USPS Can Search You!

For those of you who can’t see the above picture, the sign says:

VEHICLES AND THEIR
CONTENTS ARE SUBJECT
TO INSPECTION WHEN
ENTERING, LEAVING, OR
WHILE PARKED WITHIN
THIS RESTRICTED AREA.
ENTERING INTO THIS AREA
CONSTITUTES CONSENT TO
THE INSPECTION
(39 C.F.R. PART 232.1(B)(2)

And it’s not like this was some special parking lot out back. This is the front parking lot that everyone who uses the post office would enter. So here is my question: Why? Even if this is entirely legal…why? I don’t think it’s right.

When did this happen? Why didn’t the media get all over this?

When is it going to stop?

• Temple Square: Salt Lake Temple visitors’ center-North and South, the Tabernacle, Mormon Tabernacle Choir, Conference Center, Joseph Smith Memorial building with its Legacy Theater, Church History and Art Museum, and Tour Brigham Young’s Mansion.
• The Gateway: Discovery Gateway children’s museum, Clark Planetarium, Olympic fountains (bring towels).
• Thanksgiving Point: Dinosaur Museum, iWorlds space adventure, golfing, Dog Days
• Cabela’s- enough said!
• Hogle Zoo
• This is the Place Heritage Park- experience the Mormon pioneer version of the wild west.
• Living Planet Aquarium
• Tracey Aviary
• Red Butte Gardens (at the University of Utah). They also hold concerts, like the band Cake on the 16th.
• Bingham Mine (a.k.a. Kennecot copper mine) tour- largest open pit mine in the U.S.A.
• Connect Pass – includes admission to many of these things (that cost) and also includes a lunch at the Lion House. You can buy either a 1, 2, 3, or 365 day pass.
• Salt Lake Bees baseball game!
• Fort Douglas Military Museum
• Salt Lake Cemetery- visit the resting places of some of Utah’s most famous people!

Also you can visit Park City.

Today I hear about an optometrist in Utah who bilked Medicaid for patients he never even saw!

Before insurance companies (especially government ones) start bearing down on all of us with burdensome regulations because of a few bad actors, let’s take a step back an look at the problem from a different angle.

This is why insurances shouldn’t pay for physician office visits, but if they want to, then leave the doctor out of it and just reimburse the patient. My car insurance doesn’t pay for oil changes or gasoline. If my car insurance was crazy enough to offer an oil change benefit, then that would be great, but if I’m Convenience Lube, then no way would I take deferred payment from some car insurance company. I would demand the car owner pay at the time of service, and their crazy insurance company can reimburse the car owner later. If my car is in a major accident, then I would less likely have cash on hand for an expensive repair, so this is when the insurance companies would step in. Besides, autobody shops are much more accustomed to dealing with insurance compared to oil change shops or gas stations.

This is how it should be in healthcare. Only certain providers would really have a need to regularly bill insurances. Mostly doctors doing surgeries, hospitals, or other high cost care environments.

Number one, this helps lower the cost of medical care because people find out how much it actually costs since doctors don’t have a big menu/price sign over the reception desk. Second, doctors don’t have to spend tons of money and time filing claims. Third, the incidence of doctors perpetrating insurance fraud would go down because doctors would have less opportunity anyway. Fourth, if something isn’t covered by insurance, who presently gets to eat it? Usually the doctor. Patients paying their own office visits would force the patient to be more accountable for whether they really want/need a particular service, regardless if they expect their insurance to reimburse or not.

The doctor shouldn’t be beholden to any insurance company. He should deliver care according to his training/experience. She shouldn’t have to try to remember that Insurance A will pay for a visual field once a year, but Insurance B will allow it twice a year, etc. He shouldn’t think about if he has the patient do an extended medical history, he can upgrade his exam from level 3 to level 4 to bilk the insurance company for all they’re worth because hey, the patient is only paying a copay, right?

I think big ticket items like billing for surgeries or expensive procedures should still be billed by providers/hospitals since this is what insurance is for: paying for catastrophic, unexpected events. But all the little stuff, like inpatient food service and routine exams and regular office visits should be paid up front by patients. It would lower healthcare costs because providers could lower prices since their labor and accounts receivable would decrease. It would decrease over-utilization since patients have a financial stake in the process. It would decrease fraud since there would be less opportunity to create fraud by the majority of doctors/patient encounters.

When people ask me what’s the difference between an ophthalmologist and an optometrist, I always like to say, “Optometrists do everything an ophthalmologist does except surgeries.”  (By the way, I don’t consider foreign body removal a surgery. Chalazion removal- yes, definitely a surgery.)  Even one of the ophthalmologists in the feature story seems to agree with that statement:

“We draw the philosophical line in the sand with surgery,” says Dr. David Parke, chief executive officer of the American Academy of Ophthalmology.

Of course, proponents of the bill think that allowing ODs to perform laser surgeries is good for people because, as Governor Beshear explains:

“I signed Senate Bill 110 to give Kentuckians greater access to necessary eye care.”

Now, I would probably refute that it gives people, particularly rural people, greater access to eye care. For a doctor to buy all the necessary equipment to perform a YAG capsulotomy, he would need to invest in a pretty expensive piece of equipment. To keep up payments, he would have to do a lot of procedures. How many YAGs does a rural optometrist usually see a month? Probably not a lot. How far away is the surgeon who did the patient’s cataract surgery in the first place? Probably not that far.

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Anyway, I kind of like my definition of optometrist. What do you all think?

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.

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.

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.

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.