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Wal-Mart recently announced in a letter that they are “excited to announce a long term alliance between Wal-Mart/Sam’s Club and 1-800 CONTACTS..”

May Heaven help us, because 1-800 sure isn’t going to. I promptly wrote the following E-mail to Dr. Patel, Wal-Mart’s Director of Professional Relations:

Dr. Patel,
I would advise against any kind of alliance with 1-800 CONTACTS. You’re not the first one to try. Standard Optical, a Utah-based optical chain, aligned with this Utah-based contact lens reseller for a while, and it didn’t last long. You should talk with those in the know about why it didn’t work out.

1-800 is also militant about teaching the general public to force the doctor to make decisions not in their best interest. Everyone inside our industry acknowledges that yearly eye exams are important, but 1800’s own website indoctrinates consumers to mandate to their doctor that prescriptions should expire at the two year mark OR LATER. (see: http://www.1800contacts.com/docAndRx/DocRx-release-1.shtml ). As a Utah eye doctor, I already suffer with practicing in the only state in the nation with a minimum 2-year contact lens expiration date- thanks to 1800’s lobbying power in our Utah legislature.

I had a patient last year, whom if her prescription hadn’t expired, she wouldn’t have come back in to see me for her yearly exam. If she wouldn’t have had her yearly exam, I wouldn’t have noticed an FDT screening visual field defect and reduced vision in one eye that wasn’t there the previous 2 yearly exams. If I wouldn’t have seen her, I couldn’t have referred her to the ophthalmologist who referred her for imaging which found the diagnosis of a brain tumor. A yearly eye exam saved her life, and under 1800’s reign, we are sure to miss these kinds of cases in the future.

If your only goal is to cut costs related to online sales at walmart.com, why not use 1800 as a nameless, behind the scenes
subcontractor? Giving them the limelight is the wrong move for Wal-Mart. An alliance with 1800 disgraces our reputation.

Also, I’ll quote from your FAQ (http://www.walmartod.com/clients/1814/docs/FAQ_Alliance.pdf): “Consumers in that same survey specifically cited cost and “purchasing them is inconvenient” as reasons for over-wearing their lenses.” Wal-Mart boasts about how something like 50% of a town’s population visit their store in any given week. How is stopping by the vision center on their bi-weekly pilgrimage inconvenient? What they meant to say is expensive or don’t have enough money. They expect to buy a box per eye and stretch it as long as possible. The real problem is that people expect a year supply of contacts to be less expensive than glasses just because you throw them away, and most also expect them to be a replacement for, not in addition to, glasses. Change those two perceptions, and you’ll increase your contact lens sales without help from the enemy of 1800 CONTACTS.

Please see my previous blog posts about 1800:
https://optoblog.com/2007/10/09/check-yearly-live-another-year/
https://optoblog.com/2007/07/30/patients-say-the-funniest-things/
https://optoblog.com/2007/03/19/1-800-eat-crap-and-die/

Sincerely,
David Langford, O.D.

I’ve been having a problem with EyeMed vision insurance, so I’m taking it to the blogosphere since their support fails to find a solution.

When patients come in for an exam and contact lens fitting, their information sheet says $x copay for exam and $0 copay for Contact Lens fit and follow-up. All well, and good. I’m assuming that EyeMed will reimburse me $30 for my time and expertise in fitting contacts. Then when we go to eyemed.com and bill it, and it tells us that the patient owes the $30! What?!!

We call customer support, and they say that on his system, it says up to $55 maximum copay on CL fit and follow up, so we must have misread it.

It said $0 copay for CL fit and follow up in black and white on the patient’s insurance card. It said it on the benefits information when we preauthorized the exam online. What is the deal, EyeMed?

Meanwhile, I need to charge more money to the patient, but they’re going to have a cow about how we’re trying to rob them when EyeMed is to blame!

Please, EyeMed, fix your error on the website and send another letter to let your beneficiaries know that they will be paying for their contact lens evaluation.

Back in November, there was a guy who came in and sat on a fabric-upholstered chair for a few minutes. After he got up and left, I just had to take this picture.

I’ll go out on a limb and guess that he works in a really dusty environment.

My mentor in the Indian Health Service, CAPT Jerry Sherer, O.D. F.A.A.O, always used to tell me, “They always come in threes.”

“They” meaning unusual eye conditions that you have to manage within a short period. The other week, I had another example. Usually it’s some variety of red eye, but this time I had 3 cases of keratoconus…all in the same day…and two of them were back-to-back. And no, the individuals were unrelated.

So my question is, why do they come in threes? What is it about the universe that makes them come in threes? Do other health professionals see the same deal with threes? I’ll have to Google these questions and report back later.

Officemate ExamWriter now comes with the long awaited “feature” of allowing you to scroll up and down with a mouse wheel.

Thank You!!!!

Glass-is-half-full thinking would make me want to curse you for making me mouse-click scroll for the last year and a half, but I’m going to try to stay positive.

Kevin, M.D. brings up the point that most doctors don’t e-mail their patients because of privacy laws. Another doctor getting a lot of press for his new practice style, Jay Parkinson, flaunts that he can do whatever he wants since he doesn’t take insurance.

Wow, makes me want to not take any insurance; however, I DO think that we can e-mail our patients as long as HIPAA rules are maintained. It’s my understanding that as long as the data is encrypted, we can communicate confidential information with patients. On my practice website, patients can e-mail me using a form. This form can be optionally encrypted before sending if they have confidential information to share.

This is all done using my public key. Only my private key with its password can decrypt the message. I didn’t go to the HIPAA Security Company store and buy it. It’s totally free if you know how. While I believe this system complies with the intent of HIPAA regulations, I can’t e-mail back a patient if they haven’t made themselves a cryptographic key pair for e-mail. I’ll bet only a very small percentage of people in the world even have one, and I’ll bet the percentage of doctors that have encrypted e-mail is even less than the general population. But I did it. It’s do-able. Sure, I’m a computer geek, but I learned computers the same way I learned eye doctoring; study and practice.

But the obscurity/confusion of how to implement encrypted e-mail communications is not the real reason doctors don’t use it. I don’t get paid to sit around and e-mail patients. I get paid for examining patients at the office. On-line communication tools work well for Dr. Parkinson since that is his mode of practice. But my patients don’t pay me a subscription, so any e-mail that I have with them would most likely say something like, “I would recommend you come in for an appointment.”

By the way, I’ve had this encrypted form feature on my website for over 18 months, and no one has ever used it nor have they used my public key to send me an encrypted e-mail.

MedGadget reports that optical coherence tomography helps diagnose and manage multiple sclerosis, and they display an HRT2-3 picture.
So my HRT2 may still have legs! Now I’ll get the referrals from the neurologist (to use my HRT2) instead of the other way around!
I’m sure they’ll charge extra for the stats package that helps manage MS. But listen to this:

In addition, says Calabresi, OCT scans take roughly one-tenth as long and cost one-tenth as much as the MRI, which means they are faster and cheaper to use in studies that track the effectiveness of new treatments for MS.

They must have really cheap MRI’s where he comes from. The average price in my neck of the woods for optic nerve imaging with Stratus OCT, HRT2-3, or GDx is ~$80-90 for both eyes. Do you know of any place that just charges $800-900 for an MRI? I believe it’s more like $1200. Also, you’d have to additionally pay a Radiologist to give an interpretation and report, but the optic nerve imaging fee includes the report.

So I went to the bank today and the new teller said, “So you’re an optometrist. What’s the grossest thing you’ve ever seen?”

I assumed she meant personally, so I didn’t answer anything about what I’ve seen in text books or CE.

“Well, I haven’t had to see a lot of gory stuff since I’m an optometrist and not a surgeon…but I’d have to say something that gave me the willies was crab lice on the eyelashes. That’s an STD.”

You should have seen the look on her face. Her reaction was a combination of shock and disgust. She said, “Oh gross.”

Then she turned to her co-worker running the drive through and said, “Did you here that?”

Yep, she was so appalled that she had to share it with others.

Next time I’ll just keep it simple and say something like, “Well, there was this really, really red eye. I mean really red…”

I once heard this from a rep, and this cartoon was immediately spawned in my brain.

And I know that women don’t normally buy the engagement ring, and yes, I just use the same pictures and change the words.

Seriously, would it be okay if we farmed out patient education on presbyopia to the techs or opticians or something? Are eye doctors the only ones on the planet who have ever heard of it? From the 40-something mildly farsighted patients especially I get these incredulous looks.

“But I’ve never needed glasses in my entire life!” they say.

If they can mandate that my child take sex ed in school, why can’t they mandate that everyone be forewarned about the whole presbyopia thing? I remember in second grade health class learning about the digestive tract with a slide show of a cartoon character traveling down a river on brown barrels. Why can’t they do a little ditty about the eyes too?