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Yesterday I had 5 minutes of my life wasted by a telephone scam.

My optician takes a call from a “Mike Randall” in California. I’m occupied at the moment, but he won’t leave his number. He says he’ll call back in a few minutes.

I’m free the next time he calls. I’ll loosely quote the conversation.

“Hi, I’m Mike from CSI in California. Listen, my boss asked me to call you because– You have a 4100 printer right?”

“Yes.” We do, in fact, have an HP laser 4100 printer.

“A customer nearby your location has been sent a supply of toner for the 4100, but the customer failed to notify my boss that they’d switched to a different model, so we’d like to call FedEx and tell them to reroute the package to your office.

“Okay. . .”

So, how do you spell your last name?

“L-A-N-G-F-O-R-D”

Okay, so I’ll send those on over. What was your zip code again?

That’s when one too many red flags went off. I had never had any contact with this person before. In my government setting (Indian Health Service), my supervisor asks for printer toner by making a requisition. Everything goes through the Supply Department. If we had ever done business with “CSI” (a rather dubious business name), then they would only have the supply department’s contact information, not my clinic number.

“Wait a minute, Mike. You are confusing me.”

“I’m confusing you? Well, let me explain. . .”Then he starts to launch into the same schpeel as before.

I interrupt him. “So, are you going to charge us for the toner?”

“Well, we would offer it to you at a dramatically reduced rate since it–“

“Do you realize you are calling a government facility?”

“Uh, yah. Uh, Health and Human Services, right?”

“Yes, and you see, in the government, everything is done by requisition. I am not the person you should be calling. I have nothing to do with ordering printer toner, and–”

CLICK. He hung up on me. I am positive this was some kind of scam. If he were from a real, reputable company, then he would not have hung up. He was also trying to confuse me. I’m sure if I hadn’t interrupted him, he would have continued with questions like:

“Oh, and I need to confirm your billing and shipping address.”
“Oh, and I need your credit card information to secure shipment for the toner.”

What I still don’t get is: how did he know I had an HP 4100 printer? Afterwards, I was thinking he could have guessed, since it’s a popular printer. If he guessed wrong, he could have danced around it. Now that I’m thinking about it, I wonder if my optician told him on the first phone call. I’ll have to ask her. I’ll bet he told her part of his schpeel and said toner and asked her about the model we have.

Anyway, I thought I’d give everyone a heads up that someone out there has targeted an optometrist for a scam. I’m sure you already have policies in place about your staff ordering stuff from people named Mike with CSI in California.

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The is my second installment of Practice Names Never Used. (The first one appeared here.)

Bull’s Eye Center
Dr. Range Bull

One Eyed Clinic
Dr. Cy Clops

Snake Eye Clinic
Dr. Snake Unlucky

Pop Eye Clinic
Dr. I. Yam

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I’m test driving a new theme. I started looking for a new theme when one of those automated robot news-grabbing-sites-on- eye-surgery used the same theme as the one I was using (Blue Fade). I put in a theme chooser pull downlist. Let me know which one you like best.

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Here is the link of Capt. Greg Ketcher, OD talking about his experience being deployed for Katrina. His original two week tour of duty has been extended.
Be sure to check out the pictures he links to.

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Eyetel Imaging makes a product they call the DigiScope which they market to your family doctor (PCP). The way it works is your family doctor handling your diabetes medications can also save you a trip to your eye doctor by performing a “ten minute exam.” They dilate your eyes, take a picture, send it to Johns Hopkins, then recieve the results. This supposedly is better patient care because you are giving the patient a valuable service and saving them time. Of course, the family doc can bill for this (CPT code 92250), and if no problems, then don’t schedule with Dr. Eye, just revisit your PCP next year.

The Indian Health Service has been doing “teleophthalmology” for years using the IHS/Joslin Vision Network where remote facilities without an optometrist nearby use a tech to take retinal pictures which are analyzed at Phoenix Indian Medical Center. (Don’t quote me, but I believe optometrists are part of the reading/interpretation of the photos.) It’s a good idea considering Native Americans with diabetes have annual eye exams only 50-60% of the time. (Part due to no-shows, and part due to access to eyecare- not enough or no optometrists at location.)
So if we have a population that lacks access to eye care, a product/system like the DigiScope is a great idea. What if you live in a well populated area with lots of eye doctors around. Do you want your neighborhood PCP to go out and buy one of these?

Of course not! It cuts into our turf! They can’t do that, can they? When I get into private practice and if the local PCP decides to get one of these DigiScopes, then heck, I’ll start steeling his/her hypertensive patients. Yah, my state’s laws allow me to treat with any medication as long as it’s eye-related. Hypertensive retinopathy is eye-related, so I’ll be kicking out the lisinopril Rx’s left and right. I’ll have the patient come back for BP checks and everything. If it gets complicated, sure, I’ll refer to the “Blood Pressure Specialist.” How do you like them apples, PCPs-using-DigiScope?

Another note.
It’s been tattooed on our brains that before dilating, we must screen for possible angle closure by performing pupils, angles, and pressures. On their“Dilating Instructions” pamphlet, they simple ask about history of glaucoma and do a pen light test of angle depth. They cite the Baltimore Eye Survey as their justification for using only these two criteria to determine that it’s safe to dilate, but they actually reference a follow-up to the survey “Incidence of acute angle-closure glaucoma after pharmacologic mydriasis” published in the American Journal of Ophthalmology (Am J Ophthalmol. 1995 Dec;120(6):709-17.) Here is the abstract, and these are the quotes that stuck out to me:

. . .Of the 4,870 subjects whose eyes were dilated on screening examination, none developed acute angle-closure glaucoma. However, 38 patients of the 1,770 who were referred for definitive eye examination were judged to have occludable angles on the basis of gonioscopic methods. Of note, subjects aged 70 years and more were three times more likely to have occludable angles than those aged 40 to 69 years (P [less than] .004). . .These criteria provide 60.5% sensitivity and 93.3% specificity. CONCLUSION: If screening is performed accurately and the results are negative, the risk of dilating a potentially occludable angle was less than one in 333 subjects (negative predictive value, 0.997) in this population.

So if your family MD’s staff don’t properly apply the screening criteria, then roughly 2/100 patients could get occluded angles (the 38 of 1770 stat), but if they do it right, then 1/333. I’ll bet many family docs are willing to take those chances. It’s also interesting their pamphlet tells them to use tropicamide 0.5%. Since diabetics tend to dilate poorly, especially if they have brown eyes, I always use 1%. (I haven’t had a chance to use Paramyd because your federal government in strapped for cash, especially in IHS spending.)

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Well, not exactly.
You keep you cell phone in your pocket and use a hands free headset. The new twist is the headset is integrated on your sunglasses or Rx glasses.
Very nice. The RAZRWIRE: a Motorola Bluetooth headset on an Oakley glasses package (O-luminum frame, XYZ optics, fabulous and trendy design) makes for an attractive package for your patients on the go.
Eye doctors in Portland, OR and Silicon Valley, CA should be all over this. Make sure you suggest it to any of your patients who take calls while in your chair.

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*Edit* Whoops. Someone brought to my attention that to get this deferment, you had to have had a loan before 1993. So disregard most of my lamenting below. Still, why would an established optometrist need a deferment? I would think they’d give it to us younger, income-deficient USPHS officers.

Holy Cow! All this time I’ve been paying back my student loans when I could have deferred them if they had come out with this sooner!
They have had Armed Forces and Peace Corps deferment for a long time, but the USPHS and NOAA deferment must be recent because the last time I checked the website 3 months ago, they didn’t have this.
I think I’m going to cry. I’ve been paying back my loans for the last 2 years because the IHS Loan Repayment program lately hasn’t had enough money to give more than one new award each year. The awards are based mostly on how remote you are, and while I’m in Montana, 2 hours from the closest Big Box Store, there are others more remote in places up in Alaska.
Getting paid half as much as an established practitioner, and 3/4 as much as classmates who went commercial hasn’t been easy. I like to think that the benefits make up for it, and they do; however, I would have liked to save the money towards starting my own practice. Oh well.
Now that I’m leaving, the Dept. of Education finally recognizes the USPHS.

*edit* The deferment may be used a maximum of 36 months.

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Here is what your patients are reading. I can imagine what some future patient is going to ask me.

“Sheesh, doc. Even the local humor columnist got the laser eye surgery. How come you don’t get it?”

“Well,” I say. “I’m not a good candidate because my expectations are too high.” [I expect a good excellent result 100% of the time. There shouldn't be corneal ectasia in a low risk patient for some undetermined reason. I expect to have great vision for the rest of my life without jeopardizing it with risky cosmetic surgery.]

Too bad this columnist never had the chance to wear the new silicone hyrogels when he was young. So, how come you, doctor, haven’t already got “some new eyeballs?”

*edit* You can follow up with humor columnist Robert Kirby. Apparently it has gone okay so far. It’s lucky to be in part of the 99% group.

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I just took a MaximEyes online demo today. They sent me a demo CD last week, and I was interested, and so I agreed to have the online presentation. They have some nice functionality.

VSP calculator. I once worked as an optician for exactly one month in Hillsboro, OR. Everyone in Hillsboro has VSP because everyone works for Intel. When ever someone asked me how much their glasses are going to cost them, I had no idea. VSP has an infinite amount of plans and coverages. Once they decided what frames and lens options, then we’d get out the tables and eventually be able to tell them. Well, what happens if they decide that, I’d rather change this option, how much is that? Well, here we go again. With MaximEyes, it’s easy. Just click on the options, press a button and there you have it. What to price a different lens option? No problem! I’d be happy to. Click. Click. There you are.

Electronic interface with EyeFinity for VSP authorizations. Very nice. No waiting on the phone going through some phone tree.

EMR has a very slick feature. Let’s say you see some lattice in the peripheral retina. You diagram it with their drawing tool. It has a little picture that represents lattice that you can drag onto the fundus drawing. Once you drag that on there, it automatically adds the ICD-9 code to your superbill. Sweet! And guess what, completely customizable. I can create my own little picture and assign it an ICD-9 code! Wow.

They also allow you to completely customize the layout of your exam view. Don’t like where the keratometry box is? Move it anywhere you want. Want to keep track of some data point that isn’t already on Maximeyes, there is a way to go create it. Think of the possibilities for research! Pretend you went back in time and no software out there kept track of central corneal thickness, but you wanted it. MaximEyes allows you to create new fields to keep track of in your database.

Your printed reports are completely customizable. Very nice.

They also have a service that if you pay ~$500/year, your patients can go to your website and enter in all their history/welcome form. The data automatically gets populated in your database. What a huge time saver!

Basically MaximEyes addresses most all of my requirements, except price. Call them for a quote, but it’s in the 10-18K range depending on how many work stations you require. Also it costs 2600 per year for support and updates. Ouch.

The consultants will tell you that software is like buying another piece of equipment; however, there is a large discrepancy in price between the low, mid, and high end software solutions. I hate to buy the most expensive, if something half as much will only inconvenience me a little. I will say that if I was planning on having most my business with VSP patients, I would go MaximEyes for sure.

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