optoblog.com

It is interesting that some private practice docs can’t seem to tell the difference between Kleenex and Puffs- I mean 1-800Contacts and other retailers of soft contact lenses. This article was written in October 2006, but certain items are worth repeating in 2008:

…optometrist Wiley Curtis, of Arlington, Texas, represented the AOA’s position, tempered by his own experience. “Over the course of this year, I have tracked 18 contact lens orders placed with 1-800 Contacts,” he says. “I am saddened to report that the first 17 orders were all filled by the company without any verification contact with my office, in apparent violation of the FCLCA.”

After the hearing, 1-800 Contacts looked into this accusation. “Our records from the last 12 months to this doctor’s office show 192 phone calls, three faxes and eight total hours on the phone with his staff,” says Kevin McCallum, 1-800 Contacts’ senior vice president of marketing and operations. “We received 117 orders from this doctor’s patients. All 117 orders received a successful verification request.”

This actually happened while the congress was hearing testimony about the FCLCA. Apparent AOA stooge, Dr. Curtis, alleged that 1800Contacts broke the law, so the 1-800Contacts team stayed up all night to research, and the next day at the hearings they provided evidence to the contrary.

I only first heard about this event when I listened to Jonathan C. Coon, CEO of 1-800 CONTACTS, speak to all the Wal-Mart Optometrists on April 27th at our all-travel-and-expenses-paid meeting in Nashville, TN. He had given pretty much the same speech on a DVD sent to all Wal-Mart vision centers earlier this year after the announcement of Wal-Mart and 1-800’s alliance. Here is a significant clip. Please watch.

I wish everyone could see the entire half hour speech, but the above video clip combined with the aove AOA-is-stupid story show why optometrists blindly dislike 1-800 Contacts. I hated 1-800 blindly because that is what the organized optometrist establishment taught me to do. After learning the facts, there is no reason for any optometrist to dislike 1-800, unless that optometrist also hates all their other competitors. I don’t because I’m friends with most of the other optometrists in town and 1-800 is making my life easier now.

For these reasons, I would like to officially and publicly retract the negative comments I made about 1-800 Contacts in this previous post. It was a knee jerk response conditioned by organized optometry, for which I am ashamed.

I admire Mr. Coon and his core team for everything they’ve done to become a very successful business. I think that private practice optometrists, like the above Dr. Curtis, are just jealous. Incidentally, Mr. Coon in his speech said that after presenting the facts about Dr. Curtis’s patient orders to 1-800 Contacts, 1-800 asked him and the AOA to stop making wrongful [slanderous, defaming] accusations or privide their evidence. He has yet to bring evidence or retract his statements.

Don’t be blinded, everybody. Go to your nearest Wal-Mart Vision Center and ask to watch the 1-800 Contacts DVD.

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So I found out that I didn’t have to apply with 1800’s referral network, ProNet, for my practice located inside a Wal-Mart vision center because I’m already in the system because of the alliance between 1800Contacts and Wal-Mart. You won’t believe how awesome this is. First of all, no more telephone calls. It’s all fax now. Huge time saver for the opticians who need to keep busy helping my patients get checked out so they can pay my every-day-low-price exam fee.

And then today, 1800Contacts had a customer on the phone whose prescription expired, so they called my Wal-Mart vision center, and the customer was patched through to talk to an optician. The patient scheduled an exam for Saturday. How sweet is that?!!

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So when I first announced that I was going to shift the focus of this blog to be pro Wal-Mart and tell people about my experiences in this setting (which I will someday get around to), I was flooded with spiteful comments. The first thing one commenter, “John Smith,” did was to try and dig up dirt on me and report me to the Utah optometric board.

On my VisionHealth EyeCare practice website, he saw that I linked to Wal-Mart.com’s contact lens sales section. He (mistakenly) believes this to be in violation of Utah law and (if he can be believed) filed a complaint to the board.

Let me quote the allegation that “John Smith” made:

In the state of Utah, optometrists are strictly prohibited from marketing or advertising for the mercantile establishment. This includes websites.

Now, I don’t know how they do things in Virginia, Ru-I mean “John Smith,” but here in Utah we have no such rule. I could see such crazy rules coming out of communist states like California or even psychotic-optometry-rule states like Nevada, but not in a freedom-loving, gun-and-God-clinging state.

Another commenter decided to sell us on 1800optometrist, which got me to thinking that hey, I’m providing those links to Wal-Mart.com for free. Why not annoy R-I mean “John Smith” even more and potentially make some cash at the same time by linking to 1800 Contacts!?!

It was simple. I found out about it while reading at 1800’s website, registered, and voila’, I have cool links on my practice website for patients to conveniently order contacts and save money while doing it. If they buy stuff, then 1800’s ad manager sends me a check to say thanks for the referral. While I was browsing 1800contacts, I also registered for ProNet so they will send me referrals when someone’s Rx expires.

Here’s what the ads look like (and if you are by chance a non-optometrist reading this article, please click on this link the next time you need to reorder contacts):

So, if you are like “John Smith” and think that I am caught in a Link Gate scandal, then here is the website for Utah DOPL’s complaint department. But believe me that I’ve searched all the documents found online with the Utah DOPL, and John Doe’s alleged Utah rule is made up out of the same magical stuff that new grads grab onto if they want to start their own solo private practice: wishful thinking.

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Those of you new grads scampering to find a job might want to check out the Wal-Mart located in Brigham City, UT. They’ve only been having fill-in doctors lately, so I’ve heard they are looking for someone permanent who could stick around and grow the practice.

Contact the Vision Center manager at the Brigham City Wal-mart, and she could put you in touch with the District manager who makes all the decisions.

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The Independent Urologist has an excellent post about surviving your first 1-2 years of private practice, should you be insane enough to try. I think he makes a great point, you need much more money in working capitol than capitol equipment. That was part of my problem, I ran out of money, had to get a job 4 days a week outside the practice just to pay the bills, and that left much less time available to grow my own practice.

My financing company wouldn’t give me very much money as working capitol. They capped it as a percentage of the total loan. You’ll note that a urologist has less equipment costs than an optometrist with an optical. If I were to do it again, I would find out all the companies like Altair that give you frames on consignment. I also wouldn’t buy fancy digital phoropters and Officemate Exam Writer. I would go cheap as possible on everything- bootstrap. That’s the only way you’ll survive until the break even point.

And I wouldn’t hire a practice consultant that takes $13,000 of your borrowed money either. Practice consultants will make you think that if you build it, they will come. It’s pretty expensive flavor-aid to be drinking. You’ll get all the information you need from internet searches and free resources like the Management and Business Academy. Also, a good buying group like C&E Vision has excellent resources to help you see what numbers you should be putting up.

By the way, did you know Wal-Mart docs have the Optometric Business Academy? I hope that you didn’t really think that vendors (like Ciba, Essilor, Topcon, and Transitions) only look out for private practice docs.

Also the IU notes that while he now has a positive cash flow, he estimates that he has lost ~$200,000 in income by starting up his own practice. If you start off practicing in Wal-Mart, then you have income from the get-go. I know of doctors working for other optometrists for ~$50-60K pre tax salary for a few years with the hope of buying into the practice. Even if they are allowed to eventually buy in, what about all the income lost? They could have been making $120K+ pre tax net while working with Wal-Mart.

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Okay, so there has been lots of feedback about the new direction I’m taking. First, when I wrote that I was going to be writing future posts “demonizing private practice,” what I was trying to say is that I used to idolize it, but now I have removed solo private practice from a pedestal that it doesn’t deserve. I’ve posted before that I think that this mode of practice is endangered. Large group practice will probably make it since they can offer specialty care not found in commercial, but you can’t just plop a few doctors into the same town all at once, so new group practices will rise up from the ashes of solo practices trying to survive by evolving, and new solo private practice will cease to emerge.

So the message to optometry students is that private practice optometry isn’t the pinnacle of our profession- it’s just another way of practicing. Choose your mode of practice based on your goals. Do you really want to be a “savvy businessperson” with all the headaches of running your own practice? If so, get out of optometry and start a business where you can make some real money since optometrists have a cap on their income potential since we can only see so many patients a day.

Anyway, most of the criticism to my recent post has been words to the effect of “your exam fees are so low it disgraces the profession.” Um…why are your exam fees so high? Oh yeah, your overhead is ridiculous. Let’s say your solo private practice pretax net is $118,800. That means your practice had to gross around $396,000 (a generous 30% net-to-gross ratio), $475,200 (25%), or $594,000 (at 20%).

The Wal-Mart doctor just has to gross $132,000 or $148,500, depending if the lease is 10 or 20 percent. No problem. Oh, and the Wal-Mart doctor can gross $11,000 a month just working 4 days a week. And he doesn’t have to kill himself explaining to every single person that enters his practice why his glasses cost so much and why his exam fees are so high.

So, your ridiculously high exam fee, caused by ridiculously high overhead, is part of the problem with rising health care costs in this country while Wal-Mart optometry is helping people to save money and live better.

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Since it is an election year, everyone has been bringing up the high cost of health care. The liberal democrats, Clinton and Obama, are promising reforms which would inevitably fail and/or turn our country into a socialist/communist state. Then I read an article in Rush Limbaugh’s April 2008 newsletter entitled, “Health Care Diagnostics: Why Doesn’t Anyone Talk About Lower Costs?”

Rush brings up an ABC John Stossel report about Dr. Robert Berry who stopped accepting insurance, including Medicare and Medicaid. His office visits are as low as $40, yet his salary is typical of a primary care physician.

Well, I wish Rush would have also shared what hundreds of Wal-Mart optometrists do. We deliver eyecare for a fraction of the private practice fees. Private eyecare practices in my market of Cache Valley, Utah offer routine eye exams from $70-125. My Wal-Mart practice offers the same routine eye exam for $45-55.

Insurance companies have created this health care conundrum. Employers or individuals who buy into vision insurance are really getting scammed. My $45 exam is about what most vision insurances pay doctors anyway. So…why give any money to the middle man? And then there are a couple snobby vision plans that only let private practice doctors on their panels. The beneficiaries of these plans get doubly ripped off because sure, the exam might be covered, but when they want premium coatings or progressive lenses, they get stuck paying the balance over the basic lens. At private practice opticals, this balance can be more than the total price they might pay at Wal-Mart. So again, what good is paying money into this vision plan?

Buying vision insurance makes about as much sense as buying oil change insurance or hair cut insurance. The only people that win are the insurance companies, unless you got the coverage at no cost to you and can use your plan at Wal-Mart so that even if you do have to pay over a balance, at least you will get the best price.

In my former private practice my wholesale cost for lenses were just barely under the retail price of Wal-Mart lenses. As a doctor concerned about the welfare of my patients, I can’t continue to sell overly expensive products when Wal-Mart sells the equivalent premium products 30-50% less than what I could in my own optical shop.

So Rush, please add to your list of professionals doing what they can to control rising health care costs the excellent professionals at Wal-Mart Vision Centers.

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CooperVision’s newest lens, the Biofinity, is now available at Wal-Mart. They’re selling it for something like $49.87 (it’s a one month lens).
I guess my private practice is no longer the exclusive provider of Biofinity in the Cache Valley area.

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I just was contacted by Review of Optometry. Apparently, they didn’t want any comment from me, but they were hoping that I knew the name of an optometrist in Utah that is vocal about 1-800 type stuff (apparently not me, just any other Utah O.D.). So, Utah ODs if you want to comment on the whole 1800/Wal-Mart story, let me know so that l can pass on your information to Review of Optometry.

But I thought that if by some miracle R.Opt. makes a link to my site, I’d better update more about what I’ve discussed with others about the whole partnership with 1-800 and Wal-Mart since my original post. Of course, this has been a hot topic at Wal-MartOD.com and at other sites like the highly secretive society of ODwire (which I don’t read anymore because, hey, it’s a secret).

So in my last post, you read the e-mail that I immediately sent back to Wal-Mart HQ the moment I heard about the news. The next day I went to work, and to my utter amazement, my vision center manager thought the partnership was pretty cool. Why? Apparently, Wal-Mart currently buys their contacts directly from each company, so this partnership is supposed to make the process faster for the patient. It is also supposed to help lower costs since 1-800 and Wal-Mart can combine their buying power to ask for a deeper discount from the individual contact lens manufacturers.

Then the district manager called and expressed the same opinions, but also added that Wal-Mart would save money by transferring the expensive maintaining of walmart.com’s online contact lens sales to 1-800’s website. She also said that 1800 has a huge brand recognition. If you walk-up to someone on the street and ask them where one could go to buy contacts, something like 40% will say 1-800-Contacts.

So this tells me that Wal-Mart is using 1-800 as their sort of high recognition buying group. In my practice, I order most lenses through a buying group like Lensco, but then some lenses I just purchase through the manufacturer, and hard lenses I get through Valley Contax ( I know Lensco does hard lenses also, but Valley has the I-Kone and my alumni’s C.A.D. design.)

So is it a sin for Wal-Mart to get itself a buying group? Of course not, unless that buying group happens to belong to the Spawn of Satan. Okay, all kidding aside, I wrote the following follow-up e-mail to Dr. Patel:

…I would gladly be willing to recant anything I’ve said about 1800 CONTACTS if they would join the Vision Council of America, prominently display the “Check Yearly. See Clearly.” logo (checkyearly.com), erase from their site any directions for consumers to subvert doctor recommended expiration dates, and withdraw their lobbying efforts for government mandates on 2-year expiration dates.

You should include that as part of your bargain with them.

So, just because 1800 sells contacts online doesn’t make them my enemy. It’s their coaching of consumers to badger doctors about prescription expiration dates and worse, their lobbying for laws to mandate to doctors a minimum 2-year expiration date (which succeeded into become a Utah state law).

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