Eye Center of Northern Colorado finds strength in size, service

FORT COLLINS – The parking lot at the Eye Center of Northern Colorado is nearly full on a recent Tuesday afternoon. Rows of cars stand as a testament to the center’s success less than a year after it opened at the corner of Riverside Avenue and Prospect Road. And inside, a waiting room full of patients suggests that the center is making strides toward becoming a truly regional eye-care facility.

The Eye Center is the only facility in the region that offers complete eye care, a full-service optical center, and an outpatient eye surgery center under one roof. The 24,000-square-foot center serves the population of Fort Collins, as well as patients from Windsor, Loveland, Cheyenne, Laramie and beyond. With seven full-time ophthalmologists, a staff of about 50 and a 24,000-square-foot facility equipped with 18 exam rooms and an operating room, the center handles upwards of 50,000 patients annually and hopes to accommodate more.

“Our goal is to establish ourselves as a full-service regional center and eventually open satellite offices to reach more patients in eastern, northern and even western parts of Colorado as well as in Wyoming and western Nebraska,´ said Carol Wittmer, Eye Center administrator.

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The center is the result of not one merger, but several.

Over a period of years, Drs., Russell Boehlke, Kent Crews, Gary Foster, Gerald Olsen, Matthew Robinson, William Shachtman, Randall Smith and William Stevens combined their practices. Similarly, Poudre Valley Optical merged with Jackson Optical to form Eye Center Optical, a full-service center staffed by board-certified opticians who work with the ophthalmologists to fit patients with glasses and contacts.

By pooling their resources, the doctors were able to relocate to a large, new building, and equip it with the latest ophthalmic technology.

A driving force leading these eye specialists to combine their practices was managed care, Wittmer said. Ophthalmologists have been hit hard by managed care on several fronts, and, seeking strength in numbers, many have merged their practices. In doing so, the doctors can provide more comprehensive service more efficiently and take advantage of economies of scale, Wittmer said.

Ophthalmologists have taken the deepest cuts of any group on reimbursements from managed-care companies, she said, adding that revenue losses can be attributed in part to increased competition with optometrists.

In several states including Colorado, optometrists are permitted to prescribe medications and make medical diagnoses. Unlike ophthalmologists, they are not board-certified physicians, and therefore their rates have traditionally been lower than ophthalmologists’ rates.

Lower rates appeal to dollar-conscious managed-care companies, so ophthalmologists, long viewed as over-compensated specialists, have taken a hit.

Ophthalmologists have also felt the effects of cuts in Medicare reimbursements. Medicare has set fees for ophthalmology practices since the early ’80s and continues to chip away at them. Thirty percent of outpatient surgeries covered by Medicare are cataract surgeries, Wittmer said. So, a logical place for the government program to cut expenditures is in reimbursement levels for those surgeries.

Doctors at the Eye Center of Northern Colorado are feeling the pinch on both ends. About one-third of eye-center patients belong to a managed-care plan, and that number would be larger, except that more than half of the center’s patients are covered by Medicare.

Gradual cuts in compensation have now reached proportions that demand action, said Dr. William Shachtman, an Eye Center ophthalmologist.

“Twenty-two years ago, when I started my solo practice, it was feasible for the doctor to do everything necessary to care for his patient’s eyes,” he said. “Over the last 20 years, there has been an irretrievable evolution that has made that more difficult – if not impossible.”

A few years into his practice, Shachtman realized that the workload and overhead of a solo effort were too great, and he merged his practice with that of Dr. Olsen. Gradually, other physicians joined their practice, but when they were denied a managed-care contract a few years back because they didn’t offer optical services under the same roof as their medical practice, they knew they would have to expand or continue to lose contracts.

“We were maxed out on space,” Shachtman said. “The decision to go into debt in order to expand the practice to include an optical center and surgical facility was a tough one, but it was the right one to make if we wanted to stay in business.”

Increasing space to provide full-service care and spreading risk among more doctors helped, but Shachtman says financial pressures still exists, and the time when some ophthalmologists simply turn their backs on managed-care contracts and return to fee-for-service may not be far off.

“We’ve had to change the way we practice and use more physician extenders to take on duties the doctors use to handle just to stay afloat,” he said. “We’ve had to consider dropping out of some contracts, because even at our current level of efficiency we’re running a ship that’s riding low in the water.”

Currently, Eye Center physicians negotiate discounted rates with insurers, but Wittmer expects that within the next year or two, they will be compelled to accept capitated contracts that limit the level of reimbursement to a certain dollar amount per patient.

Eye Center ophthalmologists have found an ally against the managed-care onslaught in Fort Collins IPA.

The eye doctors are members of the IPA and have worked closely with the association to improve their situation.

“We are trying to work within the system, and we think the best way to maintain fair reimbursement and access to patients is through working with the IPA,” Wittmer said. “We believe they will advocate fair treatment on the physicians’ behalf.

The IPA’s recent announcement that it had formed a management service organization in partnership with Poudre Valley Health System was good news for the Eye Center’s physicians.

“I think we’ll see fewer insurers covering larger portions of the population, so it would be good to see more self-funded groups avoiding that lack of competition by using management services here,” Wittmer said.”

As ophthalmologists, along with other specialists, face off against managed care, the field itself continues to see rapid technological advancement.

Shachtman compares ophthalmic advancements to those in the computer field. “We are in an incredibly technically oriented field experiencing constant change both in diagnostic and procedural techniques,” he said. “We chip away at current technology with small changes, and before we know it, within a few years we have a whole new technology.

“We’re doing things today we hadn’t even thought of five years ago and five years from now we’ll be doing even more amazing things, he said.”