Tp

esIMnaswip

pcpbmgo

BJtA

1d

AOA SURVEY

The 2006 American Optometric Association Third-Party/Managed Care Survey

Bob Pieper

tmCCryieiT

HOmtmwontsiov

pdhrbHbM

he American Optometric Association (AOA) 2006Third-Party/Managed Care Survey documents in-creased participation by optometrists in third-party

lans including managed care programs. Moreover, optom-

trists are providing more services, and more types ofervices, under those managed care programs. The AOAnformation and Data Committee conducts Third-Party/

anaged Care surveys every 2 to 3 years to assess orga-ized optometry’s ongoing efforts to ensure coverage of eyend vision care services provided by optometrists. The latesturvey results show that optometry is much more engagedith managed care than ever before and that managed care

s beneficial to the economic health of the optometricractice.The survey found that about three fourths (76.5%) of the

atients visiting an optometric practice during 2005 wereovered by public or private insurance plans. Nearly half of theatients (45.6%) in optometric practices last year were coveredy public or private managed care plans, such as healthaintenance organizations (HMOs) or preferred provider or-

anizations (PPOs), with more than a quarter (30.9%) in publicr private fee-for-service plans. “Optometry’s increasing par-

ob Pieper is the editor of the Practice Strategies section of Optometry:ournal of the American Optometric Association. Opinions expressed arehose of the author and not necessarily those of the American Optometric

new American Optometric Associationurvey finds optometrists providingore care under insurance programs—

ncluding managed care plans. Third-arty coverage is increasing both pa-ient volume and revenues in optometricractices. Managed care plans are recog-izing optometrists as providers of aider range of services.

ssociation.

529-1839/06/$ -see front matter © 2006 American Optometric Association. Alloi:10.1016/j.optm.2006.09.001

icipation in third-party and managed care plans is resulting inore patients and greater patient revenues,” observed Richard. Edlow, O.D., chair of the AOA Information and Dataommittee. More than two thirds of optometrists (67.3%)

eported that increased participation in managed care hasielded higher patient volumes. More than half (51.2%) reportt has enhanced gross income. Moreover, nearly 2 of 5 optom-trists (38.3%) in the study reported their net incomes hadncreased as a result of participation in managed care plans (seeable 1).

ealth plan participationptometrists increased their participation in a variety ofanaged care and other medical/health plans during 2005,

he survey found. The survey found that the typical opto-etric practice now provides vision examinations or eye-ear under more than 20 different vision care plans. More-ver, the survey found that the typical optometric practiceow provides eye care under more medical and health planshan at any time in the past (see Table 2). (Some 16% of theurvey respondents reported that their practices were affil-ated with a retail optical company. Affiliation with a retailptical chain often involves participation in the chain’sision care plans.)Despite overall increased participation in third-party

lans, 1 in 3 optometrists (32.6%) still reported beingenied panel status access to patients for 1 or more medical/ealth or vision/optical plans during 2005. In addition, 3.2%eported that they were involuntarily dropped (deselected)y a medical/health or vision/optical plan during the year.owever, that number was lower than the 8% who reportedeing dropped from third-party plans in the 2003 AOAanaged Care Survey.

Table 1 Managed care patient volume and gross and netincome, 1993–2005

Category 1993 1997 1999 2001 2003 2005

Volume increased (%) 54.8 64.0 62.6 59.7 56.3 67.3Gross income

increased (%)40.7 42.1 41.7 40.4 39.0 51.2

Net income increased(%)

28.7 22.8 25.4 26.2 25.5 38.3

Asmiptpnw

rights reserved.

SOfvtvp

uf8iNftatcrsccs

DMetrd(ct

MNs

tpsarrb(bM

PNs2Sp

sa(rr2op

564 Practice Strategies

ervices providedptometrists who care for patients in HMOs and PPOs

urnish an ever-increasing list of covered optometric ser-ices, Dr. Edlow said. In addition to routine eye examina-ions, most optometrists (85.9%) provide contact lens ser-ices and dispense eyewear (76.4%) to managed careatients.More optometrists are reporting that they have authority

nder managed care to refer patients directly to specialistsor medical or surgical care of systemic conditions. Some4.2% reported they could make direct referrals to special-sts in the most recent survey, up from 75.8% in 1993.early half (49.4%) reported that they serve as gatekeepers

or all eye care under their managed care plans. More thanhree quarters of the responding ODs (78.3%) in states thatllow treatment of glaucoma by optometrists reported thathey provide treatment to glaucoma patients under managedare plans. Nearly two thirds of survey respondents (63.5%)eported that they comanage refractive surgery patients inome fashion, and 69.9% reported that they are involved inomanagement of cataract surgical care patients in managedare programs. One in 5 ODs (20.8%) furnish vision therapyervices under managed care plans (see Table 3).

iscountingore than half (54.0%) of all patients received discounts for

ye examinations. The average discount for eye examina-ions increased slightly to 26.6%. More patients (46.3%) areeceiving fee discounts for frames and lenses, with thoseiscounts now averaging 27.8%. Three of 10 patients30.0%) now receive their contact lens services at a dis-ount, with those discounts now averaging 17.9%, practi-ioners reported (see Table 4).

edicare and Medicaid participationearly all of the optometrists who responded to the

urvey (94.7%) provide care for Medicare patients. Of

Table 2 OD Participation in Health Plans, 2005

CategoryMedical/healthmean no. plans

Vision/opticalmean no. plans

HMO 7.3 5.4Preferred provider org. 6.7 5.2Other plans 9.3 10.5

Table 3 Percentage of optometric services furnished to mana

Services furnished 1993 1997

Eyewear dispensing 81.3 79.3Direct referral to specialists 75.8 78.1Treatment of glaucoma* n/a n/aVision therapy 18.6 12.0Gatekeeper for all eye care 37.7 31.8Contact lens services 84.3 85.5Comanage refractive surgery n/a n/aComanage cataract surgery n/a n/a

n/a � not available.* If applicable in respondent’s state.

hose, the majority (89.8%) are Medicare-participatinghysicians who agree to accept Medicare payment as-ignment in all cases. However, some (5.2%) acceptssignment on a case-by-case basis, and others (5.0%)eport they never accept Medicare assignment. Three of 5esponding optometrists (63.3%) provide Medicaid-eligi-le patients with eye examinations. More than half55.9%) reported providing eyeglasses to those coveredy Medicaid, whereas 58.1% provide medical eye care toedicaid patients.

ractice characteristicsearly half (49.7%) of the optometrists responding to the

urvey said they practice in a suburban area, with another3.1% in urban areas, and the final 27.2% in rural locations.urvey respondents estimated the population bases for theirractices as shown in Table 5.Almost a quarter (23.6%) of the respondents in this year’s

urvey were women. Respondents have been in practice anverage of 18.2 years. Most responding optometrists88.3%) described themselves as self-employed with theemaining 11.7% in the employ of others. Most of theesponding optometrists (43.3%) were in solo practice or in-member partnerships or groups (20.5%). The percentagef responding ODs in solo practice was 3.9 percentageoints lower than the 47.2% found in the 2004 AOA Third-arty/Managed Care Survey.

Table 4 Examination, frame/lens and contact lens servicediscounts, 1993–2005

Patients withdiscounts 1993 1997 1999 2001 2003 2005

Examinations 32.1 37.9 48.4 47.3 51.3 54.0Frames/lenses 24.9 31.4 39.9 38.2 41.3 46.3Contact

lenses17.1 15.1 22.7 19.9 23.2 30.0

Percent averagediscount

Examinations 19.3 21.5 22.7 23.0 24.5 26.6Frames/lenses 23.6 25.9 25.5 24.7 25.7 27.8Contact

lenses18.3 15.4 18.3 14.7 15.7 17.9

re patients, 1993-2005

1999 2001 2003 2005

87.2 82.1 81.6 76.484.4 85.5 85.0 84.265.9 68.5 71.3 78.315.4 17.1 19.2 20.835.3 39.6 40.7 49.489.3 87.6 85.7 85.960.5 66.4 66.5 63.566.5 68.9 68.8 69.9

P

ged ca

dacfo(

Practice Strategies 565

The 2006 AOA Third-Party/Managed Care Survey israwn from a stratified sample of 4,000 AOA membersnd was conducted in April 2006 to reflect practiceonditions in 2005. For more information, see Highlightsrom the 2006 AOA Third-Party/Managed Care Surveyn the Information and Data page of the AOA Web site

Table 5 OD-estimated size of practice draw area, 2005

Size of draw area Percent ODs

Less than 25,000 18.925,000–100,000 37.8100,001–250,000 24.2More than 250,000 19.1

www.aoa.org).