optoblog.com

Well, I know people have been secretly clamoring for more optoblog.com comics, so…you’re welcome!

Those of you who have been watching news only from the networks probably have no idea why current events are so scary. Those of us not simply listening to press releases straight from the White House and its Czars have learned scary things about hyperinflation, monetizing the debt, Cloward and Piven, communist infiltration in the government of a free republic, radical Muslim’s Caliphate, ATF’s Project Gunwalker, George Soros, the Nanny State, Cass Sunstein, back door gun control, Tax and Spend, the lie of Climate Change, Going Green = going broke, and ad infinitum stuff all designed to take away the God-given rights and liberties of Americans.

America, I am sure that the only way we are going to recover from this great big hole we’ve sleep-walked ourselves into is by returning to God. All of us need to repent and increase our Faith, Hope, and Charity. Only then will we be prepared to receive and accept his will regarding what our actions should be. Only then will He prosper our nation again.

Our government was founded upon faith-based principles. Invite everyone you know to increase their Faith in God, Hope, and Charity so that we can restore our government to the founder’s vision and so that God will bless the United States of America.

Tags: economy, Faith Hope and Charity, Glenn Beck, Repent, world events

Over at Student Doctor Networks – Optometry Forums some undergrad started a thread about me.

Am I real? Yes. Maybe you could have read more than just one of the 340+ posts on my blog? Maybe you could have looked at the side bar and seen the link to my twitter feed and my practice website?

Do I hate optometry? Nope. I like it fine. Sure, I’d rather be a rock star, but that will have to wait for now.

Did I make a whole bunch of inflammatory blog posts? Yes. But I can’t please everybody. I like Walmart optometry more than private practice for numerous reasons, but not the least of which is I feel like less of a salesman and more like the doctor I was trained to be. I think you can get that in other settings too, but I don’t want to work for the government anymore. I’m not academic enough to be a professor, and I don’t want to be an OMD’s “super-tech.”

In private practice, everyone else got paid…except me. The frame reps, the contact lens distributors, and labs, the staff, the landlord, , the bank, the equipment vendors…they all get their money up front or first thing. You, the doctor, get paid last…if at all. Risky.

if you like taking risks, then why not take a better bet in a different profession selling or manufacturing widgets with less restriction on maximum possible income?

Undergrad, if you really want to be a private practice optometrist, go ahead. I won’t stop you. I would ask you why you would gamble so much when you could practice in a setting with MUCH less risk. It does work out well for lots of O.D.’s, but that doesn’t mean it will work well for you.

By the way, I don’t think pointing these things out should be labeled “negative.” It’s reality. There are pluses and minuses to every profession. Undergrad, I don’t want to sugarcoat your potential career choice. I once thought I was going to be an architect because I wanted to design houses. I actually talked with an architect and found out very few architects design houses because most people buy their plan from a catalog. Most architects design banks and rest-stop bathrooms and other utilitarian buildings. That’s not what I would be happy with, so I switched majors. I’m thankful that architect shot straight. If you don’t believe me, then I hope you talk with an optometrist that you can trust who will also shoot straight.

Now, knowing more of the risks and potential negatives, if you still want to be an optometrist, then at least you’re not going into this blind. You won’t be able to say, “Why didn’t anyone tell me it would be this way?”

Anyway, I’ve spoken enough about this subject. I need to get back to writing/selling the next great screenplay so I can have a retirement.

Tags: optometrist, private practice, Wal-Mart

Flurisafe comes in a 6 mL dropper manufactorered by AL-ROSE Enterprises and is composed of Fluorexon disodium with benoxinate. Fluorexon’s heavier molecular weight makes it “safe” for use with soft contact lenses since it won’t permanently dye it yellow like fluorescein will.

If you don’t use Flurisafe, then you should try it out. I’m confident that you and your patients will like it better than fluorescein sodium/numbing drop combinations (benoxinate or proparicaine).

Here are my reasons:

1. My patients report less stinging with Flurisafe compaired to FluorBenox and especially proparicaine.
2. The mild stinging from Flurisafe seems to have a few seconds delay after installation, so that allows me to get the drop in both eyes easier for the little kids.
3. Most older patients report NO stinging with Flurisafe.
4. I can use it on any patient and not worry about rinsing it out with eyewash if they happen to want to try soft contact lenses later.

On the downside, it is a little more expensive than FluorBenox, but not significantly more. Also, I turn up my light level a little more using the blue light compared to using a Fluorette or BioGlo Strip; however, Flurisafe still lights up nicely while using a yellow Wratten filter (my slit lamp has one integrated; I just lower a pin.)

I get mine from Wilson/Hilco, but your usual ophthalmic supply company should have it also.

Try it! You’ll like it.

Disclosure: I have to financial interest in any companies or products mentioned above, and to date none of them have ever given me any free stuff.

Tags: eye drops, optometrist, pharma

I just got word that Ciba will discontinue O2Optix soft contact lenses. The time line appears to be:

• 7-1-2011 Doctors will no longer get trials for O2Optix
• 1-1-2011 Product availability not guaranteed
• 7-1-2012 O2Optix lens discontinued.

Ciba has been pushing strongly the one month replacement modality which flies in the face of the two week replacement schedule philosophy of their competitor, Vistakon. Ciba’s recommended alternative for those who have been in O2Optix lenses is to have their doctor refit them in Air Optix Aqua.

Tags: contacts, optometrist, patients, Wal-Mart

A shoplifter pulls a gun on four Walmart employees in a small room. The four employees heroically bring him to the ground. Walmart fires all four a week later because as the full story at KSL.com explains:

AP09 is Walmart’s policy on dealing with shoplifters. A copy obtained by KSL shows employees are allowed to use “reasonable force” to limit movements of struggling suspects. If a weapon comes out, however, associates must “disengage” and “withdraw,” the policy states.

Imagine you have a Walmart employee who cares more about rules than their own life. In that exact moment, they hesitate because rule AP09 springs into their head. Their hesitation could cost them their life. I applaud these three men and one women. They acted reasonably and rationally. We should throw a parade in their honor.

The pansy lawyers in corporate who wrote AP09 should revise their documentation to say, “However, in a post 9/11 world, if you believe your life is in danger, you should fight like Joshua on the 7th day at Jericho so that your inaction won’t cost you your life and potentially others lives also.”

Agreed, no one thinks a pair of socks or a computer is worth anyone’s life trying to defend it. Criminals don’t care about your life. They kill kids to steal their Nike Air Jordan shoes! They kill to try to stay out of jail. You won’t know if they actually shoot or not until after the fact, but guess what! The very fact they pulled out a deadly weapon means that they are willing to use it! This isn’t about socks or computers anymore. We have to assume that if they pull a gun they are going to shoot! They are willing to…kill…you!

Walmart shouldn’t expect people to play dice with their own life. Those Fabulous Four didn’t allow chance or the crazed mind of a felon to determine whether they went home to their family that day.

Before September 11, 2001 popular belief was that if you give into the demands of evil people, then you would be okay. Apparently corporate Walmart never got the memo that the rest of us received on 9/12.

Tags: off topic, Wal-Mart

UPDATE 2-26-2011: Ciba and Walmart came to an agreement, and ClearCare will soon be available at your nearest Walmart very soon if it’s not there already.

Walmart will sell out their existing stock of ClearCare, but won’t be reordering more. Here’s from the memo dated 1-24-2011:

• Jan 1, 2001 Ciba Vision has incorporated a substantial cost increase to their Clear Care items throughout the industry.
• We take any and all cost increases very seriously especially if the supplier is unable to justify the significant increase completely.
• In the interest of our customers, we will not carry Clear Care until this matter is resolved.

They go on to suggest that the V.C. associates can ask the Doctor Partners to recommend a suitable alternative product.

Isn’t this what happened to Rubbermaid?

Tags: CL Solutions, contacts, optometrist, patients, Wal-Mart

I noticed the OfficeMate Knowledge Base had this update for us about certain CPT codes:

In the 2011 CPT Coding Manual, which is effective January 1, 2011, CPT code 92135 has been deleted and replaced with the following codes:

• 92132 – Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral (Replaces 0187T)
• 92133 – Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve
• 92134 – Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina

I like that because I hate having to remember modifiers like RT and LT, especially on tests that are most always run bilaterally anyway. I’m sure the insurance companies will like it for stats because it’s more descriptive by differentiating optic nerve vs. anterior segment vs. posterior segment.

UPDATE: Chuck Brownlow has more on this code change along with fiscal impacts.

Tags: coding, HRT2, insurance, OfficeMate

Dan Kaminsky created an iPhone & Android App for people with red-green color deficiencies. It exaggerates the hues after you take a picture on your app-phone.

Tags: color, patients, tech

I have previously announced my intention to dump OfficeMate because I didn’t want to spend close to $1000 updating my server software from WSBS2003 to WS2008R2-standard for the version 9 upgrade (and that’s in addition to the painful yearly software agreement fee).

Well, now I’m not so sure. All I need is for something to easily enter data and claims, export an ANSI 837 file, and include a ledger, receipts, and reports system so that I can easily see my accounts recievable.

Well, apparently that’s too much to ask because I have test driven several competitors, and believe it or not, their interfaces are actually worse than OfficeMate’s!. Several of them won’t export a simple ANSI 837 file to upload to a clearing house like Apex. Maybe it’s just because I’m used to the OfficeMate system after four years. I can quickly do all my insurance billing and receipts myself (no paid help) in OM8. Of course, so far this year I only bill insurance for 27% of my exams, which is close to average for my practice profile.

So if I abandon OM for another system, it’s going to take me way more time to process claims and figure out accounts receivable. With Walmart getting into the Medicaid game on glasses, now I’m sure I’ll have even more insurance to bill in 2011. So, as of now, I am leaning towards biting the bullet and doing what it takes to upgrade to OfficeMate 9.

An interesting topic is how many mouse clicks per patient one needs in EHR/PIM software. A doc at EHR Compare forum reports that it takes his office 200 clicks per patient in OfficeMate. Is it any wonder that many docs think EHRs are not ready for prime time? (Example 1, 2, 3)

Why hasn’t someone created a free or cheap, open sourced PIM/EHR that is easily navigable? I tried OpenEMR (which you can install on a windows machine using XAMPP), but it was confusing how to create charges with attached ICD9 and CPT codes, let alone create an ANSI 837 file.

Tags: EHR, EMR, OfficeMate, PMS

In Sunday School we talked about family history, and I was thinking about how my posterity could get to know me. It should be easy enough because I have written tons of essays for school, blog posts, comments on blogs, church talks, journal entries, etc.

However, all those writings are scattered in paper, word processing files, and the internet cloud. Wouldn’t it be nice if there was a single application/program that could capture everything I write? It could be a combination of WordPress and LastPass. If I write a blog post, tweet, or FaceBook status update, it could tap the glass and say, “Hey, do you want to save this for posterity in your personal document database, and if so, under what category?”

Then it would also allow me to import word processing documents or scan from paper.  I could make an instant memoir by publishing to pdf.  I want the database file to be encrypted so I can keep my diary on there too, and I would prefer it to be a file I keep on my local machine.

Anyone know of an app like this? If not, someone should make one.

Tags: journal, software idea