There’s a lot of misinformation out there RE: opting out, largely due to the megacorporations controlling the dialog. Independent ODs are often convinced that, even if they’re in an opt-out state, it’s not what’s best for them.
Truthfully, opting out is usually FAR more profitable than staying in-network, without sacrificing any of the benefits of accepting VCPs.
Before we dig any deeper, these are the states that currently have legislation granting independent optometrists the ability to opt-out of VCPs:
- New Jersey
- West Virginia
* = new addition; extra requirements
Don’t see your state on this list? Don’t feel too defeated. More states are rolling out similar legislation with each passing year, and there are still options to dramatically improve your optical profit margins even if you’re unable to opt-out:
- Five Non-Opt-Out & Non-Self-Pay Scenarios That You Can Use PLN (or another independent lab of your choice)
- Maximizing Your Use of PLN (or another independent lab of your choice): For Both Opt-Out AND Non-Opt-Out States
For doctors who are currently unable to opt-out, we recommend watching the videos above, then skipping to the next recommendation (10.2) that can be taken advantage of.
For doctors who can opt-out, this section digs deeper into what opting out entails, how it provides a massive advantage for doctors who choose to put the effort into taking advantage of it, and dispelling common misconceptions (such as worrying that your net number of patients will be reduced due to opting out).
Opting Out, Explained
Opting out is not the same thing as going out-of-network. The term “opting out” refers to opting out of the requirement to send your optical lab work to the VCP-owned lab. When you opt-out, you’re technically still a participating provider with that VCP and listed within their provider network.
Opting out protects a doctor’s ability to send lab work to whichever lab they prefer. Otherwise, doctors are forced by the VCP to send jobs to their affiliated lab for processing (where they also control pricing, leaving doctors with absolutely zero control). When executed correctly, equal-quality house brands can be used with significantly lower costs (which the VCP recognizes as equivalent) but receive the same level of reimbursement from the VCP. This results in significantly higher profit margins without any cost, performance, or quality difference to the patient.
“But If I Opt-Out, Won’t My Number of Patients Go Down?”
This is the #1 concern we hear when doctors consider opting out. This is the trend we see with member after member we’ve helped opt-out: your net number of patients absolutely should not go down and, simultaneously, the total profit for each patient should increase dramatically.
VCPs are increasingly competing on Main Street against the doctors they were established to help:
- Davis Vision is referring to Vision Works locations.
- VSP is referring to Vision Works locations as well.
- EyeMed is referring to all of the Luxottica locations.
- This trend continues to grow with each passing year.
Even assuming your net number of patients did decrease should you decide to opt-out (which shouldn’t be the case), if you implement the correct house brands in your practice, your increased profitability per patient will allow you to absorb that decrease in net patients while still increasing profit margins. You can reinvest those profits into your own marketing and advertising efforts to build your business’s brand, making your practice more valuable and insulated from industry consolidation.
Again, we strongly recommend watching this brief video (4m 37s) from one of our co-founders regarding opting out if this is something you’ve seriously considered in the past.
Who Will Opting Out Hurt and Who Will It Help?
We at Pivotal Group have never seen opting out financially damage someone except for VSP (with the very rare exception of strange, nuanced situations — such as the optical only ordering uncoated FT28s).
The only way that opting out could significantly hurt your practice is if you attempted to continue using branded lenses after opting out (rather than equal-quality house brands). If you’re not open to implementing equal-quality house brands in your optical, opting out will never make sense financially.
What Are My Next Steps If I Want To Opt-Out?
VCPs are notorious for giving doctors who request to opt-out the runaround until they become so confused and frustrated that they give up.
At Pivotal Group, we help our members opt-out for free. We guide you on which VCPs you might consider opting out from, help put together a new supply chain that’s optimized for at least 30% – 50% increased profit (once opted out), and help get you the right contracts to ensure you’re totally and officially opted out of that VCP’s requirement to send jobs to their lab (rather than “decoy” contracts, which are often what’s delivered when a doctor requests to opt-out on their own).
Even if opting out is the only reason you choose to join Pivotal Group’s 100% free membership, it will be a very worthwhile use of your time.
NOTE: Joining Pivotal Group does not obligate you to use any of our lab partners or inhibit your ability to do business with any of your existing vendors or group purchasing organizations.