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Archive for the ‘Comics’ Category

Doctor Daycare

David Langford, O.D. on August 2nd, 2008 under Comics, Optoblog •  2 Comments

What is the CPT Code for daycare?

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?

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Tempest in a Tea Pot

David Langford, O.D. on April 14th, 2008 under Comics, Optoblog •  3 Comments

Optoblog Comic #19 Mention something good about Wal-Mart to increase readership

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.

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Engagement Eyewear

David Langford, O.D. on October 11th, 2007 under Comics, Optoblog •  Comments Off on Engagement Eyewear

Diamond Glasses - optoblog comic #18

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.

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Presbyopia Patient Education

David Langford, O.D. on October 10th, 2007 under Comics, Optoblog •  Comments Off on Presbyopia Patient Education

Presbyopia Patient Education - Optoblog Comic #17

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?

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Stinking Glasses

David Langford, O.D. on October 9th, 2007 under Comics •  Comments Off on Stinking Glasses

Stinking Glasses - optoblog cartoon #16

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.

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Insurance Discrimination Against Optometrists

David Langford, O.D. on September 10th, 2007 under Comics, Optoblog •  1 Comment

Your claim was rejected because you are an optometrist.  We only pay out to ophthalmologists.  So, you can put a price on an ophthalmologist, but an optometrist is priceless?

In Utah, the major health insurance company is called SelectHeath, a.k.a. IHC, Intermountain Health Care, SelectMed, and SelectCare. What’s funny is that they allow optometrists on their panel in remote areas and even in populated areas like St. George where there are an abundance of OMDs; however, in the most populated “I-15 Corridor” and even in Cache Valley way up north, they only allow our “EyeMD” friends. The notable exception is the Brigham City/Tremonton area.

IHC recently rebranded themselves “SelectHealth, simply there” and claim in their commercials that they are providing quicker access to care, but if they don’t allow optometrists to be paneled then they are actually slowing access to care. Currently in my area, several OMD offices are booked weeks in advance- some doctors have up to a 2 month wait. Word on the street is that the Brigham City area panel was opened for optometry because of all the employees of ATK (rocket engines) in that area. They had to open up the panel for O.D.s so there would be enough eyecare providers for their ATK beneficiaries.I talked to someone in the know. A manufacterer of car air bags had a large number of employees on IHC, yet none of the eye doctors in the area were on the IHC panel, including the OMD. They opted to let an O.D. be panelled (presumably because the OMD was doing surgeries at a non-IHC hospital). Then they later allowed the OMD to be panelled if he agreed to take the IHC surgical patients to the nearest IHC hospital.

But what is the deal with restricting O.D. enrollment? They would pay me the same as an OMD for a routine eye exam, so it doesn’t make fiscal sense…actually, it does when you think that patients get fed up with the long wait to get in with an OMD, so they just pay out of pocket to be seen by an optometrist. IHC doesn’t have to reimburse anything because they went out of network to a non-participating provider. (And the only reason the O.D. isn’t participating is because IHC won’t panel him/her.)

Anyway, I tell patients about the situation all the time, and invariably they say something like, “Oh, it’s all political.” Exactly. They get it. They realize their health plan is flawed. I wish more patients would make a stink to the IHC administrators, but I’ll bet they don’t because they’re used to SelectHealth not being there for them despite what its commercials claim.

If SelectHealth really wanted their beneficiaries to have quicker access to care, they would allow any optometrist to be paneled anywhere.

When will Utah get an Any-Willing-Provider law? This type of discrimination should be illegal.

Internet Contacts Send Mafia Enforcers Conscripts

David Langford, O.D. on March 30th, 2007 under Comics •  Comments Off on Internet Contacts Send Mafia Enforcers Conscripts

Internet contacts use patients as toughs

Some dude came in today as I was leaving my commercial fill-in job to say he wanted a copy of his toric soft contact lens Rx so he could buy more contacts off the internet. Only one problem…it’s expired…by more than 6 months.

Sure, the doctor that was there before and long since moved away had noted that the Rx should expire in one year. The Dude kept saying, “Utah law says it’s two years.”

Now, I know the national law says one year minimum, so how come Utah law states the following?

the expiration date of the prescription, which shall be two years from the
commencement date, unless documented medical reasons require otherwise.

Could it be that Utah is home to the most widely known Internet reseller and that they have deep pockets for paying off politicians?

So, in the end I gave him a copy of his prescription, including the expiration date which has already passed. I wasn’t about to put my license on the line to extend an expiration without first evaluating the patient for myself. And Dude, do yourself a favor and get an eye exam to make sure the contacts aren’t doing any harm. After all, they are FDA-regulated medical devices. Do people go around to their psychiatrist expecting a refill on their meds without regular consultations to monitor their condition?

When you think about it, a lot could happen within just one year, so I think that’s more than fair to ask for regular contact lens follow up- especially the way I’ve seen individuals abuse their eyes through noncompliance with prescribed wearing time, replacement schedule, and lens care system. The bottom line is that I have the patient’s best eye health in mind, and the internet resellers with all their lobbying power just have their bottom line in mind.

For Free

David Langford, O.D. on March 29th, 2007 under Comics •  Comments Off on For Free

The shock of paying for services rendered.

I’ve filled in at Big Box opticals where the staff tells me that the usual doctor doesn’t charge for follow ups on things like red eyes. Unbelievable. Not only are these doctors leaving money on the table, they’re making the rest of the profession look bad.

How come patients question optometrist fees so much? When they go to their PCP for a check-up on their HTN, do they expect to walk out without paying? Do they expect their PCP to refill their HTN meds indefinitely without a follow up exam?

Eyecare is healthcare, and I resent the insurance companies for making the illusion that it’s something separate (vision insurance vs. medical insurance).

Recall H-e-double hockey sticks

David Langford, O.D. on March 28th, 2007 under Comics •  3 Comments

I'm sick of CL and CL product recalls.

O2Optix, Renu MoistureLoc, Renu MP recalls and ClearCare shortages. Oh the frustration.

If I had prescribed a patient O2Optix contact lenses and them told them to use Renu solution, that patient would be out-of-luck. The opticals I fill-in at have had problems with patients who came in to order more boxes of O2Optix and were told they would have to be re-fit in another lens since the O2O is unavailable for the several months.

Then, there was the day the recall came out, I had fit a patient in O2O and ordered the lens to be shipped to their house. Two weeks later they called wondering where their lenses are. Oops, sorry. That lens has suddenly become unavailable.

So who gets the brunt of the patient frustration with these recalls? Not the manufacturers. It’s us on the front lines. Thanks a lot, you guys.

Of course, this could help us make the one year supply sale, “Just buy 8 boxes now because you never know if your lens will be recalled, making it unavailable for ordering refills.”

OMD vs. OD Glasses Rx

David Langford, O.D. on March 27th, 2007 under Comics •  2 Comments

Can't we all just get along?

There seems to be a small percentage of ophthalmologists that are vocal against optometry. This is unfortunate because most ophthalmologists work very well with optometrists and enjoy a fruitful relationship with co-management and referral networks.

But I know of a couple ophthalmologists who actively poison their patients against optometrists, especially their Medicare patients. Sure, when they eventually need cataract surgery, they’ll end up in the OMD’s office. If they get diagnosed with certain forms of AMD, then they’ll need a retinal consult. Otherwise, the O.D.s should manage most everything they see.

There are medical models for this. If you get rectal bleeding, do you automatically go to the proctologist? No, you go to your family practice physician. He’ll tell you either: 1) You just ate way too many nuts last night or 2) You’ve got a serious problem that requires more testing and a proctology consult.

So, optometry is the primary eyecare profession, and OMDs would do well to play nice, or we’ll send our referrals to someone who will.

Anyway, the above cartoon is based on a true story. Many OMDs delegate their refractions to their ophthalmic technician. Sure, if you play the averages, then it’s not going to come back to bite you a lot. You’ll recall that in optometry school, we had multiple courses on how to not only do a refraction, but also how to analyze binocular testing data and adjust the Rx accordingly. It’s important to know what symptoms and signs would lead you to do a binocular testing battery, and I don’t think techs are trained for that.

I once observed an ophthalmologist just off his refractive surgery fellowship and starting a new job. He was getting a lesson from his tech about how to use the phoropter. Seriously, can’t ophthalmology residencies spend some course time on this stuff? Would it kill an OMD to at least do a binocular balance instead of just Rx-ing monocular subjective best VA?