As the owner of a large, two-location, multidoctor practice, I need to be on top of the trends in health care, the economy, and eye care specifically to ensure that my business stays profitable and that my practice is able to continue to offer high level care to patients. The trends that are undoubtedly going to affect private practice in the next 5 to 10 years can be grouped into four categories: consolidation, health care and insurance changes, technology, and marketing.
In recent years, eye care has seen a wave of interest from private equity firms and large retail chains looking to consolidate various types of practices to generate a return on their investment within 2 to 5 years. These purchasers claim that the industry is getting tougher to manage and less profitable for practitioners and that their centralized approach to systems management can help doctors be doctors and allow their practices to become more profitable. They typically target mature practices with owners looking for an exit strategy, although some set their sights on practices that are more involved in medical treatment and management or retail. I predict that an increasing number of clinicians will decide to exit their long-standing ownership roles for more clinically oriented positions.
There are options for maintaining a percentage of ownership in one’s practice in order to benefit from a potential “second bite” when the practice is inevitably resold after consolidation of the practice occurs and the overall value is higher. I think we’ll hear more about this type of option in the near future.
For those who are in the first 5 years of practice, like me, the math favors maintaining ownership independence. When I consider my salary plus bonus potential or practice earning as an owner over the next 30 years and the potential for buyout later versus a buyout today—and possible change in quality of life, I choose the ability to control my own destiny and practice. But for those entering their last 5 to 10 years of practice, consolidation will be a hard option to turn down.
HEALTH CARE AND INSURANCE CHANGES
The ways health care is delivered and paid for will undoubtedly continue to evolve as a result of political and economic influences. With the implementation of the 2010 Affordable Care Act, we saw an increase in the number of insured individuals across the spectrum, as well as increases in deductibles, copays, and premiums by private insurers.
Two major influences on private practice over the next 5 to 10 years will be the migration of practices and physicians into accountable care organizations (ACOs) and an increase in preferred provider listings through the monopolization of health care systems. What I mean by this is that health care insurance companies have decided that they want to own not only hospitals, but also various specialty outpatient clinics, health insurance options, and even vision and dental plans. These organizations are growing and competing and looking for ways to improve their overall bottom dollar. Private practice ODs can compete with these entities or become valued partners by doing the things we do best.
Over the next 10 years, optometry can play a larger role in providing systemic disease care, and thereby help ACOs reach their health efficiency data information goals. Achieving these efficiency scores dramatically alters what health care insurance entities and ACOs get paid. One way that we can help ACOs and insurers provide better care, while also expanding our scopes of practice and solidifying our value as independent private practice optometrists, is by expanding our roles in caring for and managing patients with hypertension, diabetes, and cholesterol issues. I predict that within the next 5 years 25% of states will have adjusted their laws to support these roles for optometry, and within 10 years all states will allow optometrists to initially manage these conditions and continue the care with the consultation of a primary care doctor.
The eye care profession is one of the most technologically advanced areas of health care, with ever-evolving technologies, measurements, and treatments to improve the overall health of our patients. The catchphrase often used to describe the latest tech in our profession is disruptive. This word is defined by Merriam-Webster as “causing or tending to cause disruption,” but recently it has also come to mean innovative or groundbreaking. Certainly, the most well-known disruptive technology came in the form of online refractions several years ago.
Disruptive technologies will no doubt reshape the way we practice. It is predicted that, within the next 5 years, we will see an uptick in companies offering online refractions and companies offering full examinations in a telehealth format. I am confident that our practices will remain insulated to some extent over the next 5 years, but, as did online contact lens sales, so too will automated refraction services become a norm in 10 years. In fact, as technology improves, I predict that optometrists could electronically check hundreds of refractions in about an hour each day and focus the rest of the day on medical care.
Social media will likely play a larger role in the way optometric practices market themselves in the next 10 years. Social media, like medicine, will continue to be individualized and experience-based. Ads and videos on social media sites will allow optometrists to speak directly to potential patients. Perhaps ODs will even have the ability to interview patients through these sites, to determine in only moments their candidacy for certain treatment options or the need for an examination.
Online reviews and word-of-mouth marketing will continue to be significant drivers of health care consumption, but it seems likely that individualized marketing efforts that grow out of web searches, GPS tracking, and facial recognition while shopping will become more influential than classic approaches.
AN OPPORTUNITY FOR THOSE WHO CHOOSE IT
Private practice is often misrepresented as a dying breed of practice. Some think the option is too expensive, that the competition is too fierce, or that it’s too difficult to be both a good doctor and a good businessperson. I choose to believe that these negative attitudes only open up a path for the real pioneers, and that these movers, shakers, and healers will completely revolutionize private practice in the next 5 years.