Sometimes, there's only so much you can take before you realize you're in a race to the bottom. That point came for Dr. Joseph Day and the team at East Main Vision Clinic a few years ago.

The optometry practice, based in Puyallup, Wash., began considering a change about four years ago. But what, in the first place, forced East Main Vision Clinic into this race to the bottom? The practice, with one doctor and 17 team members, had over 8,000 patients, 45% of whom covered their appointments with managed care plans. Not only was managed care forcing East Main Vision Clinic to write off chunks of potential revenue, it was also affecting the practice's ability to provide excellent customer service.

So, two years ago, East Main Vision Clinic officially stopped accepting vision plans. Instead, the practice opted to work with patients to help them unlock their out-of-network benefits. However, that couldn't happen before some planning.

Planning network freedom: How East Main Vision Clinic prepared to go out-of-network

It took nine months for the East Main Vision Clinic team to game out how their practice would operate out-of-network. And in that time they did some very important work that laid the foundation for increased revenue per exam and practice growth.

It starts with realizing you're essentially starting a new practice. How you sell your services to patients, schedule appointments throughout the day and bill will all change. While the end result may be network freedom for your practice, you'll have to do some work to get there.

"The analogy I would tell patients is," Dr. Day noted in explaining how he told patients his practice had dropped managed care, "if you were a teacher and one year you had twenty students; you add a student every year. Over ten years it's not as manageable. It takes away some of the quality time. And that was the same thing we felt with our patients."

Before you get started...

There are some things you need to be sure of before you begin dropping one or more vision plans in order to achieve network freedom for your practice. Let's look at what it takes to successfully extricate your practice from managed care:

• You need the numbers: Knowing where your practice could be requires knowing where your practice stands now. You won't be able to build an effective strategy to drop vision plans without understanding core practice metrics. Which plans are your practice reaping the most profits from and which have fee schedules you could do without? What does your A/R look like—can your patients afford to pay the cost of the visit up front? Figure out where your practice stands now before building a plan for where you hope to take it.
• You need buy in from your team: Leaving one or more vision plans is intimidating. The East Main Vision Clinic team will be the first to tell you that. However, they realized that if you're not concerned then you don't care enough. You need to prepare staff for what's ahead and make sure you have total buy in from the team before moving forward.
• You need a plan: With buy in from your team and a thorough understanding of practice performance you can develop a strategy. Will you leave every plan at once or one at a time? How will your lab relationships change? How will you tell patients—if you tell them at all? What will change about your practice scripts? It took East Main Vision Clinic nine months to figure these things out, but once they did the preparation showed through increasing revenue per exam and a growing practice.

Building your plan

Your plan for dropping managed care will have several components: How many vision plans you'll leave and whether you'll do it piecemeal or all at once; how you'll tell patients you've dropped their vision plans; how you'll convert new, out-of-network patients; and more. You shouldn't do anything without having detailed answers for these questions.

Dropping vision plans

Network freedom is whatever it means for your practice. For some ECPs, that means not dealing with vision plans whatsoever. For others, that means dropping the one plan they feel isn't working for them. However you do it, be prepared for a process.

Typically vision plans require you to send notification in writing. Afterward, you'll have to wait a set period—often up to 90 days—in order to be officially out of the network. And you may have to follow up to be sure the process is moving along.

Developing new scripts and processes

The way your team communicates with patients will have to change to fit the new way you work with their vision plans. The same old scripts won't work anymore. Planning new scripts based on your practice brand, practice specialties and new approach to vision plans will help you mold your messaging moving forward.

"[Scripting] was very well planned before this all happened." Angie, the practice's front office lead and biller, explained. "There are always going to be people who are more comfortable speaking to a patient about things, but our biggest thing was stay positive. What we're doing is a good thing ... The planning and prepping before hand, and scripting and practicing, role playing, nine months before we did this—it was very important. The whole thing was very strategic."

Telling your patients

Whether you're updating current patients or trying to convert prospective out-of-network patients, communicating your new message can seem intimidating at first. However, with the right scripting and planning it becomes much easier.

"We explained to them what we were doing, why we're doing it; and explained to them that we could still bill their insurance. That was very helpful for them and for us." Angie explained. "Just be honest with our patients and let them know why and how we were still going to be able to serve them even better than before."

Most practices drill down to two options when deciding how to tell patients: Communicate it en masse via an email blast or calls, or tell each patient as their next appointment approaches or you connect with them next. Many of the practices we work with, including East Main Vision Clinic, choose to tell all patients at once. It helps maintain honest relationships with patients.

What happened after East Main Vision Clinic dropped managed care

All of the training, planning and scripting helped the East Main Vision Clinic team communicate their decision to drop managed care honestly and effectively. However, they still lost some patients. It's inevitable: Certain patients are going to want to stick with a provider who's in-network with their vision plans. East Main Vision Clinic was able to withstand this loss of patients for a couple of reasons.

First, they were able to collect more revenue patient—and collect it up front—as an out-of-network practice no longer beholden to fee schedules. Additionally, the practice was able to capture new patients they may not have accepted prior. As is the case for most practices that drop managed care, these two benefits helped mitigate any negative effects. And better yet, most patients who leave for in-network providers tend to come back when they realize they miss their old ECP and are willing to pay a little extra for better care.

"There was never any apology for no longer taking their insurance," Angie explained, "it was what we had to do to be able to take the very best care of our patients. It was never, never an apology, ever. It's only given us better opportunities to take care of our patients and prove to them that we're worth that."