“ The total startup costs for a new Pearle Vision EyeCare Center range from $ 399,439 to $ 603,904 ”. 9
“ The most common estimates for startup costs for ophthalmologists are between $ 200,000 to $ 300,000 , with a $ 100,000 line of credit to cover operating expenses after opening , as it typically takes three to six months to break even ”. 10
Summary
The start-up cost of a mobile eye clinic is comparable to the average brick-andmortar clinic , however there is significant variability and discrepancy in the available data ($ 200,000- $ 603,904 ). 10-11
Insurance-based funding models are suitable for ensuring long-term mobile vision outreach fiscal stability .
Viewpoint 1 Per Census . gov report , 294.6 million Americans were insured in 2017 . Ninety two percent of children under 19 and in poverty are insured . Insurance coverage is widespread and sustainable care models should focus on properly utilizing available insurance reimbursements .
Viewpoint 2 Insurance reimbursement rates are consistently decreasing meanwhile ; the costs of operating medical clinics are rising . According to the American Hospital Association 2017 Fact Sheet , 63.9 % of hospitals are losing money on Medicare patients and 22.6 % of hospitals are losing money overall . In fact , there is an annual $ 57.8 billion dollar hospital deficit secondary to Medicare and Medicaid underpayment . Reimbursements are available for low-income patients , but the reimbursement rates are less than what it costs to provide quality care . Additionally , there is much uncertainty regarding the willingness of insurance companies to reimburse for mobile health services .
Viewpoint 3 : Avoiding declining insurance reimbursement in favor of receiving Affordable Care Act mandated community benefit allocations might be an amenable solution to sustaining a mobile vision clinic for Arkansas kids . As of 2013 , each nonprofit hospital is required to conduct a community needs assessment and then make subsequent allocations to meet these community needs .
The Wills Eye Hospital has leveraged this mandated regulatory requirement to meet the vision care needs of underserved children ! The Wills Hospital staff conducted a community needs assessment and subsequently funded and outfitted a screening van specifically for testing pediatric vision and dispensing glasses . All of these activities and costs are covered under mandated sustainable Community Benefit Funds .
Conclusion
The state of insurance coverage and the level of reimbursement to providers is constantly evolving . A paradigm shift is necessary to reach the 2 out of 3 Arkansan children who fail their school vision screening without follow-up . Relying on health insurance for reaching the underprivileged at this time , may be less stable than an ACA Community Benefit Based model .
However , ensuring these funds are allocated to pediatric vision outreach will require personnel dedicated to being Community Benefit Advocates . They must champion the cause of pediatric vision care to non-profit hospitals resulting in Community Benefit Fund allocations to the children ’ s mobile vision clinic .
Tactically , mobile clinics are ideal to overcome logistical and transportation barriers . A mobile vision clinic that served 15 children per day ( 5 days per week ) could care for all 15,000 Arkansas children currently without care in fewer than 4 years . Interdisciplinary support from community leaders , parents , school nurses , clinicians , and ophthalmology and optometry professional societies will be critical in ensuring this solution is effective in reaching the children in need .
References
For a complete list of references , email ams @ arkmed . org .
Figure 1 . Mobile Vision Clinic Layout , Author : John Musser
Volume 117 • Number 6 DECEMBER 2020 • 127