the number of Americans with health insurance by mandating purchase to avoid penalty and by relaxing Medicaid eligibility requirements." The baby boomer increase in Medicare patients and the growth of accountable care organizations (ACOs) likely will play a part, too.

How to deal with changing revenue sources

The report made the following recommendations for optometrists:

  • Understand your contracts. "The power of your pen has never meant more," the report noted. "As new contracting arrangements are developed, it is imperative that ODs understand the terms of every contract being offered."
  • Understand the changing marketplace. Reform will bring both new payment models and downward pressure on vision and health plans. Knowing these changes and your own costs will help you find the right plans and negotiate to your benefit.
  • Recognition of opportunities. This relates to optometry's role as the primary source of eye care. The report recommended developing strong working relationships with providers, primary care physicians and organizations such as ACOs. The AOA's Rethink Eyecare program and tools for working with ACOs (member log-in required) can help.

Read Part 1: Our place in the market.

Read Part 2: 3 tips to increase demand and revenue.

Read Part 3: Expanding scope of practice.

September 13, 2013

comments powered by Disqus