I Have a Question.

I have a question. If there is difference that makes no difference, is it still a difference?  Is there a real difference between a hammer with a red handle and a hammer with a blue handle?  Even if the blue-handled hammer is made by Sears and the other by Makita, are they somehow functionally different?  Is there a real difference in my optical care if the optometrist who sees me works in an office owned by an optometrist or one owned by an optician?  I suggest that these points are the same: a hammer is a hammer regardless of color or manufacturer and the care provided by an optometrist is the same regardless of who owns the space they are in.  

That is why I cannot understand the difference between an optometric office that is owned by an optician and one that is owned by an optometrist.  I ask this question because there is a very large corporation called VSP (Vision Service Plan) that says it sees a difference. I simply don’t understand what it is.

What I do understand is that VSP was started by a group of optometrists many years ago. This was before vision insurance was generally available. This group of optometrists wanted a way to bring more patients into their offices and began selling a program to local business to increase patient traffic.

They decided that part of this program was that they would exclude anyone that wasn’t at the party when it started. Initially that meant the only offices in the program were those owned by one of the optometrists who had started VSP.  As would happen when a good idea comes along, things got bigger than anyone expected and these few optometrists needed more offices to satisfy the growing demand. So they called up their optometrist friends and invited them to join.  

VSP continued as an OD only program for decades, growing year after year.  Finally, when they had exhausted the OD community and needed to bring in new blood and new services, VSP decided to invite ophthalmologists to join.  Ophthalmologists of course are MD’s and therefore sit at the top of the optical food chain.  Surgery, refractions and by now eyewear are all within the scope of an MD’s practice.

But VSP continued to require that a covered office had to be owned by an optometrist or ophthalmologists.  Any office that was owned by an optician would be excluded.  As VSP likes to say, “By Optometrists For Optometrists.” 

At the same time VSP was growing larger and larger, opticianry was dying a slow death. Between the large national chains and vision insurance, opticianry has been relegated to a supporting role.  In most states opticians are not even licensed (which is a true shock).

One may think that in today’s competitive world VSP would have dropped the ownership requirement.  In fact I think that it has. At least it did for itself when Cisco announced it would be building its own eye care clinic on its corporate headquarters campus. VSP could either allow Cisco’s employees to use their VSP benefits at this clinic or Cisco would switch to a competitive company. VSP, being no dummy, made the exception and hired an independent OD to work in Cisco’s new clinic at the Cisco corporate campus. Apparently VSP doesn’t see a difference in ownership, so long as a large enough contract is involved.   

Here is my quandary. I am a board certified optician and own my own optometric practice, which is not a franchisee or a chain.  As the owner and operator, I employ a fully licensed and trained optometrist to provide care for our patients.  Patients come to my office not only for dispensary needs but also to see our doctor. She provides them with a thorough exam and expert advice as to their eye care needs, including eyewear and contact lenses.  If necessary, we refer patients to an MD for further care.

Of importance is that the optometric care and services that patients receive in my optician-owned office from our optometrist are the same as they would receive in an optometrist-owned office.  We have the same equipment and the people providing the care have the same credentials as in an optometrist-owned office.  

Thus, we have a difference (ownership of the physical location) that in reality makes no difference.  In other words, an optometric office is the same regardless of who owns the fixtures.

So, why does VSP continue to draw a line?  Why does the title of the person that signed the lease make a difference?  Maybe someday I’ll understand.  In the mean time, if a benefits manager out there wants to help a small local business, feel free to tell VSP you won’t renew your contract if they won’t sign my office on as a panel provider.