Article Date: 4/1/2005

fix this practice
Succeeding Sans Managed Care
You can succeed without accepting vision insurance plans -- you just have to know how.
Richard S. Kattouf, O.D., D.O.S.

Q I'm an independent optometrist in a general mode of practice. I refuse to participate in any managed care plans and my income is in a steady decline. What should I do?

Dr. T.L. Hahn, via e-mail

A: Congratulations on your decision to not participate in managed care plans. However, the number of private-pay patients is diminishing throughout the country, so to achieve financial success, you must meet the following criteria:

Develop your own vision care programs. Throughout every community, law firms, grocery stores, accounting firms, small factories and numerous small businesses don't have vision care. Push out and make changes happen.

Specialize your practice. If you feel "rusty" in performing specialty care, hire a consultant to teach you the clinical and management components. (This must include follow-up support to assist you in implementing the technique.)

Maximize medical care. Optometrists are guilty of undercharging and underusing their therapeutic prescribing agents licensure. An optometric consultant can teach proper coding and change the mode of practice to mimic that of M.D.s' so you can reap the financial reward you deserve while rendering a higher level of professional care.

Branding. Products such as Coke and Kleenex have achieved true branding status. If you want to be free of managed care, you must develop a "community brand" of your own. Develop recognizable logos, court the corporate optometrist by developing a professional newsletter that keeps your "brand" in their face for multiple referrals. Schedule television and radio interviews to promote your "brand" of vision care, get on the speakers' boards of the American Diabetes Association, the American Heart Association and all service organizations.

If you're a generalist, then with or without managed care you'll struggle financially. The above criteria are key to financial freedom.

Being different pays off

A few years ago, Dr. Dollar (not his real name) hired me to grow his practice and increase his net. We added developmental vision, orthoptics and corneal reshaping therapy and in two years, his specialties alone were grossing $240,000 (his overall gross more than doubled and his net income increased by two and one half times in the same time).

Dr. Dollar retained me to appraise and broker his practice after we added the above-mentioned specialities. His dream was to sell it and open a specialty practice just outside his zone of restrictive covenant. He didn't want an optical. His total focus was on corneal reshaping vision therapy and medical optometry. Because he had no optical, he couldn't participate in any managed care program. He's thriving in his specialty practice and with no product inventory and higher fee for service, his net income is at 48%. Dr. Dollar is the apex of the real doctor image that we've created. His patient base indicates that his radius of draw is three times greater than the average general practice. Consumers drive much farther to receive specialty care from him now.

Change is good

The face of optometry is changing rapidly, yet many optometrists continue to resist change. Such resistance will lead to the value of their practices hitting rock bottom and their net income continuing to decline.

Dr. Kattouf is president and founder of two management and consulting companies.  For information, call (800) 745-EYES or e-mail him at The information in this column is based on actual consulting files.

Optometric Management, Issue: April 2005