With a mousepad, cut, copy, and paste YOU can draw too!

It appears that another optometrist with an actual art degree has been making comics for years and now has a book out. Review of Optometry even did a profile on Dr. Scott Lee, O.D.

I’ll bet he even draws them on paper instead of using a mouse in Paint.net.

Well, I see I shall have to get my game on to compete. But there is one thing Dr. Lee doesn’t have: seafoam green backgrounds. Yup, that was my idea.

I also now have Optoblog poetry, so I’m really diversifying my portfolio which will pay big dividends when I cash in on my book deal.

Be sure to stay tuned to my Optoblog comics. They’re just for optometrists. Patients won’t get them, but you will. Feel free to use them in your C.E. presentations. Send me a cell phone photo when you do!

To LASIK or not to LASIK...

I did this one because someone searched for “LASIK comic,” and I’m sure they were sadly disappointment that I didn’t have one.

Now before you get all over me for not spreading sunshine and lollipops about refractive surgery, let me first clarify that the above comic is comical, I thought. If I was told that my chance of winning the lottery was 99%, then I’d probably play it. If I was told that if I played the lottery that I had a 1% chance of dying then I wouldn’t play it.

I feel bad that I have to explain the resurrection reference, but I must make sure that those of you who never went to Sunday school understand that in the resurrection, our spirit will be reunited with our bodies which will be in a perfect form (our bodies, not us), so any LASIK disaster that plagued our days in mortality won’t bother our resurrected body.

My actual opinion regarding LASIK is pretty main stream. If someone really, really wants it and they have the proper medical prerequisites like cornea thickness, refractive error, good eye health, etc. AND they have a really good understanding of the risks and expectations, then I will recommend them to a good surgeon. Perhaps the surgeon that would do my LASIK if I wanted it.

But I don’t want it. I don’t fit the psychological profile since I’m perfectly happy in Night and Day contacts. I’m also rather wary of my family history since I’ve had three close blood relatives get it and most were left still needing glasses or enhancements.

The not so simple question...

There is a not-so-simple question that pretty much every patient asks, “How much is your eye exam.”

While the medical model has varying levels of exam, like Level II-New vs. Level IV-Est, which depend upon the history, exam, and complexity of that particular case; however, there are some among our profession that make it an especially hard question to answer, and this issue raises concern over the ethics of a fairly popular fee structure.

For example: the price in front of the Big Box says “Eye exams starting at $45!”
But are they really? Sure, for a “routine eye exam” where nothing is wrong and you just want your glasses updated, then it’s the $45. But what if I have some allergy eyes, so the doctor gives me a prescription for Pataday as well as my glasses Rx? All the sudden the exam somehow costs $120!?!?

Huh, something funny going on around here. I think big box doctors are more likely to do this since their exam fees are so low, they make up for it by gouging in other fees. I have no problem with a doctor who says their S0620 is $100 and their 92004 is $120. However, I think there is something wrong if the S0620 is $45 and the 92004 is $140.

It’s like some among us in the optometric profession are playing the windshield chip repairman scheme.

But what really happens? Patients won’t typically notice this bait-and-switch. It’s really the insurance companies who get hammered. The patient pays their copay, and if the doctor can come up with any excuse to bill a medical code, they use their medical model fee structure to justify it.

Ethics applies when we realize that, for some reason, private pay patients are rarely charged the same high fees as the insurance companies. Huh. Oh well. It’s a victimless crime because those big, bad insurance companies won’t miss the extra cash. Until we realize that the more insurance companies pay out, the more the patient’s premiums will be raised next year. Whoops. Sorry, Mrs. Smith, that you can’t afford to keep your medical insurance in the future because I wanted to get paid double or triple my usual fee because you have insurance today.

By the way, it cost me about $2000 to bill insurance last year (PIM software license, E-filing charges, and postage/paper for mailing statements/refunds). Also add to that the cost of time spent filing claims and handling overpayment and underpayment. If I didn’t have to deal with insurance, I could drop my exam fee by at least $5 per person.

I have an idea: All patients should pay for office visits out of pocket. If they have insurance, get reimbursed later. The doctor won’t know about their insurance, so there won’t be a conflict of interest about what exam fee structure he’ll choose. The doctor can lower his fees since filing claims is expensive and time consuming. Everyone wins. Another idea, insurances should allow me to charge either them or the patient a $5 claim filing service fee.

Take home point: I don’t believe it is ethical to have one fee structure for insurance patients and another drastically different one for private pay. Yes, I’m all for charging more money if something is more work and more time. That’s why a contact lens evaluation is paid on top of the routine eye exam. That’s why there are different levels of 99*** office visits. But sneaking a huge fee onto an insurance claim just because there is some medical code excuse is something I don’t think our profession should feel comfortable with.

Clear vision isn't all it's cracked up to be.

It’s the return of the Optoblog comics! Comics are by far the most searched for items on my blog, so I’m just bowing to demand.

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?

So ever since I announced my new direction on this blog, my readership has increased tremendously. Now, I don’t have advertising on my blog, and I didn’t do it as a publicity stunt, but nevertheless, what happened happened.

All you commenters who want to dissuade me, you can’t. You should probably start your own blog at wordpress.com called ILoveSoloPrivatePracticeAndSoShouldEveryoneElseAndIHateYouIfYouDisagree. That way you can counteract the “faulty reasoning” and “manufactured reality” that I’m feeding the uniformed optometry students because I’m “jaded” and “so opinionated.”

Let’s reiterate. I love being a Wal-Mart Optometrist. I believe it’s the future of primary care optometry. If you disagree, start your own blog.

I once heard this from a rep, and this cartoon was immediately spawned in my brain.

And I know that women don’t normally buy the engagement ring, and yes, I just use the same pictures and change the words.

Seriously, would it be okay if we farmed out patient education on presbyopia to the techs or opticians or something? Are eye doctors the only ones on the planet who have ever heard of it? From the 40-something mildly farsighted patients especially I get these incredulous looks.

“But I’ve never needed glasses in my entire life!” they say.

If they can mandate that my child take sex ed in school, why can’t they mandate that everyone be forewarned about the whole presbyopia thing? I remember in second grade health class learning about the digestive tract with a slide show of a cartoon character traveling down a river on brown barrels. Why can’t they do a little ditty about the eyes too?

This is what I wish I could say to patients when they ask about private practice glasses prices. Do you ever feel like we’re being sold out by the very lens companies that say they’re looking out for us? For example, Wal-Mart sells lenses for cheaper than I can buy them from my lab. How does that happen?

What if a whole bunch of private practices started a co-op lab so that all profits from the lab go to the doctors? Or is Red Tray Optical the answer?

I like the consignment deal that VSP offers with their line of glasses. Why should I have to pay for frames that haven’t sold? Since frames now days look so freaking wacked, I think all frame vendors should work on consignment.

All I know is that doctors seem to be getting the short end of the stick while the frame and lens makers are assured their cash. I don’t see a profit motive for Big Lenses to help out private practice docs since commercial makes them more money overall.