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It looks like doctors are at the bottom of the totem pole. We are in the wrong profession if we’re trying to make tons of money. I’ve recently had a few undergrad students want to shadow me at work. I tell them all the same thing, “Don’t become an optometrist because you think you’ll have an easy lifestyle and comfortable living. I work six 10-hour days a week, and I don’t even have a house. Only become an optometrist because you love it.”

They all give me that same look of trying to hide their befuddlement. I know they’re thinking, “Yah, but it’ll be different for me. You must be a bad optometrist because statistics say I’ll make over $100 grand a year.”

And I’m thinking, how could anyone possibly love to be an optometrist unless you already work as an optometrist? It’s a Catch 22. By time you are one, it’s too late to back out of all those school loans if you decide it’s not for you. Maybe a good check about whether being an optometrist for you is to go out everyday and explain to ten people, all over the age of 40, what presbyopia and astigmatism are and why all the sudden they can’t see up close anymore even though they used to see just fine until about two months ago. If you enjoy that, then maybe optometry is for you.

The Independent Urologist’s post makes me think maybe we should just start buying products directly from those who make them, not necessary those who distribute/market/resell them. Insurance has done nothing to help optometry, and I wish people realized they would be better off paying doctors directly for eyecare instead of adding a middleman who takes money from both of us.

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The AOA News reports that the FTC sent letters to a few eye doctors saying they were in trouble for not releasing the contact lens prescription.

This isn’t a problem for me. As soon as the contact lens prescription is finalized, I give them their copy. I even make it good for 2 years since that is what Utah law requires (unless there is a medical reason to make it one).

My problem is that almost every day, I receive a request for another copy of a patient’s CL Rx-and I know for darn well sure that I gave them their copy already. Patients are apparently losing/misplacing their CL Rx, but why do I have to waste time, paper, and toner to fill out another one?

I think I should be allowed to charge money for extra CL Rx copies. The first one is free, but additional ones will cost you. That is in a perfect, fair world. But life isn’t fair. As it stands, I’m not allowed to charge for additional copies. You know that one lady who comes into your dispensary at least once a week to get her glasses adjusted? What if you had some perverse person who enjoyed making you fill out a CL Rx every day or weekly? Do we have a recourse for that?

P.S. Normally you can’t access the AOA News site unless you have a user name and password, which requires membership in the AOA. This is also a big hassle because it should just be able to go publish an RSS feed so I can reed the content in Bloglines or Google Reader. Do they really expect me to open a web-browser, type in the URL, then type in my user name and password everyday just to see if they have updated content?

I think it’s funny that Ciba and VisionWeb pay for advertisements that only a small portion of the optometrists even see. The WSJ is going free because exposure of ads outweighs revenue from paid subscription. The AOANews should do the same. Hey Ciba and VisionWeb, tell the AOANews to go free and publish a site feed!!

By the way, you can circumvent AOANews’ username and password requirement by simply pasting “?AOAMember” at the end of each URL. Again, another reason to go free and offer RSS, AOANews.

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I had a great round of Golf with area O.D.s yesterday. Mount Ogden Eye Center sponsors a lunch, one hour of CE, and then a round of Golf for any northern Utah optometrist that is interested in taking the day off.

It was really cool to get together with local O.D.s who share the same concerns that I do about business aspects of practicing optometry in Utah.

I recently talked about a local HMO/Insurance Plan, IHC-SelectHealth, that discriminates against optometry. A lawsuit was brought against them by a group of individual optometrists which they later lost and now there can be no more appeals. My question was why wouldn’t the Utah Optometric Association or even the American Optometric Association get involved and sponsor the suit. The answer was not enough money and that there would be serious repercussions. The thinking is that IHC won’t counter-suit a bunch of individual optometrists, but they would the UOA, which could go bankrupt in such a scenario. Apparently a lot of optometrists were upset that there was a lawsuit in the first place because they thought there should be more diplomatic means.

I say the only diplomacy we need is with our state legislatures to enact an Any Willing Provider law so that IHC/SelectHealth’s discrimination would be illegal.

Another thing, this Insurance sponsored discrimination fosters an Us vs. Them attitude with ophthalmologists. The areas where both ODs and OMDs are all paneled is usually because early on, the OMDs went to bat for the ODs and got them on. In areas where ODs are not allowed, the ODs can start resenting the OMDs for not going to bat for them. Pretty soon, all our referrals somehow end up going to Ogden instead of staying local in the valley. Then the local OMDs get perturbed by not enough referrals from the ODs, so they might vow to never go to bat for the ODs. A vicious cycle.

The patients are the ones who really lose from this situation currently happening in Northern Utah. IHC/Selecthealth claims in their T.V. commercials that they are “Simply There” and according to their website, “SelectHealth offers members respect, convenience, excellent service, and affordable health coverage.”

Did you see the convenience part? How is it convenient to wait for weeks to see an eye doctor for a routine eye exam? I suppose it’s convenient for SelectHealth that people don’t want to wait for weeks so they go see an optometrist instead, and SelectHealth won’t allow optometrists to bill them and they won’t reimburse the patients either. I think that must be their evil master plan: subtly encourage patients to see non-network doctors so that they don’t have to pay out any money.

By the way, SelectHealth’s copay for eye exams is $35. So what’s another $10 to the patient to see a big box doctor for a $45 eye exam. Yet another way they encourage the OMDs to dislike the ODs for having such a thing as commercial optometry.

Insurance in general hasn’t done anything to help private practice ODs. We were much better off years ago when 90% of optometry exams were private pay. Vision Insurance is as worthless as haircut insurance. It only adds a middleman who takes from both the patient and the eye doctor. If we all just stopped taking vision insurance and slightly decreased our fees, the whole populous would be better off.

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I was listening to OD Conversations’ OD Radio podcast about school screenings. They don’t allow comments on their site, so I’ll comment on my blog.

They were talking about how they work with the school nurses and help out with screenings. They also implemented some additional tests to help catch more subtle problems. Wow, I’m jealous.

I contacted the local district nurses (they don’t have any in the school full-time, just traveling ones), and they gave me the brush off. They said they run their programs according to state guidelines and that they don’t need any additional help.

Now that my son is in school, this year I’m going to try to infiltrate the program from the inside by volunteering as a parent in the PTA to help with screenings.

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The United States Public Health Service Commissioned Corps has their own YouTube Channel.

I searched for an American Optometric Association YouTube channel but didn’t find one.

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In Utah, the major health insurance company is called SelectHeath, a.k.a. IHC, Intermountain Health Care, SelectMed, and SelectCare. What’s funny is that they allow optometrists on their panel in remote areas and even in populated areas like St. George where there are an abundance of OMDs; however, in the most populated “I-15 Corridor” and even in Cache Valley way up north, they only allow our “EyeMD” friends. The notable exception is the Brigham City/Tremonton area.

IHC recently rebranded themselves “SelectHealth, simply there” and claim in their commercials that they are providing quicker access to care, but if they don’t allow optometrists to be paneled then they are actually slowing access to care. Currently in my area, several OMD offices are booked weeks in advance- some doctors have up to a 2 month wait. Word on the street is that the Brigham City area panel was opened for optometry because of all the employees of ATK (rocket engines) in that area. They had to open up the panel for O.D.s so there would be enough eyecare providers for their ATK beneficiaries.I talked to someone in the know. A manufacterer of car air bags had a large number of employees on IHC, yet none of the eye doctors in the area were on the IHC panel, including the OMD. They opted to let an O.D. be panelled (presumably because the OMD was doing surgeries at a non-IHC hospital). Then they later allowed the OMD to be panelled if he agreed to take the IHC surgical patients to the nearest IHC hospital.

But what is the deal with restricting O.D. enrollment? They would pay me the same as an OMD for a routine eye exam, so it doesn’t make fiscal sense…actually, it does when you think that patients get fed up with the long wait to get in with an OMD, so they just pay out of pocket to be seen by an optometrist. IHC doesn’t have to reimburse anything because they went out of network to a non-participating provider. (And the only reason the O.D. isn’t participating is because IHC won’t panel him/her.)

Anyway, I tell patients about the situation all the time, and invariably they say something like, “Oh, it’s all political.” Exactly. They get it. They realize their health plan is flawed. I wish more patients would make a stink to the IHC administrators, but I’ll bet they don’t because they’re used to SelectHealth not being there for them despite what its commercials claim.

If SelectHealth really wanted their beneficiaries to have quicker access to care, they would allow any optometrist to be paneled anywhere.

When will Utah get an Any-Willing-Provider law? This type of discrimination should be illegal.

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Until I heard a Nidek podcast, I had never even heard of someone doing a corneal topography on all complete eye exams. Dr. Marc R. Bloomenstein is of the opinion that the information gleaned from a corneal topography is essential in evaluating every patient’s glasses prescription, eye health, contact lens evaluation, and surgery evaluation.

Wow, that thought has never even occurred to me before. EVERY patient? Holy cow, that would take forever with my current corneal topographer, a Keratron Scout. It requires 4 readings per eye, and then it has to download into the computer software. I have to spend a bunch of time to process the data and then finally print out a report for each eye. It does have a CLMI keratoconus screener which I find invaluable, but to do that on every patient would be extremely time consuming.

I actually had the nerve to e-mail Dr. Bloomstein after I listen to the above podcast, and he graciously responded:

So much information is derived from the topography that I feel we can not make informed decisions without this technology. In fact, I was just talking to a group of OD’s in LA last night about the apparent increase in Pellucid diagnosis, when in fact the topographer is just picking it up faster.

I recognize what Dr. Bloomstein is saying because it does give some useful data, but I would like to take a CE class about specifically what I can glean from routine k-topos. I know about the big things like KC, Pellucid, sim-K’s, but I need to know some of the finer details.

Have any of you reading this attempted to perform corneal topo on every patient, or even every contact lens patient? Until now, I have only done it on KC suspects and difficult CL fits and refractive surgery co-management. If any of you have successfully integrated K-topo on every patient, what kind of topographer do you use? Is it fast from reading to report? Did you raise your routine eye exam fees when you implemented K-topo for everyone?

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Is Retasure a good thing? Systems like this have been in place with the Indian Health Service in certain areas of the Southwest, but more on that later.

The Utah Optometric Association took exception to Retasure only saying the word “Ophthalmologist” and never even allowing for optometry to enter the picture. I take exception too, but if they have significant problems, they would go straight to the retina OMD guy/gal anyway; however, what are their referral criteria?

With any result other than no pathology, the American Academy of Ophthalmology and the American Diabetes Association recommend an immediate referral to Ophthalmology.

If there is any amount of retinopathy, they still refer to ophthalmology. Note, it doesn’t even have to be a retina specialist. General ophthalmologists are getting referrals that I, an optometrist, can manage. I can discern whether DR requires a procedure vs monitoring at specified intervals. Even after a procedure, I still monitor them and call or send a memo to the retina guy/gal about their progress. This exclusive “ophthalmology” wording is sick and wrong.

And I’m sure the system could be a potential cash cow for the PCP, but only if he has everyone do it- even if they would normally go see an eye doctor yearly anyway. I can foresee lots of patients getting upset if they find out their annual eye doctor visit isn’t covered because they already took a Retasure picture in the PCP’s office, so now they have to pay out of pocket for an eye exam to check their glasses. And us eye doctors are also going to want to check their eye health, and even if they could produce a Retasure photo, what about the anterior segment, vitreous, and peripheral retina health?

So, Retasure, did you really forget about optometrists or are you trying to make a political statement? Are you prejudiced against us? Do you suppose us not worthy to refer to? If so, check our training. We can handle diabetic eyecare. We also send notes to PCPs regarding the results.

But what about you? Do you really think this is a good system? Does it best serve diabetic people to be screened with this verses getting comprehensive eyecare annually? Eyecare which they probably want anyway so they can update their glasses and such? Also, in the Indian Health Service, they use this type of remote viewing system only in rural locations where there aren’t any eye doctors. Why do we need Retsure unless the PCP office is a significant drive from the nearest ophthalmologist OR optometrist office? And how many PCP offices fit that description? I’m sure not enough to make a profit for you.

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Have you all seen the future of visual field testers?

It’s made in Australia. I heard about it from medGadget, and you can read all their ophthalmology entries if your interested.

Sicne patients don’t have to press a button and it’s a short test, I’m hoping this would be a great test for geriatric patients.

It appears to me that we’re always going to have to update our equipment every couple years. What kind of practice setting allows us to do that? I bought an HRT2 last year, and now the latest edition of Review of Optometry equipment guide doesn’t even mention it! Should I always expect my income to be subtracted by thousands of dollars so I can always buy the latest and greatest tech?

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Ha-ha. You all are going to have a big laugh about this. An internet contact lenses price comparison website contacted me about possibly advertising on my blog. I think that’s pretty funny since you and I sell contact lenses in our respective practices, so why would we want to advertise to buy them online?

Anyway, I was thinking about more appropriate advertising, like products from ophthalmic distributors. But being a blogger, I’m not sure I want to accept advertising money because I want to avoid bias. What I would rather do is have vendors contact me about simply test driving their products, and then I can write a review about them.

If vendors think they have a cool product ready for prime time, then they shouldn’t be afraid of anything that a regular optometrist in the trenches has to say about it. Any publicity is good publicity, right?

Vendors, e-mail me at: david at optoblog dot com if you want me to test drive and give an honest opinion of your product.

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