a moral dilemma…

At some point in our lives, most of us have experienced an empty wallet.  Perhaps you’ve endured the stress of  splitting your last twenty dollars between gas for your car and the bare necessities to sustain your appetite until the next paycheck.  Or even worse, not having that twenty dollars and being left to wonder if the gas and food you already have is enough to get you through.  At times like these, the unknowns in the financial realm can be unnerving, if not down right scary. Luckily, for most people, those stressors don’t last long as maturity brings an understanding of how to be frugal where needed and perhaps provides the opportunity to increase your income – both welcomed milestones. Unfortunately though, some people exist in that state constantly.  Splitting that twenty dollars is their reality week after week, and year after year.

Imagine you are the parent of a middle schooler.  You’ve searched three or four years for the solution to your child’s struggles.  You have a smart kid who reads slow, cannot comprehend well, and performs dismally on tests.  A friend informs you of Vision Therapy and you decide to delve deeper.  You meet a Behavioral Optometrist for a full evaluation and discover they have the answer. Vision Therapy will not only remove all limitations current hindering your child, it will set them up for unbridled success. Every parent’s dream.  Just one problem though, it costs more than the twenty dollars you’re used to dealing with.  What do you do?

I faced this dilemma recently, but from the clinical side.  Had a patient with strabismus who had made great gains and was finally experiencing success in 7th grade, after years of failure.  With about one third of her VT program left to go, dad came to me and announced with hat in hand, they were out of money and had no choice but to discontinue. I think I was more disappointed than they were.

Any practice management consultant worth their salt would keep an emphasis on the bottom line and keep your focus on the revenue stream. Global fees and advance payment is the way to go since maintaining positive cash flow is key to any successful business.  But is Vision Therapy just a business? Is money, or lack thereof, a good enough reason to not change a person’s life for the better? What about the patients who cannot afford it?  What about the patients who have made all the sacrifices possible (like my patient) and still came up short.  How can you ask them to live with the idea that their child will suffer, and possibly not reach their full potential, all because their wallet wasn’t fat enough?

This certainly is a sticky topic, to which there may be no clear or universal solution.  Some practices barter with patients, some give scholarships, some even offer payment plans. Personally, I’ve worked in places that have succeeded and/or been burned by all three options. One doctor I know even has a parent clean their office in trade for the child’s VT.  Some practices ask “what can you afford?” and accept a reduced fee.  There is always Care Credit for those who qualify, and some people have an aunt or uncle with money tucked away willing to help them out.  I’ve always felt that money shouldn’t decide what’s best for any child.  Just like no insurance company should dictate what mode of treatment is in a patient’s best interest.  It’s just not right.

Plenty of patients pay full fee, which helps sustain our lives and keep the lights on.  But for those few who can’t, the ones that don’t meet the credit criteria and aren’t fortunate enough to have a relative with cash under the mattress, we should offer a solution. Morally, we have no choice. Even if it means mom and dad clean the office every week.

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Posted on May 12, 2013, in From My Perspective.... Bookmark the permalink. Leave a comment.

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