optoblog.com

The not so simple question...

There is a not-so-simple question that pretty much every patient asks, “How much is your eye exam.”

While the medical model has varying levels of exam, like Level II-New vs. Level IV-Est, which depend upon the history, exam, and complexity of that particular case; however, there are some among our profession that make it an especially hard question to answer, and this issue raises concern over the ethics of a fairly popular fee structure.

For example: the price in front of the Big Box says “Eye exams starting at $45!”
But are they really? Sure, for a “routine eye exam” where nothing is wrong and you just want your glasses updated, then it’s the $45. But what if I have some allergy eyes, so the doctor gives me a prescription for Pataday as well as my glasses Rx? All the sudden the exam somehow costs $120!?!?

Huh, something funny going on around here. I think big box doctors are more likely to do this since their exam fees are so low, they make up for it by gouging in other fees. I have no problem with a doctor who says their S0620 is $100 and their 92004 is $120. However, I think there is something wrong if the S0620 is $45 and the 92004 is $140.

It’s like some among us in the optometric profession are playing the windshield chip repairman scheme.

But what really happens? Patients won’t typically notice this bait-and-switch. It’s really the insurance companies who get hammered. The patient pays their copay, and if the doctor can come up with any excuse to bill a medical code, they use their medical model fee structure to justify it.

Ethics applies when we realize that, for some reason, private pay patients are rarely charged the same high fees as the insurance companies. Huh. Oh well. It’s a victimless crime because those big, bad insurance companies won’t miss the extra cash. Until we realize that the more insurance companies pay out, the more the patient’s premiums will be raised next year. Whoops. Sorry, Mrs. Smith, that you can’t afford to keep your medical insurance in the future because I wanted to get paid double or triple my usual fee because you have insurance today.

By the way, it cost me about $2000 to bill insurance last year (PIM software license, E-filing charges, and postage/paper for mailing statements/refunds). Also add to that the cost of time spent filing claims and handling overpayment and underpayment. If I didn’t have to deal with insurance, I could drop my exam fee by at least $5 per person.

I have an idea: All patients should pay for office visits out of pocket. If they have insurance, get reimbursed later. The doctor won’t know about their insurance, so there won’t be a conflict of interest about what exam fee structure he’ll choose. The doctor can lower his fees since filing claims is expensive and time consuming. Everyone wins. Another idea, insurances should allow me to charge either them or the patient a $5 claim filing service fee.

Take home point: I don’t believe it is ethical to have one fee structure for insurance patients and another drastically different one for private pay. Yes, I’m all for charging more money if something is more work and more time. That’s why a contact lens evaluation is paid on top of the routine eye exam. That’s why there are different levels of 99*** office visits. But sneaking a huge fee onto an insurance claim just because there is some medical code excuse is something I don’t think our profession should feel comfortable with.

Clear vision isn't all it's cracked up to be.

It’s the return of the Optoblog comics! Comics are by far the most searched for items on my blog, so I’m just bowing to demand.

I got my copy of the February 2010 National Geographic today (I have a fair and balanced waiting room: Guns and Ammo and National Geographic). There’s a big feature article about life in the FLDS church. On page 61 with the photo of the Jessop family offering a morning prayer, there is a small bottle on the sink counter-top in the background, and I’m pretty sure it’s a bottle of Systane Ultra.

I’d post the picture, but I’m not sure if I’d get sued by NG, so just go find a copy and tell me if you think it’s some other eye drop brand.

In Answers to Your Search Questions Part 1, Part 2, and Part 3, I pithily answered the questions on your mind as indicated by the web search that brought you to my site.

Just to review, I know what IP address you have and the URL that was in your address bar just before coming to my website. A search URL contains the search term that you used. So let’s see what everyone is curios about!

1. “how to become a millionaire optometrist” – Ha ha ha ha ha. Wow, that’s funny… Huh? Your serious? Well, I guess the only way I’ve heard of is starting your own consulting company and charging other suckers optometrists tens of thousands of dollars to blow smoke up their
2. “get rich in optometry” – See above. Man, what is the deal with all these capitalist pigs thinking they can be a doctor AND be rich? Haven’t they drank the Obama juice yet?
3. “contact lens comic” – Let me put in yet another plug for my fine body of work as a cartoonist.
4. “going to vet school after being an optometrist” – If working in healthcare for human beings didn’t work out for you, what makes you think dogs and cats will pay you any better? They don’t have checking accounts or credit cards.
5. “what should I expect after optometry school” – Oh Lordy, I don’t envy you. Let’s see…where do I start? First, get yourself a temp job packing frozen dinners until your license comes in July. If you applied for a government job don’t expect to start work until October. If you want to work a chain store, expect to fill-in at different places for a while until you find an opening in a town you actually want to live in. When you work for another O.D., expect to be paid half what you bring in. Expect to pay a whole bunch of money in business insurance, professional liability insurance, general liability insurance, student loan repayment, business loan repayment, rent, wages, and on and on until you bring home so little bacon, it’s actually just a sprinkle of bacon bits…and they’re actually made out of soy.
6. “How the FCLCA has decreased costs in contact lenses” – Good question. I know how it’s raised profits for online retailers. Theoretically, the more retailers there are, the more competition there is. More competition breeds price wars. Price wars make retail price go down. Of course, in practice, the first thing Walmart did when they joined 1800Contacts was raise most of their contact lens prices to match 1800’s pricing structure. Anybody have a good answer to this question?
7. “easiest optometry school” – Again, people keep asking this question. If I were an optometry school, I would set up a honey pot site so that anyone asking this question would probably get referred to the honey pot from a search result. Log all the information you can (IP address, location info, etc) and compare it to their logs of people requesting information from the optometry school website. Then make a “do not interview” list based on the database cross references.
8. “the best and worst optometrist that you have worked for” – I’m pretty sure no one would really post actual names since you don’t want to get sued for something, but I’d stay clear of any practice that seems to hire an O.D. for a couple years, promising them a buy-in option, but then they renege so the new O.D. leaves.
9. “how much does it cost to start an optometric practice” – as much as a house.
10. “doctors melton and thomas” – They’re awesome. As far as I’m concerned, drug reps don’t have to visit me since I’m just gonna do whatever Drs. Melton and Thomas say.
11. “1800contacts sending contacts without dr verification” – Well, if you don’t respond to their fax and/or phone call, then they have to assume what the patient told them is correct.
12. “i hate science, but i want to become an optometrist” – If by “science” you mean this whole global cooling- I mean warming- I mean climate change fraud, then I agree. If you mean true science, then I’m not sure I can help you. But I will suggest you do an internet search for the easiest optometry school to get into and maybe you’ll get through it.
13. “what should you major in if you want to get to optometry school?” – anything you want, but you’ll have to take all the prerequisite classes also. Since most people want to leave undergrad in four or five years, this usually involves having to major in some biological science. I think it would be cool if more optometrists majored in business or marketing and then minored in the biology. But I hate those majors, so that’s why I didn’t go that route. Do what you love.
14. “optometrist strategies in 2010” – I heard Sam’s club or its doctors are going to try to give $20 exam rebates to patients, but I don’t know the reasoning behind it. No one likes rebates. Instant rebates might fly, but then, why not have your fee be your fee? I didn’t major in marketing so you better not ask me.

This concludes Part 4. Keep searching!

I would just like to ask every Walmart optometrist reading this blog to please nominate me to go to the Health & Wellness Conference May 3-5th, 2010 in Bentonville Arkansas. I want to be one of the 250 optometrists in attendance.

To nominate me, find the e-mail that was sent to you from Walmartod.com on 1-8-2010 and click on the link. Here is the information you will need:

David Langford
Store # 1888
North Logan, UT

Why should you nominate me?

• Because I guess you can’t nominate yourself.
• I’m a cub scout Wolf den leader. I go to church every Sunday
• The associates in my vision center like me- we’re even friends on Facebook.
• I’m all techie. I even have a Humphrey Matrix VF and HRT2 in my office.
• I recently raised my fees and no longer charge extra for dilation.
• I was featured in the Review of Optometry with an article highlighting Walmart optometry.
• I’m like one of the original optometry bloggers. ‘Nuff said. I’ll blog the whole thing so it’s just like you being there (except without having to lose money while not doing exams at your office.)

There you have it. All the reasons you need.

I think this product is great.

Let’s hope 80-year-olds are computer savvy these days. I think this product could really help, but I also think there are some big hurtles to overcome:

• How much is this thing gonna cost?
• How much will it cost to train grandma and grandpa to do it?
• How much will the doctor charge to review the results every time it’s done?

I think you’re going to need a really motivated, affluent, tech savvy patient who is not in denial about their AMD for this machine to be viable.

In Answers to Your Search Questions Part 1 and Part 2, I improved by search juice and answered the questions that seem to be on everyone’s mind.

Well, I’ve done it yet again. There seems to be no end to all the inquiring minds out there. Just to review, I know what IP address you have and the URL that was in your address bar just before coming to my website. A search URL contains the search term that you used.

1. “is Crizal worth the extra expense” – That depends. The original Crizal, Crizal Alize, Crizal Alize’ with ClearGuard, Crizal Avance’ with Scotchgard, or the next one that they come out with 6 months after you buy the one available now.
2. “satan’s plan” – This search term was by someone from Lagos, Nigeria, Africa. (It directed them to this post.) Lemme splain. In pre-earth life, Jesus wanted us to have the freedom to choose to follow Heavenly Father and obtain Eternal life. Those who don’t obey God’s will and never repent would be lost. Those who disobey (all of us) would need a Savior in order to be worthy enough to enter into God’s presence again. Well, the Son of the Morning didn’t like that. Satan, wanted us all to be forced to choose God and obey His commands so that none of God’s children would be lost. It’s kind of like liberals vs. conservatives when you think about it.
3. “what scanner should you use with officemate” – If you are going to scan, go big. You will not regret buying a fast document scanner like the Fujitsu 6130. I used to have a slow HP ScanJet N6010. It lasted two years and died. I wasted so much time waiting for files to scan. With my Fujitsu, waiting is a thing of the past. Let’s say you get an EOB that you want to scan into OfficeMate. You pull up the patient’s file, select the eDocuments tab, and then press scan. It will scan duplex, then you hit complete, and you’re done. Fast, fast, fast. Plus mine came with Acrobat 9 Standard.
4. “nbeo optometry review notes” – I just wanted to bring this up because I’m so glad I’m done with school and boards.
5. “how to recharge pachmate dgh55” – I’m thinking you should read the owners manual. If you don’t like keeping dead trees around, then scan it into a pdf with your Fujitsu scanner.
6. “stylish medicaid frames” – NO SUCH THING
7. “screening acute angle glaucoma with mydriasis with pen light in pcp office” – Yah, so what I think they want to know is before they dilate somebody, what’s the likelihood that they give them an angle closure pressure spike. I believe that should be in the manual for your nifty DigiScope. Someone in Maryland should just refer to their local optometrist.
8. “best way for optometrist to get FDA job” – I’m pretty sure you can get any government job you want by contributing enough money to the DNC. If you’re not a trust fund child, then I would spend loads of money to attend optometry school, study hard, work hard, graduate, and join the rest of America in the unemployment line.
9. “optometrists are stupid” – Someone in Alameda, CA was having a bad day.
10. “crack officemate” – Some web surfer in Indiana needs a crack for Officemate. Let’s see, I’m pretty sure stealing around $6000 for the initial year and ~$1400 per year after that could be considered enough to get you in trouble with the state optometry board. I don’t think it’s worth it. If you can’t afford it, do yourself a favor and try something else. Or, like I’ve said before, if you’re willing to crack expensive, niche software, then why stop there? Robbing banks and pimping can “earn” you boat loads of tax-free money.
11. “average christmas bonus for optometrist” – Let’s see. Um, try about $0.00
12. “pronounce similasan” – put the emphasis over the second “i” and then say the rest really fast. sim-IL-uhsahn. Or call their consumer information line, 1-800-240-9780, and they say it on the recorded message.
13. “Biofinity review” – This is by far the most searched term by people coming to my website from google and yahoo. Seriously, why don’t you just try it for a week or two? If you don’t like it, then try something else! These lenses could work great for you and terrible for someone else- or vice versa. It’s like asking other people if a certain brand or size of orthotic shoe insert works good.

I’m here to help.

InfantSee: Optometry’s Contribution to Socialism!
InfantSee: The AOA loves BIG GOVERNMENT!
InfantSee: Baby Steps towards Communism!

Earlier I discussed InfantSee here and here.

Now, it turns out the AOA has secured federal tax dollars for InfantSee.

I don’t mind charity, but let me choose the charities to which I desire to give of my property. Giving all my money to the government and letting them redistribute it is the opposite of freedom. I am not going to participate in InfantSee. If I were a member of the AOA, I would demand that Optometry’s Charity™ – The AOA Foundation return all tax dollars to the government.

You wouldn’t think people would want the government meddling in healthcare and health insurance, especially when everything bad about our system is a direct result of government interference. For those of you who think it would be awesome for Obama, Reed, and Pelosi to have their way with you, watch this video. It’s about healthcare in Canada.

I know Canadians. I’ve visited Canada a couple times. It’s nice, but America, you don’t want what Canada has got with a healthcare system.

Imagine waiting months for a non-urgent visit. The doctor spends 3 minutes with you and prescribes a medicine that doesn’t work. Now you’ve got to wait who knows how long to get back in. What do you do? That’s right, you decide it’s not worth the trouble so you just live with your ailment.

Imagine an urgent need, and you still have to wait hours or even days to get evaluated. The doctor is busy and can’t be bothered trying to figure out what’s wrong with you, so they say you really don’t have an urgent need so just go home. Or you need a certain drug that they are all out of, so come back in a week when you might get a dose from their next shipment.

The next thing you know, big brother is telling you that you really don’t need an eye exam all that often.

Say no to any government healthcare “reform.” Real reform would be Texas style tort reform. Decreased insurance costs would happen if people would wise up and realize that insurance would be cheaper if you only used it for emergencies and just paid for routine and minor office visits yourself- life the high deductable plans meshed with health savings accounts. It’s not a coincidence that those are going away under the legislation being debated right now.

So the NIH sponsored a study published in Archives of Ophthalmology about myopia prevalence and severity over about 30 years. Bloomberg tries to pin it on texting and web surfing, quoting the lead author of the study for a reference. And why not blame computers since no one used them back in 1971? But it’s funny how the full text of the study doesn’t even mention texting or web surfing.

So…no one thinks that genetics could possibly be a bigger factor than near point stress? People in the 70s didn’t read or something? Isn’t the prevalence of many diseases increasing since our ability to treat them is increasing, like type 1 diabetes? Here’s what struck me from the study:

A review [of the literature] concluded that increasing levels of education combined with possible genetic susceptibility are likely to be responsible for the reported increases in the prevalence of myopia.

Possible genetic susceptibility??? Umm, let’s think about this. The study acknowledges that myopia is easy to treat. No one is being selected against because they can’t see stuff (enemy soldiers, criminals, dangerous obstacles, wild animals) since we correct those who care with glasses, contacts, and LASIK so they don’t get blindsided by those baddies. There is no law or even a social mos stopping these myopic people from hooking up with others of their kind and breeding like rabbits.

There’s no doubt that near point stress contributes to some myopia, but when two myopes marry and have six kids, which plays the more important factor in myopia prevelance from 1970 to 2004? Especially when today you could theoretically not even know your mate has contacts or LASIK until after you’re married. (The glasses they had back in the 70s acted effectively as birth control.)

Identifying modifiable risk factors for myopia could lead to the development of cost-effective interventional strategies.

If people are really out there ringing their hands because they’re so fearful of their kid getting more than 1 diopter of myopia, how come more parents aren’t willing to pay the price for Ortho-K lenses? Even still, the myopic gene is still there.

I’ll tell you what attitude needs changing: that myopia is bad. What’s wrong with it? Sure, if the global warming Stalinists get their way and we return to human populations as they existed in 3000 B.C., then myopia will become a problem for those Post-Algore-and-John-Holdren survivors trying to muck out an existence without modern conveniences like ophthalmic lenses and iPods.

I don’t need an intervention. I can marry whomever I choose and not abort any babies. You can throw away your laptop and iPhone if you want to. You can keep your kids from going to school. You can quit your job and become a prison tower guard (the only career I could think of that has to look far away all day). All I need are my Ciba Night and Day contacts, and I’m good.