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@optotrician: This is Safe, Right?

on May 30th, 2013 | Filed under @ the Optotrician, Optoblog

I was halfway done administrating non-contact tonometry (a.k.a. air puff test) when a 30-something man asked, “This is safe, right?”

To which I replied, “Well, yah. A small percentage of people could faint, but…pretty safe.”

To be fair, I have never had anyone faint after the air puff, but I have had two different men almost faint (lightheaded, sweating, nausia, paleness) after Goldmann applanation tonometry and corneal foreign body and rust-ring removal.

It helps to be prepared for the vasovagal response, so I have on hand an ammonia-based respiratory stimulant and Sunny Delight sugary punch.

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@optotrician: Time for an Eye Exam

on April 26th, 2013 | Filed under @ the Optotrician, Optoblog

Don't talk to Willie!

Don’t talk to Willie!

Our Walmart Vision Center has a life-size poster of a tough-looking beared guy from Duck Dynasty. Someone thought it would be fun to put a Walmart name tag with the name “Willie” on it.

It’s strange having Willie in the optical because you see him out of the corner of your eye and you instinctively have to look over at him to see who’s there, but the then you feel stupid because you’ve already told yourself a thousand times before that Willie is just a cardboard picture.

The other day, an optician saw a lady trying to talk to Willie and asking a question. Of course it was only for a few seconds, but it was a couple seconds longer than most people would talk to a cardboard picture.

The VC manager decided to take the name badge of Willie after that. Now most people just come over and have a picture taken with cardboard Willie.

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Acuvue2 Colours Going Away

on April 16th, 2013 | Filed under Optoblog

Colored contacts are economically impossible to keep in inventory, but now it appears that the manufacturer can’t afford to even produce them.

VISTAKON announced that effective 3-31-2013 doctors will no longer have access to trials of the Acuvue colored contacts, and effective 12-31-2013 VISTAKON will no longer sell the revenue boxes of Acuvue2 Colours to doctors and distributors.

In the memo, the reason cited is “to better align our capabilities to produce more of our most popular and more innovative products, like 1-DAY ACUVUE TrueEye…1-DAY ACUVUE MOIST…and ACUVUE OASYS Brand Contact Lenses.”

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Insurance Companies Pay via Credit Card Now

on April 9th, 2013 | Filed under Optoblog

Well, this was annoying. I did a favor for a patient and billed an insurance that I’m not contracted with but which allowed any provider to bill them.
Instead of the mailed EOB including a check, it had a graphic of a credit card with its number, expiration, security code, and zip code.
They call it “QuickRemit, virtual prompt payment.” (I guess by prompt, they mean 6 weeks from date of service.)
If I didn’t have a merchant account, I wouldn’t be able to process the funds. Luckily I have Square that allows me to punch in the numbers to get paid from a card not present, but I find it really annoying that I lost about 4% of the payment because the insurance company chose not to sent a check!
I wonder what the benefit is for them to do this. I get charged to process the payment and I’m sure they get charged to charge a virtual credit card. So, why not send a check, Insurance?

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New Year’s Resolution: Stop Losing It!

on January 1st, 2013 | Filed under Comics, Optoblog

Police officer asks man with dilated eye to show contact Rx as proof of recent eye exam. He replies that of course he lost it already.

optoblog comic #27 Stop Losing It!

If it’s the law that I have to give them the Rx, then can it be the law that they have to keep it? Or pay for another one? Or pay to have it faxed or verified by a third party?

I have seen contact lens Rx’s on the black top of the Walmart parking lot. Can’t people at least take it home before throwing it away?

I wouldn’t be so annoyed, but lately lots of people have been asking for copies of their Rx, and every time I feel like asking, “What happened to the one I already gave you?”

I don’t get paid to fill it out the second time, you know.

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Penta Bridge Style

on December 30th, 2012 | Filed under Comics, Optoblog

Man wears penta bridge glasses and woman says, "Now that's what I call a bridge!"

optoblog comic #26 Penta Bridge Style

Real men need sturdy eyewear, but double bridges are so passé…

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OBA 2012 Practice Metrics are out for Walmart-Sam’s Club Optometrists

on December 28th, 2012 | Filed under Optoblog

Each year the Optometric Business Academy releases their survey results for practice stats of Walmart and Sam’s Club affiliated doctors. (The OBA should not be confused with the MBA, Management and Business Academy run by the same sponsors for private practice optometrists.)

The OBA has the 2012 metrics for download here, and you’ll probably have to log in to get it. Even though it is the 2012 report, it’s really analyzing 2011 stats.

If you were to guess the most likely day an optometrist takes off, you would guess Sunday, of course. But did you know the second? Turns out that about a quarter of us take Mondays off. That’s me, too. I like to pretend I have a weekend.

And seriously, here are some points they make that I ordered and would like to discuss:

  1. Typical affiliated ODs spend less than
    0.5 percent of gross fee income for
    marketing. The median expenditure is
    $500 annually, a sum insufficient to fund
    any significant initiative.
  2. Affiliated ODs are generally less
    active in service improvement processes
    recommended by service experts than are
    private practice ODs.
  3. Among the major advantages of hiring
    staff is the ability to shape a service
    culture and service standards to deliver a
    consistently excellent patient experience.
  4. …only a minority of affiliated practices actively market medical eye care services today.

Okay, #1. Part of the reason that I don’t spend on advertising is that I don’t collect a lot of money to do so AND I’m in a high traffic location anyway, so spending a lot on external marketing doesn’t make a lot of sense. Maybe Sam’s Club doctors should spend more, but one of the advantages of being a Walmart doctor is that my marketing budget can be low since I have more awareness by default. Also, private practice doctors spend more on marketing because they sell $500 pairs of glasses. I only collect money on exams. My gross is much less, so my overhead should be less and that includes the marketing dollars.

#2 and #3 are related. Again it goes back to overhead. If I wanted the headaches of hiring, paying, training, providing benefits, scheduling, managing complaints, and firing staff…then I would be a private practice doctor. If I let Walmart handle the headaches, then why can’t I also let Walmart handle the service improvement process while I make the occasional suggestion? Also, where am I supposed to get all this money to compensate the staff I hire? If I’m a one-room doctor whose appointment book is not full, then what incentive do I have to spend money on staff? If I’m a doctor whose appointment book is starting to get full, it’s a big cut in pay for me to hire more staff, hope business picks up, and somehow try to change exam-traffic flow in a Walmart optical floor plan.

Speaking of which, where does my hired air-puffer do my insurance billing when they’re not taking acuities? There is no nurse’s station. The Walmart floor plan needs to change before I get crazy and hire a staff of people.

#4. I’ve been hearing for years about how we’re supposed to be on board with the “Medical Model” which is a code word for billing a lot more medical insurances, which is more code for jacking up your medical fees because “you don’t want to leave any money on the table.”

First, there are three major insurance carriers in my area who only allow ophthalmologists on their panels- no optometrists. Second, if I start seeing a whole bunch of medical insurance people, then my accounts receivable will go up, and these are sicker patients who take up more time in the chair. Then I’ll have to start raising exam fees. Once I start raising exam fees, business will taper off because that’s the whole reason most people come to Walmart: the exam is cheaper.

Some people think it’s fine to charge a wildly different exam fee for “medical” vs “routine vision,” but I’ve addressed this topic elsewhere. In summary, I don’t think having a $50 “routine” eye exam while charging $150 for a “medical” eye exam is ethical.

On the other hand, I would love to charge some patients more if their case is complicated, but try explaining that to someone who got quoted a certain price, so that’s why they signed up for an exam. They won’t be happy paying more than they expected.

I wouldn’t mind having an hourly rate. I think that would be more fair for everyone except the insurance companies.

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Brian Regan Divorced from Wife in Summer 2011

on December 5th, 2012 | Filed under Asides, Optoblog

Did you all know that the famous comic, Brian Regan, had a divorce all the way back in Summer 2011? Me neither.

Since I’m an optometrist and Regan has a funny bit about his visit to the eye doctor, about every 1-2 weeks a patient talks to me about Brian Regan. This is especially true around the time he makes his annual pilgrimage to Utah. He was just in Logan, UT last week. I had gone with my son on a Thursday night (he did 5 shows in little Logan that weekend). Regan even mentioned our little town in a tweet:

Brian Regan ‏@BrianReganComic 29 Nov 2012

Hey All, Thu, Fri, Sat I have shows in Logan, UT. Sun show in Cheyenne, WY. If you’re within 2000 miles of either city, love to have you.

It turns out this patient went that same night.

We got to talking about how his opener, Kermet Apio, was hilarious and that Regan seemed to have an off night. I observed that when we saw him here ~3 years ago, the crowd was more enthusiastic and Regan did two encores- even taking requests from the audience about what bits to perform. This year on a Thursday night, the crowd seemed more subdued, the show started late, and he did one encore without taking any requests.

My patient mentioned that he might be going through a hard time because he got a divorce last year.

What?!?!

The patient and his wife saw him January 2012 in Salt Lake City, one of TEN shows he did over two weeks at Abravanel Hall. (By the way that’s the same venue where they taped Regan’s 2010 album “All by Myself” which I now think of as an ironic title.) The patient’s wife commented afterwards that she thinks Regan got a divorce recently. The patient was taken aback, but his wife perceived it because of some things Regan said during the act.

They went home and did an internet search. Sure enough, they found out Regan had recently been divorced.

Here’s where it gets interesting for me. I couldn’t verify that when I searched for it December 2012, almost 18 months after it happened! It’s almost like it has been scrubbed from the Internet, or at least Google and Twitter.

Finally, I found one mention of it during a Yahoo search. Some SiriusXM radio show called Opie and Anthony had Regan as a guest on November 18, 2011 starting about 2:16:45. At about 2:29:30 they ask him, “How’s the family?”

Regan replies, “Uhh…you know.”

He goes on to say,”You move along in life…There’s some changes. Some changes in my world…but everything is good. The kids are good.”

When asked if he’s depressed about it, Regan responds a little too evenly, “No. No. Everything is hunky dorey.”

He teasingly continues, “In fact I had that worded in the divorce decree. It says hunky dorey in several paragraphs. Actually it was a very amicable situation. You know, it’s just one of those things.”

When asked how long has he been single, Regan replies, “Uhh…since June, July [2011].”

The interviewers and Regan go on to joke about how, because of the divorce, he presumably needs more money so he’s got to push a lot more merchanising like “YOU TOO” Snuggies.

Now, I don’t seek out nor follow celebrity news. Sometimes celebrity tidbits get mentioned in the RSS feeds I follow. For example, I knew that Morgan Freeman was divorced, so my question is why didn’t Regan’s divorce make the news? How come I unwillingly find out that Brittney Spears used a gas station bathroom while barefoot, but my favorite comic in the whole world gets zero news about a major change to his life?

Another thing, in a recent interview Regan did with a correspondant for a North Carolina newspaper, the reporter writes in September 2012 that,

” The 54-year-old standup comedian, who resides quietly in Las Vegas with his wife and two kids, is finding…”

Did Regan remarry? Or did the reporter just assume something because Regan’s divorce hasn’t been publicized whatsoever?

In the wake of media malpractice concerning presidential politics, it comes as no surprise to me that I didn’t find out about Regan’s divorce until 18 months later. However, I kinda feel a little bad for Opie and Anthony. Even though they seem to have the exclusive on this bombshell, word never got out. But after scrubbing through their vile 4 hour show searching for the start of the Regan segment, it’s immediately obvious why no one must listen to them.

 

UPDATE:

Apparently one reporter in the entire world is doing their job.  Brian Regan volunteered the divorce news in an Interview with Atlantic City Weekly published April 3, 2013.  He was making fun of Wikipedia being wrong about his life stats; however, I have never seen his page mention his wife, so he may have been giving a little artistic license to illustrate a point leading to a punchline.

Also, see my new post “Brian Regan Performing at Arena February 2014 in Salt Lake City.”

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What Kind of Society do We Live In?

on November 30th, 2012 | Filed under Asides, op-ed, Optoblog

Walking into Walmart today, the door greeted me with this poster over the retail theft detectors:

sickening poster of Farcry3 video game

What?! We’re just playing. Having fun.

Everyone who enters Walmart gets to see this intense, menacing, threatening, brutal, cruel, violent picture. Innocent four-year olds, impressionable tweens, expectant mothers, you, me…everybody!

Don’t get me wrong. Mr. Fairy-face could just as well be holding a baseball bat. The issue is not about sidearms. Every sane, law-abiding adult should be allowed to carry a gun on the beach- holstered until needed to save own/family’s life and limb. The issue here is about men wearing makeup.

The other issue here is showing such an intense, graphic, violent scenario for public display. The poster is sickening. Despite Mr. Fairy-face’s great trigger-finger discipline, he is pointing a gun at a guy’s head. A guy who has been buried to the nostrils in the sand, unable to defend himself, waiting in suspense for his brains to exit his skull. You would normally have to watch an R-rated movie to see this kind of imagery. Now Walmart uses it as their welcome sign!

Okay, America. What kind of society do we want to have? I think it would be a good idea to go to church and pray about that.

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Walmart and 1800Contacts are Splitsville

on October 31st, 2012 | Filed under Optoblog

In an e-mail today to Walmart affiliated optometrists from Dr. Chad Overman, director of professional relations, he announced in relationship to Walmart and 1800Contacts that:

“Given future diverging business interests, a decision has been made to end our relationship effective December 31, 2012”

This isn’t 1800Contacts’ first divorce. As I explained before, 1800Contacts shacked up with a regional optical in Utah, Standard Optical, a few years before their civil union with Walmart in 2008.

Dr. Overman continues:

“Even before our alliance with 1-800 Contacts, our patients have counted on us to provide them a broad assortment of contact lenses at affordable prices, and our pledge to them and you is that we will continue to do so. In the event your patients have questions, thank them for their continued trust and patronage and provide them assurance of our continuance of this commitment…
Why are we ending our relationship?
Our customers trust us to provide a broad assortment of products at everyday low prices, and we approach every business decision through this lens.”

The last few years I did enjoy how we typically get contact lens orders to patients in just two days. That’s great customer service, but I’ll bet it’s more cost expense than Walmart is willing to pay in hopes of keeping prices low. I guess we’ll go back to saying “about a week?”

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