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Well, this was annoying. I did a favor for a patient and billed an insurance that I’m not contracted with but which allowed any provider to bill them.
Instead of the mailed EOB including a check, it had a graphic of a credit card with its number, expiration, security code, and zip code.
They call it “QuickRemit, virtual prompt payment.” (I guess by prompt, they mean 6 weeks from date of service.)
If I didn’t have a merchant account, I wouldn’t be able to process the funds. Luckily I have Square that allows me to punch in the numbers to get paid from a card not present, but I find it really annoying that I lost about 4% of the payment because the insurance company chose not to sent a check!
I wonder what the benefit is for them to do this. I get charged to process the payment and I’m sure they get charged to charge a virtual credit card. So, why not send a check, Insurance?

Tags: insurance, management

Each year the Optometric Business Academy releases their survey results for practice stats of Walmart and Sam’s Club affiliated doctors. (The OBA should not be confused with the MBA, Management and Business Academy run by the same sponsors for private practice optometrists.)

The OBA has the 2012 metrics for download here, and you’ll probably have to log in to get it. Even though it is the 2012 report, it’s really analyzing 2011 stats.

If you were to guess the most likely day an optometrist takes off, you would guess Sunday, of course. But did you know the second? Turns out that about a quarter of us take Mondays off. That’s me, too. I like to pretend I have a weekend.

And seriously, here are some points they make that I ordered and would like to discuss:

1. Typical affiliated ODs spend less than
   0.5 percent of gross fee income for
   marketing. The median expenditure is
   $500 annually, a sum insufficient to fund
   any significant initiative.
2. Affiliated ODs are generally less
   active in service improvement processes
   recommended by service experts than are
   private practice ODs.
3. Among the major advantages of hiring
   staff is the ability to shape a service
   culture and service standards to deliver a
   consistently excellent patient experience.
4. …only a minority of affiliated practices actively market medical eye care services today.

Okay, #1. Part of the reason that I don’t spend on advertising is that I don’t collect a lot of money to do so AND I’m in a high traffic location anyway, so spending a lot on external marketing doesn’t make a lot of sense. Maybe Sam’s Club doctors should spend more, but one of the advantages of being a Walmart doctor is that my marketing budget can be low since I have more awareness by default. Also, private practice doctors spend more on marketing because they sell $500 pairs of glasses. I only collect money on exams. My gross is much less, so my overhead should be less and that includes the marketing dollars.

#2 and #3 are related. Again it goes back to overhead. If I wanted the headaches of hiring, paying, training, providing benefits, scheduling, managing complaints, and firing staff…then I would be a private practice doctor. If I let Walmart handle the headaches, then why can’t I also let Walmart handle the service improvement process while I make the occasional suggestion? Also, where am I supposed to get all this money to compensate the staff I hire? If I’m a one-room doctor whose appointment book is not full, then what incentive do I have to spend money on staff? If I’m a doctor whose appointment book is starting to get full, it’s a big cut in pay for me to hire more staff, hope business picks up, and somehow try to change exam-traffic flow in a Walmart optical floor plan.

Speaking of which, where does my hired air-puffer do my insurance billing when they’re not taking acuities? There is no nurse’s station. The Walmart floor plan needs to change before I get crazy and hire a staff of people.

#4. I’ve been hearing for years about how we’re supposed to be on board with the “Medical Model” which is a code word for billing a lot more medical insurances, which is more code for jacking up your medical fees because “you don’t want to leave any money on the table.”

First, there are three major insurance carriers in my area who only allow ophthalmologists on their panels- no optometrists. Second, if I start seeing a whole bunch of medical insurance people, then my accounts receivable will go up, and these are sicker patients who take up more time in the chair. Then I’ll have to start raising exam fees. Once I start raising exam fees, business will taper off because that’s the whole reason most people come to Walmart: the exam is cheaper.

Some people think it’s fine to charge a wildly different exam fee for “medical” vs “routine vision,” but I’ve addressed this topic elsewhere. In summary, I don’t think having a $50 “routine” eye exam while charging $150 for a “medical” eye exam is ethical.

On the other hand, I would love to charge some patients more if their case is complicated, but try explaining that to someone who got quoted a certain price, so that’s why they signed up for an exam. They won’t be happy paying more than they expected.

I wouldn’t mind having an hourly rate. I think that would be more fair for everyone except the insurance companies.

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Tags: Consultants, Income, management, MBA, metrics, OBA

Does anyone know good sites to buy old optometry equipment at a discount price?

Tags: doctors, Equipment, For Sale, management

So I have OfficeMate in my practice. I started using them in 2006 with release 7.x, and I currently have 8.x. It uses an access database which never really needed a server because it’s just a file that you could put on one computer and share it peer to peer. At the time I went ahead and bought an expensive Windows/Dell server because they recommended it, but I found out later from working with it that I could have just put the OM db file on cheaper network attached storage.

Anyway, along comes progress. OM with release 9 has implemented the famous, awesome SQL database. What makes it famous and awesome is that SQL is opened source and cross platform. So of course OM implements a Microsoft only version of SQL. The Windows Server Small Business that I’ve been using isn’t supported, so now I am faced with paying a whole bunch of money for a new edition of Windows Server standard. If I upgrade to that, I might as well update my client machines to Windows7. If I do that, my current video cards don’t support it, so I’ll have to either buy new video cards or just a new box.

So now, with all that plus the yearly, over $1K fee for OM, I’m wondering if I shouldn’t start over with some other solution. To tell you the truth, the only thing I use OM for is electronic billing. I just scan my paper charts with my awesome and fast Fujitsu Fi-6130 document scanner.

I really wish OfficeMate would have implemented a cross platform implementation of an SQL db. I could have just used a free Linux server to host the db.

Tags: EHR, insurance, management, optometrist, PIM

I have a little side project at roadmapplanner.com. It’s especially suitable for students (college or high school), but as a professional I use it too. It’s really helped me since this summer to stop being a slacker spiritually and get on task. My family is happier for my becoming a better person by performing the tasks and achieving the goals I set for myself. Please consider it for a Christmas gift for you or someone you love.

The Roadmap Planner with the Daily Dats System™ is a set of 53 small, portable weekly planners with goal tracking integration and 3 week future calendar and white space for taking down notes.

An 8 1/2″ by 11″ sheet of white, uncoated, card stock paper is scored for a trifold on the y axis, and the user also trifolds it along the X axis. This double trifold design (like a road map 😉 ) compacts the page to a 2 7/8″ by 3 11/16″ footprint that fits in your pocket. Because it’s card stock, it’s rugged enough to last traveling in and out of your pocket the entire week. Fifty-three sheets come in the package, one for each week of the year.

Features:

• The Daily Dats System™ for making, tracking, and achieving your goals.
• To do list at top of each day.
• Plan A and B for each time slot of the day.
• Half hour time slots starting at 6:00 AM and ending at 11:30 PM.
• Current week planner on front and 3 week future calendar on back.
• White space for recording new contacts and other notes.
• Different motivational quote for every week.
• The day and date is pre-printed so you don’t have to write it out.

Tags: Goals, management, off topic, Roadmap Planner

For you optometry students trying to make up numbers for your business plan, here are some percentages from my average Walmart practice:

In 2007 and 2008 I didn’t track the percentage of patients using insurance because I didn’t have to bill very much back then.

For more interesting stats to help you make your business plan, the OBA-CE has compiled these:

• Revenue Per Exam
• Complete Exams per OD Hour
• Annual Revenue Growth Rate
• Internet Site Penetration
• Contact Lens Usage by Lens Type
• Recall System Independent of Vision Center
• Walk-in Ratio
• Contact Lens Exams Percent of Total Exams
• Medical Eye Care Visits as Percent of Total Visits
• Exams Percent of Active Patients
• Professional Fee Income Percent of Total Location Revenue
• Performance Metrics by Years at Location
• "Elite” Practice Metrics
• Performance Metrics for Walmart and Sam’s Club Locations

Tags: Answers, contacts, eye drops, Income, insurance, management, optometry school, Wal-Mart

I think we should all consider going the route of “insurance free medicine.”
From guest blogger Dr. Mintz at Kevin, MD:

Thus, I think a term that I would like to propose for use in further discussions of newer ways of practicing primary care is “insurance free medicine.” The term “insurance free medicine” captures the essence of the newer models of primary care. Patients have certainly seen their premiums and deductibles increase and can probably relate quite well to reasons why a doctor would not accept insurance.

Insurance free primary care practices could certainly adopt retainer membership fees and promote improved access, but eliminating terms like “boutique,” “concierge,” and “cash only” might help eliminate the notion that primary medical care without insurance is somehow tainted or only for the super-wealthy. Previously, I discussed that without substantial changes, primary care will soon go the way of psychiatry in that patients who use their insurance to see a psychiatrist get one kind of care (very brief visits, mostly management by a non-physician) and those who pay their psychiatrist out-of-pocket get the kind of care that we see in TV and the movies.

With more frequent use of the term “insurance free medicine,” patients might start realizing that if they continue to pay their primary physician using their health care insurance, they should expect even briefer visits, longer waits to get in, seeing non-physicians, and greater delays getting a return phone call or results back.

I calculated the other day that I spent about $2000 a year to be set up and able to bill insurance. Further, I spent all that time and money for about 538 patients, or close to one-fourth of my patients per year. Now that Walmart no longer bills many vision plans for me, both numbers will go up, and so will my accounts receivable. In anticipation of this, my fee went up by $5 per patient at the beginning of the year.

I would lower my price if we could all convince the general public that routine medical office visits should be paid out of pocket. Your car insurance doesn’t pay for oil changes.

Tags: commercial, insurance, management, optometrist, patients

E-mail is awesome because you can send notes, pdf’s, and other files quickly and easily- except when you are a doctor. Since any script kiddie can sniff your e-mail inbox, doctors can’t send e-mails of cornea topographies to labs, referrals to colleagues, or special testing results to patients because that would be a breech of patient confidentiality and a violation of that one unnecessary, burdensome law.

I’m sure George Q. Public doesn’t want his K-readings leaked to the press when he decides to run for President someday.

But seriously, sometimes birth dates and stuff are printed on the reports, so if doctors want to use this cool, new thing called “e-mail,” we’ve got to set-up our e-mails to have the capability to send and receive encrypted messages and attachments. What does it look like?
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So your email inbox gets a message that looks like this. You have an e-mail client plugin that you have set up. You input your password, and the message magically translates to:

Dude, isn’t this so cool that not even the government can tell what I’m writing you? Unless…you forward this message to them unencrypted, but I trust you.

You can see this in action on my practice website. To get started and do this you need a few things:

Your practice’s domain name (usually your web host will offer e-mail storage)
or
any e-mail address that you can access via the e-mail client Thunderbird. (ie POP3 or gmail)

Download the following:

• GnuPG– the free, open source engine that runs encryption. The Windows version is found at gpg4win.org.
• Thunderbird– a free, open source e-mail client.
• Enigmail– a free plugin for Thunderbird that makes it easy to make your encryption keys, share your public key, store other people’s public keys, and encrypt/decrypt e-mails. You should read the install instructions for Enigmail.

Make sure when you generate your encryption key password that it is extra long and random. You must assume that anyone could capture it and try to brute force it. If it is long and random, it would be nearly impossible to crack. I suggest keeping your random, long password in a password wallet.

Why not do it?

• You are afraid.
• You don’t get paid to e-mail patients.
• Spam? Some people think that if they share their public key on a key server, spammers will harvest their e-mail address. I’ve had mine there for a couple years and that’s not happening…to me.

Barriers to entry:

• It doesn’t do any good for you to have e-mail encryption if the person to whom you want to e-mail the top-secret K-readings doesn’t have e-mail encryption set up. They must have a public key that they share.
• I’ve just presented a free way (unless you have a paid practice URL/webhost) to do this, but it does require some tech savvy to download, install, and implement the tools. This way requires the Thunderbird e-mail client. If you use Outlook or something, there are paid solutions out there.

Why do it?

If every doctor would just get in gear with e-mail encryption keys, we could send patient referrals with high quality color photos and reports instead of low res, black and white faxes (usually with a few vertical black lines on the page). We could send the lab a topography. We could send a patient a report or copy of their Rx. We could talk about the stupid government and how we all secretly agree with Glenn Beck, Rush Limbaugh, and Ann Coulter.

Tags: communication, HIPAA, management, optometrist, patients, politics

With Walmart’s announcement of a sweeping change about getting out of the business of billing vision insurance companies for their doctors, a whole new cottage industry has sprung up. Businesses are soliciting Walmart doctors to let them handle all the insurance billing.

Yup, I’ve said it before and I’ll say it again. Ophthalmic vendors think we optometrists are so stupid. Just because we picked this profession, they think we are prone to making poor financial choices just like some people are accident prone.

Any of you vendors seeking to do insurance billing for me are wasting your time. All I need is my practice management software and Apex EDI. It’s as automated as can be. Most of the vision insurances have their own website for authorization and billing, and then I use Apex EDI for my BlueCross, Medicaid, DMBA, and other miscellaneous insurance companies. (You can do Medicare also, but I am disinclined to participate with them.)

Apex EDI works great. It’s fast and easy. And I don’t need no stinking slick Rick to be some unnecessary middle man. It’s cheap too. I pay 43 cents per claim, less than a postage stamp these days. I also pay the extra $20 a month for the ERAs and Electronic Tools which make my life a lot easier, so it’s worth it.

Call up Apex EDI and tell them I sent you. Use my Champions Code (sales code) to get a better deal: Champ148. I use it in my practice (VisionHealth EyeCare PLLC), and you can use it in yours without the growing cottage cheese industry of Walmart insurance billing middle men.

[Note to Slick Ricks: Any more “comments” made by you to advertise your middle man services will be marked as Spam and deleted. Do us all a favor and go con some other profession.]

Tags: Consultants, insurance, management, Wal-Mart

Now, I don’t want you to get the wrong idea. I love kids. I have three young ones myself. I don’t even mind if patients bring their kids with them. We do that all the time. I don’t even mind if the kids are somewhat disruptive, like speaking out of turn, constantly asking questions, or even running around. It’s all good.

I was just speculating on what would happen if the kids where heck-bent on destroying stuff or if the parent decided not to manage inappropriate behavior at all and let them run around the office unsupervised. Then I thought it would be funny to put it in a cartoon. So don’t be upset. It’s comedy.

Bye the way, does anyone know the CPT Code for daycare?

Tags: Comics, management, patients