H/T to Dr. Maino.

Fly open. Zipper Broken.
Eyes elevated. Me Mortified.
Seventeen bucks at Division 1 saves the day.

True story, BTW.

Beginning April 15, 2010, PEHP will no longer reimburse consultation codes. Providers will need to bill the appropriate Evaluation and Management code for the visit.

I’ve probably never had to bill a consultation code, but I imagine ophthalmologists won’t be too happy with this change.

I wonder how long it will be until every insurance company finds out that private pay individuals rarely get billed the higher fee consultation codes…

Rush brings up an ABC John Stossel report about Dr. Robert Berry who stopped accepting insurance, including Medicare and Medicaid. His office visits are as low as $40, yet his salary is typical of a primary care physician.

Well, I wish Rush would have also shared what hundreds of Wal-Mart optometrists do. We deliver eyecare for a fraction of the private practice fees. Private eyecare practices in my market of Cache Valley, Utah offer routine eye exams from $70-125. My Wal-Mart practice offers the same routine eye exam for $45-55.

Insurance companies have created this health care conundrum. Employers or individuals who buy into vision insurance are really getting scammed. My $45 exam is about what most vision insurances pay doctors anyway. So…why give any money to the middle man? And then there are a couple snobby vision plans that only let private practice doctors on their panels. The beneficiaries of these plans get doubly ripped off because sure, the exam might be covered, but when they want premium coatings or progressive lenses, they get stuck paying the balance over the basic lens. At private practice opticals, this balance can be more than the total price they might pay at Wal-Mart. So again, what good is paying money into this vision plan?

Buying vision insurance makes about as much sense as buying oil change insurance or hair cut insurance. The only people that win are the insurance companies, unless you got the coverage at no cost to you and can use your plan at Wal-Mart so that even if you do have to pay over a balance, at least you will get the best price.

In my former private practice my wholesale cost for lenses were just barely under the retail price of Wal-Mart lenses. As a doctor concerned about the welfare of my patients, I can’t continue to sell overly expensive products when Wal-Mart sells the equivalent premium products 30-50% less than what I could in my own optical shop.

So Rush, please add to your list of professionals doing what they can to control rising health care costs the excellent professionals at Wal-Mart Vision Centers.

Wow, makes me want to not take any insurance; however, I DO think that we can e-mail our patients as long as HIPAA rules are maintained. It’s my understanding that as long as the data is encrypted, we can communicate confidential information with patients. On my practice website, patients can e-mail me using a form. This form can be optionally encrypted before sending if they have confidential information to share.

This is all done using my public key. Only my private key with its password can decrypt the message. I didn’t go to the HIPAA Security Company store and buy it. It’s totally free if you know how. While I believe this system complies with the intent of HIPAA regulations, I can’t e-mail back a patient if they haven’t made themselves a cryptographic key pair for e-mail. I’ll bet only a very small percentage of people in the world even have one, and I’ll bet the percentage of doctors that have encrypted e-mail is even less than the general population. But I did it. It’s do-able. Sure, I’m a computer geek, but I learned computers the same way I learned eye doctoring; study and practice.

But the obscurity/confusion of how to implement encrypted e-mail communications is not the real reason doctors don’t use it. I don’t get paid to sit around and e-mail patients. I get paid for examining patients at the office. On-line communication tools work well for Dr. Parkinson since that is his mode of practice. But my patients don’t pay me a subscription, so any e-mail that I have with them would most likely say something like, “I would recommend you come in for an appointment.”

By the way, I’ve had this encrypted form feature on my website for over 18 months, and no one has ever used it nor have they used my public key to send me an encrypted e-mail.