I’ve heard this imbecile raving on ODwire. I would agree…he (Stephen Nelson) probably is the most hated OD in America.

I am exploring contracting with a local Walmart. Dave, your cynicism runs deep and wit runs long for sure. I understand most of your points.

I think Brian is right about having the scope of practice that would be what is considered a “thorough” exam. I think you can have your cake and eat it too. Prove all the private OD’s wrong. Practice to the highest extent of your training and state law, and reap the financial benefits while doing what’s best for the patients (thorough eye care with advanced technological benefits). Brian, we need to talk. One thing I disagree with though is the S-code. You can’t charge an S-code to the patient then turn around and file it to insurance. That is fraud. The S-code is designed to be charged to patients for ‘routine’ services (ie. refractive Dx only) who do not have or choose not to use their routine vision insurance.

Currently in the practice I am in, we charge $150 for a Comp NP, $60 for a refraction, and are Contact evaluations start at $59 (usually discounted 15% due to insurance or prompt pay if pt is paying out of pocket). Since I came on, we have added retinal photography (avg med ins reimbursment is $55) and GDx which has a screening mode on it. Last month we made $3.5K in cash screening fees and $4K on insurance billings for the testing mode. We have Humphrey’s VF, a scout topographer for Wave lenses, fitting Synergeyes hybrid lenses, have an Ophthonix WaveFront Analyzer for correcting higher order abberations and am next going to convince the owner he should had a divice that measures macular pigment density (another great service to patients that brings in money on the screening and Nutritional products to decrease risks for developing AMD).

How many of these services do you think I would be able to offer my patients at Wal-mart? That is a serious question. I know Wal-mart’s marketing strategy has been price so is it realistic to expect to offer the highest quality services and technology (which makes their lives better——clear, comfortable vision makes people more productive and nicer when that is not the kind of patients that they have traditionally attracted?

How do I find out more about this OBA? (are they related to Obi Wan Kenobe?)

My challenge for all OD’s reading this blog is to have a civil conversation about what is realistic and acheivable without personal attacks.

Thanks

[I posted a link to them in another post, but you have to have a user name and password to access their site. A really useful thing they have is the "Key Metrics of Optometric Practice at Wal-Mart and Sam's Club" which I will mirror here until someone's legal department sends a cease and desist letter, but I do so not having seen or read anywhere that this information is confidential.
If you are thinking about signing a Wal-Mart contract, I would ask the District Manager for a way to log into this website so that you can see all the great resources they have. -DJL]

[No, but that would be a good question to ask any new grad thinking of opening up their own solo private practice...]

Still, with a net to gross difference that high, you can extrapolate the true compensation per patient by caluclating the average revenue per patient. At an average private practice this might be around $250. This equates to around $75-85 per patient that they NET. Using the same math backwards, at a Wal-Mart, you will need to gross $100-113 per patient to take in the same amount of money per patient.

BUT at a private practice, and again I speak from experience, you will deal with a lot more hassle with the optical, patients coming for adjustments, complaints, training and re-training staff how to fit and adjust and repair glasses. AND if you own your own building heaven help you if your air conditioner dies or equipment or something else in your office needs repair. It would be difficult to calculate the actual time spent on each patient, but I would argue it would indeed be less, even with the same quality of care, at Wal-Mart. Not because the exam is any less thorough or the doctor doesn’t chat with patients as much, but because the doctor is involved in managing ALL facets of private practice.

As far as exam fees go… it would be slightly difficult to acheive $100/patient on exam fees only. But you could approach that level by billing using an S code or using a cash/prompt pay discount (up to 25% is widely acceptable and legal with insurance companies), and then billing the insurances a rate that may be that much higher. Also, adding screening retinal photography can increase that revenue by $15-20 per patient (if you charge $25-$35 for the photos, and a good portion of patients elect that though good patient education. – again I’ve seen this done successfully by a corporate doc who averaged $18/pt in increased revenues) I have a plan at my corporate practice where I expect a $95 average revenue per patient.

Now with all of that said…. you can’t discard market economics. Doctors discussing and changing exam fees as a group is illegal, and a Wal-Mart doctor would hurt severely for suddenly and drastically increasing exam fees. Again the OBA reported an average 7% increase/patient in their doctors offices from 05-06. In my area, corporate doctors charge around $70. I’m further out in the country and feel that I offer a very thorough exam. Noone is complaining about my fees, so I plan to increase mine to be higher than that. Next year, if no-one complains, I will increase again. One ophthalmologist told me once… if people aren’t walking away, and noone’s complaining, and you’re getting paid your exam fee, you’re not charging enough. I think this applies next to a corporate entity too, and it’s a good rule of market economics.

Just my two cents… take them for what their worth, if it helps. but these are actual facts that I’ve seen in other people’s practices, and reported by the walmart oba.

[Wow, Brian, this is the most thought out comment I've seen on my site. You have won the Optoblog Comment of the Quarter Award, 2Q08. Feel free to print yourself out a certificate of achievement. My only comment is that I once heard an exam fee/billing guru say at GWCO that a 20% prompt pay discount was bordering on getting you into trouble, so I just had a 10% in my private practice because that is what many physician's offices in my area do.
So, how does everyone feel about changing my Wal-Mart exam fees to $Y where Y=X*Z, where X is the full fee fee (what is billed to insurance), Z is the prompt pay discount fraction, and Y is the actual fee my cash paying customers pay.?]

(nice going)

[Umm...Steven, there is something called "Comment Moderation." I don't check my site every second of every day because I'm too busy seeing patients or having a family life.]

I guess when someone posts a good thought you just outright delete it…

Interesting.

Steve

Dr. Nelson’s comments are well-intentioned and are very useful. I suggest you listen to them rather than just discounting in a confrontational manner EVERYTHING that anyone posts on this “blog.”