Archive for January, 2007

Dr. Neil B. Gailmard, OD, MBA, FAAO, a practice consultant and editor of Optometric Management Tip of the Week says in his latest tip that private practice optometry still has a chance. Actually, when I read the tip, it was more about how it’s still possible for new/recent grads to open up cold. I agree with that because I just did.

He still didn’t convince me that private practice has a bright future. Acquiring financing is not the same thing as making money. Big box stores can sell eyewear for less than I can buy it, and while I can argue until I’m blue in the face that my lenses are better, it still doesn’t change the general public perception. Private practice competitor Luxottica, parent of Lenscrafters, keeps getting all the trendy, hot brand names like D&G, Prada, and even Tiffany’s to plaster on their frames. Vision plans reimburse less for eye exams than Medicare. Big box optometrists charge about as much for exams as what we eventually…someday…hopefully will get reimbursed from insurance. So that smaller cut of cash up front starts to make sense except private practice has 60-75% overhead while they have ~20%.

So, someone blog a compelling argument that private practice is here to stay instead of going the way of the pharmacist.

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David Langford

New Vitreous Floater Treatment

In the interest of full disclosure, we should tell our patients that two ophthalmologists are using lasers to zap away floaters.

CNN reports on two ophthalmologists, Dr. John Karickhoff of Virginia and Dr. Scott Geller of Florida, who use lasers to obliterate the floaters “to a very great extent.”

I wish I lived in Oklahoma. I’d dedicate my whole practice to this money making machine.

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A few list items for your consideration:

  1. Optometrists who fit one contact lens during the initial lens evaluation, but on the follow-up visit (if they even have one) write a prescription for 4 or 5 different contact lenses. If you don’t try them on their eyes, why even bother charging for an exam? Once I changed only the spherical power on a toric lens, and it caused the patient to have ghosting, so we went back to the original trial power and no ghosting. I can’t imagine not doing a trial of for each brand of lens that you want to prescribe when even different powers of the same brand can cause problems.
  2. Optometrists who don’t dilate anyone, or if they do, they don’t have a BIO. It’s deplorable how many practices I’ve observed without a decent BIO (if they have one). If you don’t dilate, it’s gonna catch up to you. If you dilate, do it right and use a BIO. Go buy a nice BIO. ‘Nuf said.
  3. Optometrists who give 5 minute eye exams. Everyone knows it’s not possible to give a good eye exam in five minutes, even your patients. A case history takes 5 minutes. If you’re entire basic eye exam takes five minutes, I have no idea what you’re doing, but it’s probably not ethical and/or legal. Step up your exams to 45 minutes (patient time) and do a thorough job. I like to do initial 15 minutes for case Hx, entrance skills, refraction, and IOP. Then let patient’s dilatation activate for 15 minutes, then return for last 15 minutes for eye health evaluation, recommendations, and patient education. Throw in an extra 10-15 minutes if they wear contact lenses.
  4. Eye doctors who prescribe old material contact lenses. We have PC-hydrogel and silicone hydrogel now-a-days. Wake up and smell your retirement, you old fogy, if you’re not prescribing them as your main lenses. They are much more healthy on the eyes. I think people with corneal neovascularization should sue if their doctor keeps them in plastic hydrogels if silicone hydrogels are available.
  5. Eye doctors who tell their patients that it’s okay to stretch their contact lenses beyond what is recommended by the manufacturer. I can’t count how many patients were astonished when I told them that all Acuvue lenses are 2 week replacement. They think I’m the liar, when it’s their prior sleazy optometrist who said it’s okay to wear an AV lens for a month. Don’t you realize that what ever you tell your patient regarding disposal frequency, they’ll probably double it?! Do you think you’re doing them a favor? You’re not because I’ve seen the corneal neovascularization, GPC, and the infections to prove that it IS a huge problem.

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David Langford

Do Not Become an Optometrist

I know there are many young people out there aspiring to become an optometrist. Maybe your sight was bad until one day, like magic, an optometrist outfitted you with glasses and contact lenses and voila’, you saw great. Maybe you think optometrists make a good living and your primary goal is to make a good living with minimal stress and inconvenience to your family life.

Well…kill your romantic notions of what it means to be an optometrist and focus on getting a better job.

First of all, what is the image of an optometrist? Perhaps you think it is overwhelmingly positive. Perhaps all of the optometrists you know have, like a clown, a smile on their face and a funny joke to tell. Trust me, they are crying on the inside.

Speaking of a good joke, have you noticed that every optometrist joke is a bad one. By bad I mean dirty. Trust me, don’t do an internet search for eye doctor jokes unless you like vile, base, worse-than-locker-room jokes. The only two clean optometry jokes aren’t even funny.

Seriously, optometrists have a huge PR problem. When ever we’re mentioned, it’s disparaging. Dave Barry goes to the eye doctor and his devoted fans use the comment section to crack wise. People on the internet view you as worse than used car salesman because you try to convince/sell them on the best (and more expensive) contact lenses and eyewear technologies.

Where is the love for optometrists?! Why can’t people respect their eye health enough to be glad the optometrist wants to dilate their eyes?

Doctor, “Can we dilate your eyes today?”
Most Patients, “No, I’ve got stuff to do today, so I can’t be bothered by with making arrangements once every year (or two or five) to have my eyes dilated. Eye exams should be like haircuts, in-and-out. It’s not like this is healthcare or anything.”

And that’s the problem. People value healthcare, but they don’t recognize that eyecare belongs to healthcare. They’ll pay their primary care physician what it takes to manage their kid’s allergies, but for their kids’ myopia, they’ll go to the big box store instead of the private practice optometric physician. They’ll buy their kid uncoated lenses and a no-name frame which only serves to lower his/her self esteem and get their lunch money robbed.

When I was in undergrad, we had a lecture series for students going into health professions. The doctor told the assembly, “If you want to be a vet that’s fine, but animals don’t pay the bills. People do.”
His point was that when faced with a choice to do an expensive procedure on an animal, they’ll opt for the cheaper option of putting it down; however, humans will pay what it takes to stay alive. The same applies to being an optometrist. Go into a profession where people value your services instead of complaining about the cost. Which is funny because optometry offers the best value for the healthcare dollar (according to Williams Group).

So people value healthcare, but they don’t value eyecare. Which is crazy because eyecare IS part of healthcare. “Vision Insurance” is such a bad thing because it makes people think that their vision is somehow unrelated to their whole body medical care. All eye exams should be under medical insurance, even if their isn’t a “medical diagnosis.” People get routine physicals and check-ups all the time without a specific complaint. Why can’t we do eye exams and be reimbursed by medical insurance without a specific complaint other than making sure our eyes’ health is fine and getting an updated glasses Rx?

I’m sure the dentists don’t mind that they’re not usually under the umbrella of medical insurance coverage. They have nice high fees. People value having a great smile. When the dentist does a filling, does he ask you if you would like the worst, cheapest metal implanted in your teeth? When I went in for a check-up, the dentist handed me a tube of Flouride and said to use this. In my mailed bill, there was a charge of $7. Did I contest it, saying I can’t believe you would charge that amount of money! I could have gotten it on the internet for $5!

Heck no.

So why the grief with eyecare services and products? How come people aren’t willing to pay what it takes for quality eyecare and eyewear?

Probably because there aren’t any big box dentists…yet. But why would the dentist go for the big box. They make good money. Optometrists go to big box because the money is there, right then, cash up front. If I’m new out of school and go to work for another optometrist, I might expect to be paid $50,000. Commercial will offer me $70,000-80,000, or if I own the contract of a busy store, I’ll get $100K+. Why in the world wouldn’t a new grad do commercial? Seriously, the only other alternative worthy of consideration is the Indian Health Service working as a PHS commissioned corps officer. If you do that your entire career, the non-contributory retirement more than makes up for not being paid as high a salary in the early years. The only drawback is living in a remote area, but if you and your family are fine with it, then you’ve got it made. Plus, IHS optometrists get to do real eyecare, not just refractions. If you want to diagnose diabetes and leukemia by looking in people’s eyes, then you want IHS. If you want to wear out your fingers writing prescriptions for eye drops and oral meds, then IHS is for you. If you want a full month of paid vacation, then IHS is for you. The patients actually respect you because they know you take care of their eye problems.

People in the city with an acute eye problem go straight to the OMD. It never even crosses their mind to come see you, the optometrist. Besides, you, an optometrist, are not even on their list of providers to see for medical eyecare because their insurance won’t let you, an optometrist, on their panel.

If the only reason you wanted to be an optometrist is because you want good pay and easy hours, then you are wrong on both counts. Pharmacists get paid just as much, if not more, than most optometrists- and they don’t have to sell stuff. The patients come to them with exactly what they want. Optometrists have had to expand their hours to evenings and weekends. Big box optometrists started it, and private practice copies it to stay competitive.

Do yourself a favor and be a software engineer, pharmacist, or anything else. Optometrists’ lifestyle will only go downhill. You’ll end up working Saturdays and Sundays, and during the week you’ll have to work every day until 7 or 8 PM. The student loans are not worth it. Pharmacists have the same pay without the student loan debt of optometrists. So do salesman. Do something else for your own sanity. You’ll end up poor and bitter. In fact, become an ophthalmic products salesperson. They make as much as the optometrists, and you can sell anything to an optometrist. After all, he/she was duped into becoming an optometrist, so they’ll be easy scores for your over-priced products.

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David Langford

Another OfficeMate Gripe

As if it weren’t enough that I had to buy a piece of software for $6000, I have to pay a yearly maintenance fee or else the software becomes disabled. Last year I remember them telling me it was going to be around $1000. I got my first notice that I have to pay this fee, and guess what. It went up. To $1400.

I think it’s hilarious that in their “Dear Loyal OfficeMate Client” letter (I’m only loyal because the program locks and holds my records hostage if I don’t pay) they say that the “invoice reflects a slight increase over last year’s fee.”

SLIGHT! So they’re laughing all the way to the bank while I’m already at the bank…on my hands and knees…asking for a bigger line of credit.

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David Langford

OfficeMate Upgrade from 6.4 to 7.1

I have Officemate, for better or worse. I have never been completely happy with it, but when I was doing research a year ago, the cost/benefit ratio for Officemate seemed like the best.

7.0 had been out for a while, and I was dismayed that no one had contacted me about upgrading. I guess because they have thousands of practices using it, they were doing a slow roll-out. I contacted them and asked for the new release, so they gave it to me (because I’m still paid up), and luckily the newer version 7.1 had just been released which fixed some of the bugs in 7.0.

There is no striking new look in 7.1 versus 6.x. It looks identical except they made a new icon that looks cooler. In other software products, usually there is a whole new look/feel to the application when changing version whole numbers. Oh well.

The coolest new feature in my mind is the new Reports tab called Business Analysis. It includes an Insurance Profitability report. In my practice and at this point in time, EyeMed has 58% reimbursement ratio and VSP has 43%. When I installed it, the numbers were 52 and 49 respectively. Your numbers may vary, but I like the tool.

The scheduler also got some new worthwhile features like the Today View and Confirmation, but I still hate it. It’s like they are thinking about what would be easier for the programmer to design and implement rather than what the user would like their experience to be. I don’t think it should be that hard to block off an afternoon or a day. Also, if you schedule someone without first making them a patient in your database, they won’t show up on your Quick List as having an appointment.

The Exam Writer also got some new features. Any e-docs appear at the bottom of the chart. If there is an glasses Rx already entered, the coding will automatically pull up myopia, hyperopia, etc. The spectacle and contact lens data entry are in separate windows. Unfortunately they forgot that sometimes contact lenses do have an add. I also hate, hate, hate the new design of the printed prescriptions for glasses, contacts, and meds. When it was smaller it was better because I had a pre-printed sheet with a “vision report” for the glasses and a pre-printed sheet with contact lens care and wear schedule for the contact lens prescriptions. Now they made the officemate printed prescriptions take up so much room on a sheet (3/4 of a page) that my old pre-printed forms are useless. But that won’t effect everyone.

Was does effect everyone is the confusion the officemate prescriptions cause. They have boxes for “Lens Information” that include Product name, category, material, and tint. I’m sorry, but that is for the optical order printout, not the Rx that I give to the patient in the exam room. The fields don’t even populate because I print it out before they are even sent to the optical.

Does anyone know how to change the template back to the old one for prescriptions?

Anyway, my upgrade process was smooth. I backed up everything before attempting it, and then Officemate backed it up again while converting it. The database back end is still a Microsoft product, but it needed to update the different tables and fields and junk I guess. I keep my database in a MS Server 2003 box with Raid 5. Officemate just requires a mapped network folder to store all the files. If I could do it over again, I would probably go cheaper by having just a file server that could make backups. On the other hand it is nice to have RAID 5 for back-up reasons, but paid a lot of money for that MS Server 2003 and client licenses. (edited to add: I didn’t mean backups, I meant in case of drive failure. I make encrypted backups everyday that I take off site in case of fire.)

I had heard all about 7.1’s ability to interface with VSP/Eyefinity, but I was dismayed that you must pay even more for this feature. I’ve already shelled out too much money for an equipment interface, so I don’t have anything left for VSP integration. I’ll just keep using eyefinity.com for free.

I’ve never used Report Writer. I don’t get it because if I had that much time to go through and enter in the options for the report, I might as well type it up from scratch. Why doesn’t it go through the exam and pick out the information instead of me having to select Established Patient, Reason for Visit, etc. You know, all I really want is something that can tell what diagnosis codes I billed, and ask me if I want to print out a patient information sheet for those diagnoses. That would be useful.

Anyway, the new reports are the only thing in my mind writing home about with Officemate 7.1. What did you think?

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