Viewpoint

Stop dreaming: self-pay can be realistic income

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

Recently much has been written about concierge medicine, especially in internal and family medicine. The idea is that you charge patients an annual or monthly fee to be their doctor, give a really thorough annual exam (leaving no cavities unexplored), and be available to spend quality time with them year-round for anything they need medically. The bonus? Close-to-complete avoidance of insurance and government red tape. Just treating patients, giving good advice and care — the sort of thing perhaps you envisioned doing long ago.

I’ve thought about what a great life that must be. That could never happen with us eye docs. With our dependence on Medicare and other payers, the last thing an ophthalmologist could offer is a practice built on private pay alone. Or am I wrong?

Although they are in the minority, a few ophthalmologists do practice completely as private pay, particularly refractive and oculoplastic specialists. For most of us, however, that wouldn’t work, especially those of us in rural areas.

But does a practice have to go self-pay all the way? Must it be all or nothing? I don’t think so.

You can do insurance work and a substantial amount of self-pay. Besides ophthalmology being the all-time greatest specialty in medicine, it turns out we also do have a lot of self-pay opportunities. As I mentioned, there is a huge field of cosmetic oculoplastics, from neurotoxins and fillers to surgery. The refractive field is ripe for resurgence, from LASIK and PRK to the new presbyopic treatments on the horizon. Despite the recent downturn, LASIK is still the most widely performed elective surgical procedure. Add to that the large potential for growth in refractive cataract surgical options, including premium IOLs and femtosecond laser technology.

But it doesn’t stop there. The dry eye segment growth is just being tapped. With newer diagnostic and treatment applications, I think a lot of you would be surprised at how many patients would gladly pay out of pocket to get relief. I’ve written before about integrating audiology into your practice. Don’t forget about contact lenses and optical dispensaries. And when all else is said and done (what does that phrase mean, anyway?), remember that we are still allowed to charge a reasonable fee, which we deem appropriate for refractions.

For many of us, “self-pay” could be at least a substantial antidote to the future of reimbursed health care. See the interview with Robert Grant on page 39 for an interesting take on this. As our patients (let alone us) age, the desire grows to live better and live longer. The demand for solutions to enable people to invest in themselves and their health and wellness will only increase.

This isn’t just about making more money. It’s about running my practice my way, spending my time my way, treating my patients the best I can. OM