optoblog.com

There are great 2.5 minute healthcare podcasts done by D.O.s at the Ohio University. Actually, the program is called Family Health and is broadcast on radio stations. Overall, I rate the D.O.s involved very favorably towards optometry. They had two different podcasts devoted to “which type of eyecare provider should you choose.” While I felt like they emphasized a little to much that “optometrists are not physicians” it was still pretty good. Even though we go by the name optometric physicians, maybe he meant not a whole body physician?

The bone I would pick is the episode about sports-related eye injuries. I’ve seen several cases, and the majority I was able to handle without referral to a surgeon. Your healthcare dollar would be better spent seeing a private practice optometrist for your sports-related eye injury evaluation. Most should offer 24-hour emergency eyecare. If there were a big problem like retinal detatchment needing referral to a retinal surgeon, you would still pay less for the optometric physician visit than going to the ER. I personally wouldn’t go to your family physician right off the bat (assuming you only have an eye injury and not some multiple system problems) because most don’t have dilating eyedrops, eye pressure testers, biomicroscopes to check for inflamation in the eye, and special lenses for seeing every part of the retina to rule out detatchment.

But really a great site. Great information in little 2.5 minute snippits. You can browse their archives yourself, or I compiled a quick list of eye-related podcasts that I picked up as I quickly scanned their archives:

orbital cellulitis

uveitis

Poor Eyesight and Aging

Eye Floaters

Astigmatisms and 20/20 vision

Eye exercises won’t improve vision

Subconjunctival Hemorrhages

Antioxidant supplements

Pinkeye

colorblindness

Treatments for Macular Degeneration

http://fhradio.org/RAM/archives/25210.ram
photosensitivity

http://fhradio.org/RAM/archives/25129.ram
Dry Eyes

http://fhradio.org/RAM/archives/25124.ram
Eye-care professionals

http://fhradio.org/RAM/archives/25123.ram
Vision changes in middle age

http://fhradio.org/RAM/archives/25099.ram
Causes and treatment of Glaucoma

http://fhradio.org/RAM/archives/25007.ram
The Eye Doctors

http://fhradio.org/RAM/archives/24215.ram
preventing macular degeration

http://fhradio.org/RAM/archives/24214.ram
Macular Degeneration

http://fhradio.org/RAM/archives/24205.ram
Pinkeye

http://fhradio.org/RAM/archives/24140.ram
Vision problems and young children

http://fhradio.org/RAM/archives/24121.ram
The causes of glaucoma

http://fhradio.org/RAM/archives/24051.ram
Eye Injuries cuased by sports

April fools has REALLY jumped the shark when people start claiming they have an in home, do-it-yourself solution for LASIK.
The domain is registered by proxy, so we don’t know who is perpetrating this fraud. I seriously hope the general populous doesn’t believe it. The comical cartoon of someone performing LASIK on themselves really gives this away as some sort of joke. I also like the “No-Blink” eye drops so that you won’t blink while lasing yourself.
I’m pretty sure this has to be an ophthalmology resident with too much time on their hands and wanting to make a couple bucks from google adsense advertizing. Trying to order the “kit” only causes an error message, so at least they aren’t trying to hoodwink anyone out of $100.
Also, even if it were for real, wouldn’t the home user be prosecuted for practicing medicine without a license?

I saw this from an Optometric Physician e-mail newsletter. Coopervision has a website that will attempt to keep track of legislation regarding contact lenses.
I especially enjoyed the letter they wrote to the Utah Attorney General.
Coopervision also has an interesting news site regarding its own contact lenses.
Here’s what I think. Since Utah law makers are so keen to pass laws helping thier own Utah businesses instead of protecting patients and free market enterprise, why don’t all contact lens companies establish offices and factories inside Utah? Then lawmakers won’t know which Utah company to help, so in the end they’ll just have to look at the facts instead of special interests.

I have finally decided to take Medicaid, but now that I will, I probably won’t see very many people this year. When money gets tight with Medicaid, Vision and Dental always seem the first to go. Of course, some people claim money isn’t tight in my state since we had a budget surplus (but they’re not going to give it back to the tax payers).

Anyway, the reason I decided to participate is because I had a wise colleague tell me that when starting up cold, some days Medicaid patients might be the only patients you see that day. My consulting firm also told me to accept as many insurances as possible at the start, then when business picks up a lot, we can decide which low paying plans to drop.

My wife says that it’s good PR to take Medicaid. She’s right. I’m going to take Medicaid patients, and I’m not going to complain about it. I will, of course, write letters to the government to number one, stop taking so much money away from me, and number two, give a poor doctor a break and reimburse better.

I have been exploring the option of accepting Medicaid in my practice. I have been told by some not to bother because the reimbursement is so low. Anyone can look up the reimbursement rates on the Utah state website. I’ve compiled the ones I expect to commonly use into a spreadsheet and compared them to Medicare’s reimbursement rates. Keep in mind that Medicare typically sets their rates at 60-80% of the average usual and customary.

The first thing you will notice is that UT Medicaid reimbursement is ridiculously low. Now, take the time to read the vision provider manual at the UT Medicaid site.

If you are like me, then you will have some questions. Here are the ones I had. Can any of you answer them?

1. Can I be a provider of Medicaid optometry services but not bother with providing Medicaid frames and lenses? I’m asking this because I may not be able to break even with thier reimbursement for materials.

2. Does Utah Medicaid have a lab I should use or would I be expected to find some ridiculously cheap frames and lenses to dispense? Oregon has a Medicaid optical lab where all Medicaid orders are processed. The doctors don’t lose money on materials, and they can charge Medicaid a dispensing fee.

3. The example of a frame upgrade in the manual was: normal price $35. Upgrade $50. Medicaid reimbursement $27.50. Is it okay for me to find some frames that I sell for $27.50 and dispense them to all Medicaid patients? I have heard stories of opticals using frames they can’t get rid of (i.e. discontinued models, ugly frames) as their Medicaid frames. Then they use an in-house lens grinder and put cheap plastic lenses with only a single side scratch coat into the frame. Is this okay? Pretend I only have ugly, BC frames for 27.50. The rest of my stylish frame selection runs around $100-$300. If the patient wants anything fashionable, then they’d be forced to upgrade and pay the difference themselves. So, why would I have any frames in the low price range other than 27.50?

4. Does the state of Utah honestly expect $27.50 frames to last two years? Seriously!

5. Can I opt to see only Medicaid children, not adults? I can see as many as 3-4 children in one hour, whereas adults take longer (they have more problems and love to orate about what a shock it is that ever since they turned 43 they can’t see up close anymore), so I can only see 2 per hour. If I’m getting so little reimbursement (39.29 on an S0620), then why not earn more money per unit time?

6. Can I opt to see only blue card recipients and not purple or yellow? From what I understand, blue card allows me to bill Medicaid $30 and any difference between 30 and my usual and customary can be charged to the patient. With Purple and Yellow, I have to accept Medicaid’s assignment as payment in full. Why would I want to see anything but blue card patients?

7. Why does UT Medicaid require refraction be included with 92004 and 92014 when that is not the definition of these services in the AMA’s cpt code manual? This question could be asked of most vision insurance companies. I believe the reason lies in getting something for nothing.

8. Why does Medicaid not pay for polycarbonate lenses for minors when that is the standard in the entire eyecare world? I believe the answer will be fiscal-no concern for trauma prevention.

9. Why is pachymetry (76514) not a covered procedure? Even Medicare pays 11.04. It’s only standard of care for not only Glaucoma, but many acute corneal conditions.

10. Why is the reimbursement for 92060 (VT Diagnostic exam) and 92065 (VT progress exam) set at the ridiculously low price of $5.32 and $4.13? Even Medicare, which typically reimburses 60-80%, pays $50.43 and $31.83. Do you think it’s ethical of me to know how to treat vision therapy conditions, do so regularly on patients with other insurance, but refer out a Medicaid patient because the reimbursement would cause me to lose money? The overly low reimbursement for VT services really chaps my donkey. They are forcing us to be unethical if we decide to be a provider because who in their right mind would accept 5-10% of their usual and customary as payment in full? The assignment is so low you would lose tons of money to try VT on a Medicaid patient.

Anyway, this is just the start of my concerns about becoming a Medicaid provider. I talked with an OBGYN physician once, and he says that for him, seeing Medicare and Medicaid is his charity work.

Another thing I don’t think is fair: How do you explain to your private pay patient that your exam really is worth the $85-100, but at the same time accept $35.50-39.19 as payment in full from a Medicaid patient?

For those of you consider PM and EMR in your ECP practice, I’d give Officemate a look. I am. A cool feature about their support service is that they not only have an online knowledge base, the knowledge base comes with an RSS feed! Very cool. Officemate must be one of those progressive companies.
I noticed they recently redesigned their website. At first they didn’t have up any barcode scanner partnerships, but now I see they have it back, including one that is bluetooth wireless, so you can walk around the room scanning stuff.
I don’t know why they partner with a tablet PC company if in their hardware specs they state that wireless computing is not recommended. I plan on implementing some of my computeres as wireless, so I’ll let you know how that goes.
Yes, right now I am planning on buying officemate. It’s been a long road of research, but for the money, I get the most features with officemate. I just hope the add-ins like barcode scanners and the box for integrating pretesting equipment doesn’t throw the savings out the window.

Neckties of doctors containing bacteria are old news; however, I saw a news report on it again this week. There are those who advocate the abolishing of neckties from the doctor’s office and hospitals. I won’t complain about that, but isn’t there another alternative to think about?

How come the necktie industry hasn’t come up with washable ties? In our day of space-age fabrics and technology, surely someone somewhere can manage to successfully market washable ties.

Actually, I love retinoscopy. I find that for me it is more accurate on kids than the autoRx. Anyway, an alert Optiboarder happened upon this [broken link- does anyone know where it is now?retinoscopy simulator. Since it’s in Spanish, allow me to translate.

The green circle on the left side is a spherical plus lens, the left red circles are minus lenses. To actually put the lens in front of the eye, you must click on the circle you want. The middle number is the retinoscope’s light orientation in degrees. The red and green circles on the right are minus and plus cyl respectively. Obviously, those of us belonging to the primary eye care profession won’t have need for the plus cylinder. Adjust the minus cylinder axis in front of the eye by clicking on the red circle to put it in play, the click on the little 3-circle-icon below it until it orients to where you want it.

The dice are to generate random patients. If you want to test yourself, then close both of the eyes by clicking on them.
If you want to generate an Rx yourself to see what it looks like, then you can adjust the controls by first clicking on the type you want, Myopia, Hyperopia, SMA, CMA, SHA, CHA, and mixed (in that order) then press the up and down buttons next to sphere, cylinder, and axis (in that order). The astigmatism value is limited to a maximum of 6D. I’ve personally seen patients with 7.50, but I suppose they are simulating a phoropter without the accessory lenses.

In the lower right corner is the working distance adjustment. If you normally use the R +1.50 lens in the phoropter, then leave the “Compensacion por distancia de trabajo” at zero. But if I wanted to simulate skiascopy racks, then I’d put my working distance at 1.50, and then I would only use the spherical lenses on the left.

Anyway, I thought this might be useful for optometry students to hear about. It also looks cool.

I thought the state of Utah was already beyond the pale with their blatent anti-optometry ruling in Optometry vs. IHC. Now, certain Utah state legislators want to take it further.

Utah Senate Bill 176-SO1 wants to take away a common contact lens industry practice of private labeling. You know, the Biomedics 55-type lenses that are custom wrapped for different businesses. Mostly I just see the big box stores do this, but I suppose there are still private practice ODs out there doing it; however, I believe most private practice ODs should have already switched to silicone hydrogels exclusively for regular spherical lenses since they are healthier for the eye and usually have a better margin.

Anyway, the proposed law has already been recommended by the Business and Labor Committee. I find it ironic that the State legistlature has already done away with the mandatory seat belt use this session citing the notion that:

“This is a case of taking away a personal choice or freedom without sufficient cause,” [Senator] Christensen said.

Well, how about the nosey government getting in the way of a patient-doctor relationship? How about the patient’s right to refuse some private label? They can advise their doctor that they only want a lens available anywhere.

This is also a Darwinian matter. The doctors supporting private label schemes get selected against by savvy consumers while un-savvy consumers get selected against by getting trapped into a unilateral source.

Why didn’t they just make a law requiring contact lens patients to buy a full year supply up front instead of going somewhere else? If the legislature is really intent on benefitting patients, then they should think about the eye health of all those people over-wearing their contact lenses, getting eye diseases, all just to save a couple bucks. If they want to be consistent, then these Nazis Utah legislators in bed with 1800CL should enact laws to MAKE them buy a 1 year supply upon getting a CL Rx.

What’s comical is that the proposed bill:

19 . provides for certification of contact lenses with the Utah attorney general;
20 . requires the attorney general to maintain a listing of all brands of contact lenses that
21 have been certified with the attorney general; and
22 . provides penalties for violation of the certification provisions.

Won’t that be great! There are no monies appropriated to this bill, and in the fiscal note, they claim that “It is estimated that provisions of this bill can be implemented with existing resources.”
So the UT Attorney General staffers are going to do what a whole business called Tyler’s Quarterly does? I can already hear the cursing from the AG’s office about all the busy-work they’re going to have to do.

Let’s also scrutinize this sentence from the bill:

(1) “Alternative channels of distribution” means a mail order company, Internet retailer, pharmacy, buying club, department store, or mass merchandise outlet, without regard to whether it is associated with an individual authorized to prescribe contact lenses under this chapter.

Guess which Utah company the top 2 alternate channels describe? 1800CL. Which Utah company could have the clout to push a needless bill like this one? You guessed it.

This whole thing is a big sham. The only people who could possibly want to legislate this issue are 1800CL and their employees. If we have the freedom to choose to not wear a seat belt, then we also have the freedom to discuss with our doctor which brand of lens we’re going to try out. If (s)he persists in wanting to only Rx a private label, we also have the freedom to go somewhere else.

Next thing you know, they’re going to legislate that we can’t support our local grocery store. We’ll only be able to shop at Wal*Mart since their house brand of peanut butter is cheaper.

If you want to keep track of this bill’s progress, you can sign up for an e-mail notification.

BTW, the UT state senator who proposed this bill publicly revealed a “Health care” confict of interest.

North Carolina democrats in the state legislature want to “repeal a requirement that kindergartners get a comprehensive eye exam.”
What the…? Shouldn’t the government pay for everything? We’re already paying for their breakfast and lunch. Why not an eye exam?

“I am surprised that (the senators) don’t want to do everything possible to detect early problems so those problems do not interfere with a child’s ability to learn for years,” Black said.

What about the parents? Are you going to tell me they shouldn’t want to do everything possible? You know, like maybe budget for an eye exam?

I’m just surprised this is a democrat motion. Where are the conservatives?

Of course you know what this means. The dems took a lesson from Jimbo Carter and the AOA. It’s the eye doctors who should pay for children’s eye exams, so why should the government?:roll:

EDIT:
Whoops. This article explains that the law states the kids have to go get an eye exam on their own– it won’t be paid for by the state government; however, it has to be done before the kids get in school. They also site pediatricians and ophthalmologists that claim complete exams aren’t necessary because vision screenings are adequate.
I’m glad tax dollars aren’t used to pay for exams. I’m also glad that someone is trying to tear down unneeded government regulations.
I’m not impressed by the MD’s who say vision screenings are adequate. If that were true, wouldn’t we have an end to refractive amblyopia and other conditions that can be minimalized by early detection? Parents should take some responsibility and get their kid an eye exam per AOA recommendations. I feel that vision screenings give parents a false sense of security. Sure, not paying for something is convenient, but what about the parent whose kid got a false negative, could have obtained a complete exam, but didn’t bother since the kid supposedly passed the screening?