optoblog.com

With Walmart’s announcement of a sweeping change about getting out of the business of billing vision insurance companies for their doctors, a whole new cottage industry has sprung up. Businesses are soliciting Walmart doctors to let them handle all the insurance billing.

Yup, I’ve said it before and I’ll say it again. Ophthalmic vendors think we optometrists are so stupid. Just because we picked this profession, they think we are prone to making poor financial choices just like some people are accident prone.

Any of you vendors seeking to do insurance billing for me are wasting your time. All I need is my practice management software and Apex EDI. It’s as automated as can be. Most of the vision insurances have their own website for authorization and billing, and then I use Apex EDI for my BlueCross, Medicaid, DMBA, and other miscellaneous insurance companies. (You can do Medicare also, but I am disinclined to participate with them.)

Apex EDI works great. It’s fast and easy. And I don’t need no stinking slick Rick to be some unnecessary middle man. It’s cheap too. I pay 43 cents per claim, less than a postage stamp these days. I also pay the extra $20 a month for the ERAs and Electronic Tools which make my life a lot easier, so it’s worth it.

Call up Apex EDI and tell them I sent you. Use my Champions Code (sales code) to get a better deal: Champ148. I use it in my practice (VisionHealth EyeCare PLLC), and you can use it in yours without the growing cottage cheese industry of Walmart insurance billing middle men.

[Note to Slick Ricks: Any more “comments” made by you to advertise your middle man services will be marked as Spam and deleted. Do us all a favor and go con some other profession.]

I hope all of you that attended the 2009 Walmart doctors meeting Health and Wellness Conference in Atlanta had fun. I tried to register too late, so they put me on a waiting list, which I think is a generic term for sorry, you’re not going. 😥

Also I see that Walmartod.com‘s interactivity has been transformed from a bulletin board to a Facebook-like community. Looks pretty neat. I still can’t get logged in, but I hope to join in…someday. UPDATE: I got logged in just fine after an e-mail to support. Any rumor that I’ve been blacklisted is completely unfounded. 😉

In my first edition of Answers to Your Search Questions – Part 1, I answered 20 questions…as a public service. I’m at it again in Part 2. Again the idea is that people have come to my site from a web search, looking for answers. I am now going to explicitly answer them (explicitly as in specifically and openly-not the other way you were thinking about).

1. “Biofinity contacts” – Okay, I made a huge mistake by thinking that someone was out to get Biofinity, and I’ve never been able to live it down. It’s by far the most hit blog entry on my site. Big egg on my face. I should take the post down, but I hear that’s bad form, so I just made another post retracting my error. Please, let’s just put all this behind us. It’s not like I forgot to pay $130K in taxes or something (oh, wait, that’s rewarded in this country).
2. “optometrist blog” and “optometry blog” – Nothing to say here. I don’t even have one snarky comment.
3. “can you get rich working as a walmart optometrist” – No, but to be fair, you can’t get rich being any kind of optometrist.
4. “getting around vsp at walmart” – I find it hard to believe an optometrist would want to be this unethical; however, you could try getting paneled to VSP at a private practice. Then advise VSP that you need to update the practice location address (to your Walmart location but you don’t say that). Eventually they will discover your deceit when they figure out that you aren’t selling any eyewear, but at least you stuck it to them for a little while. You should also do the same for EyeMed. Then you should go rob a bank and kidnap someone for ransom.
5. “2008 better than oasys contact lenses biofinity” – I would say that in the year 2008 Acuvue Oasys sold more pairs than Biofinity, so you could make an argument that it’s better. On the other hand, Biofinity just came out with 1 week extended wear and it’s a one month lens whereas in the U.S., Oasys is a two week lens, so Biofinity comes out on top for cost-effectiveness. I would say try them both and see what you think. Ask your eye doctor if extended wear is right for your eyes in these lenses.
6. “http://health.groups.yahoo.com/group/optometrysucks/message/1424” – This isn’t a web search but it does show that someone in that Yahoo group linked to me. I’ve said before that I don’t condone this group, or rather, it’s name. Optometry definitely doesn’t suck. If you aren’t in it, be aware of it’s problems before getting in so that we have less whiners.
7. “acuvue oasys vs biofinity” – I normally wear Ciba Night and Day, but I’ve tried both of these. I’ve even done Biofinity on extended wear. I like it. Anyway, see above. Ask your eye doctor if extended wear is right for your eyes and contact lens material.
8. “officemate eyecare software crack” – You know, the yearly fee to keep Officemate up and running is around $1200. I’m sure you could pay some kid less than that to come up with a crack. But then, why stop there? I hear robbing banks and kidnapping for ransom will also help you have more money to spend.
9. “s codes in optometry and dilation fees” – The last billing expert I heard said that you can’t charge extra for dilation. S codes are awesome. I use them all the time.
10. “how to make the most out of being optometrist” – Start a blog for your personal therapy. Make sure you get plenty of time away from work. When you get sick and tired of explaining presbyopia or saying “which is better,” then try to imagine what you will be doing after work. You’ll say the same things over and over again so much that you could say them on autopilot, leaving you to think about other stuff, like your next blog entry.
11. “optometrist wedding favors” – Okay, that’s just weird. Can’t you let them be just a person on their wedding day? Why do you have to remind them of work?
12. “bad things about being an optometrist” – I think there is a Yahoo groups site about this.
13. “what do eye doctors think of their jobs” – I can’t speak for everybody, but I like it. There are much worse jobs.
14. “optometrist lifestyle” – We run around in private planes, eat caviar, and schmooze with celebrities and politicians. When we’re not doing that, we’re working in a dark room, saying the same things over and over.

Okay, that will do. As I collect more data, I’ll be sure to respond in future editions.

You may not realize it, but I know the web page you visited just before coming to my site. So for example, if you went to Google and did a search for “optometry blog,” I see in my logs that you just came from the site “http://www.google.com/search?hl=en&fkt=1859&fsdt=5568&q=optometry+blog&btnG=Google+Search”
(By the way, I’m number one on the list today. You could be if you bothered to blog.)

It’s really interesting to see what search terms get people to my site. I think it would be even more interesting to analyze and respond to questions implied by people’s search keywords. As a public service, I will now respond to actual search terms and attempt to answer any implied questions. Seriously, I am not making these up. It is not a comprehensive list, but these particular ones make good blogging fodder.

1. “career switch from optometry” – I hear ya’, brother, but do you really want to throw away four extra years of school and over $150K? Is optometry really that bad?
2. “do optometrists make lots of money?” – Yes, they put a question mark in their search. No, we don’t is the short answer, but more on specifics down the list.
3. “why become an optometrist” – Only because you love it, but that begs the question: How do you know if you would love it unless you already became an optometrist?
4. “easiest optometry school to get into” – Okay, first of all, this person hopefully won’t get into optometry school, but I think it’s safe to say that the answer to the quesiton is Pacific University because, hey, they took me. (That was a joke.)
5. “walmart optometrist average salaries” – There are only a few optometrists in the country actually employed by Walmart. In many states that scenario is illegal (stupid government interference.) Walmart optometrists working on a contracted lease only make what they get from exam fees, so it’s not a salary because you aren’t guaranteed an income. The Optometric Business Academy publishes a yearly survey of Walmart and Sam’s Club affiliated optometrists and the median gross fee income is: $161K for 2007 and $167,473 for 2008. Keep in mind your net will be at least 20% less.
6. “optometry debt” – I don’t have any statistics, but most of my class was around $100-150K and that was 2003. Now a days it’s becoming debatable whether the loan debt is worth your potential income. The actual numbers for indebtedness for 2005 averaged for all schools is $125685 (from ASCO under data and surveys).
7. “AOA optometry dues too high” – Yes, I agree. Next question.
8. “average number of new patients seen for start up optometric practice” – Um, try zero.
9. “how to become an optometrist” – First, get good grades in high school. Then get good grades at college (state universities are just fine). Schmooze influential faculty members your first two years of college to get a good recommendation letter for your optometry school application. Take the OAT and get a good score. Then apply for optometry school your third year of college. Get an interview and do really well. Get accepted to optometry school. Take out $150K in student loans. Get good grades in optometry school. Take the NBEO and pass all sections. Graduate. Get a state license when your NBEO passing scores are released. Do temp work from May to July of your graduation year (I made frozen dinners). Start practicing around July of your graduation year. Wow, you know, for all the same work you could have entered a career field that pays better or entered a field that pays just as much but requires less time and loan money.
10. “what should you know about optometry” – well, for starters see the previous question. You should also know that you are paid according to how many exams you do. You can only do so many exams, and people will only be willing to pay so much for an exam, so already you are limiting yourself. If you want to make some real money you need to consider a career field that allows you to sell an infinite amount of widgets to anyone, anywhere in the world.
11. “How to make optometrist buy from you.” – As I’ve said before, that shouldn’t be too hard. He or she chose to became an optometrist so they are easier to fool.
12. “what pays better, a pharmacist or optometrist” – They pay the same, but the pharmacist doesn’t have $150K in student loan debt. People point out that pharmacists have to work late hours and weekends, but optometry is quickly heading in that direction.
13. “when did eye exams become so expensive?” – Ever since the optometrist hired a practice consultant. (Again, what is the deal with putting a question mark in a web search?)
14. “optometry school worth it” – Only if you want to be an optometrist. A better question would be which optometry school makes it the most worth it.
15. “how much school does an optomitrist have” – Bad spelling aside, the short answer is eight years post high school.
16. “laws against 1800 contacts” – Yah, there should be a law that says someone else can’t take my business away from me without my permission. The government needs to fix all my problems. Where’s my binky?
17. “are prompt pay discounts for medical exams legal” – The previous billing expert I listened to said yes. The one before him said up to a reasonable amount like 10%. The true answer should be I should be able to charge whatever I want to whoever I want, but thanks to the government and insurance contracts that is not possible.
18. “what to take in high school to become an optometrist?” – Take whatever the heck you want. Who cares about high school? College is the new high school. By the way, why take the extra effort to type in a question mark in a search box?
19. “what retinoscope looks like” – Shh! It’s a secret.
20. “optometrist jokes” – I would refer you to some excellent, witty cartoons sketched on a mouse pad by a charming optometrist.

Well, that concludes the first edition of Answers to Your Search Questions. I’ll release more later, so stay tuned.

For those of you who remember Link Gate on my practice website, you’ll remember that my response to criticism of linking to Wal-Mart.com was, “Why link for free when I can sign up to earn ad revenue from 1-800 CONTACTS link referrals?”

Some outfit called Commission Junction handles the details for 1-800’s referral program, and I got this email from them today:

You are receiving this email because we are concerned that your Commission Junction publisher account has not generated any valid commissions (from payable transactions) recently. We encourage you to begin earning commissions as quickly as possible. Otherwise, your publisher account is at risk of deactivation due to dormancy…

So for the one guy who started Link Gate, let me assure you that no one cares that I link to 1-800 or Wal-Mart since apparently no one follows the links anyway.

According to Al Cleinman, VSP is hurting the very private practice doctors that it purports to help.

How ironic. Al has a whole bunch of posts about VSP. I would have to say that the only people VSP is trying to help are the execs at VSP. Of course they don’t care about the doctors. When they feed you the line that they are there to help traditional private practice doctors, it’s simply a marketing gimmick. And of course they don’t care about the patients either, otherwise they’d let them have freedom of choice to see any doctor they want, including a [gasp] Wal-Mart doctor.

I’ve come across some websites you may be interested in:

• Local Eye Site

Interesting because it allows all people who work in the eyecare field to use the same site for forums, job search, and buy/sell equipment or practice. I especially like how it is open so that anyone can read what has been posted without being registered. Registration is free if you want to post something.


• Wal*Mart OD

See what your main competition is up to. You won’t be able to post anything, though, because registration is limited to Wal-Mart doctors like me.

• Association of LensCrafters Leaseholding Doctors (ALL Docs)

See what the Lenscrafters eye doctors are up to at this website. From the looks of it, half the site is dedicated to their National Meeting which includes “recreational and social events to help unwind.” A.K.A. providing plenty of booze so you can get hammered and make funny faces while being photographed for their website.

But seriously, what professional organization doesn’t spend all your dues and sponsors’ donations in support of this glorified purpose?

There was an interesting article written at the AmateurEconomist.com about “Why Doctors Are Not Good Businessmen.”

Hat tip to Kevin, M.D. who commented on this story and said,

“This is why the private practice model of medicine is dying. More practices are being bought by hospitals where the physicians are salaried. This relieves the burden of administrative tasks and supervising ancillary staff, so that the doctor can focus on medicine.”

Rob at VSP says that “[private practice doctors] provide the best care.” Well, if I’ve got the weight of a business on my shoulders, doesn’t that detract from patient care? Additionally, in our field where the private practice doctors sell what they prescribe, can you totally rule out any conflicts of interest which potentially detract from patient care?

Again, independent doctors of optometry in a Wal-Mart setting don’t have the conflict of interest and their administrative duties are much less than private practice.

What’s funny to me is that every CE event I’ve been to always has some talk about why optometrists should start the “medical model” in their practice and watch the money role in. Well, how is adding more third party payers going to help you make more money? Primary care medicine is dying according to Kevin M.D., and yet the roboconsultants are telling us to join more insurance panels. I think getting rid of insurance companies in your practice is the way of the future.

The roboconsultant woos you buy saying that for one case of dry eye you can milk an insurance company for $500-$800 in office visits and procedures. Well, do you do that for every dry eye patient, even the poor self pay patient or the patient with insurance but poor benefits? I would think that doing it just for those with good insurance would be unethical as well as probably insurance fraud.

I think the more your appointment book is filled up, the more you should be able to charge for your services. It’s the old supply and demand of free economics. I think a better system would be for patients to have to front the money to pay the doctor for office visits at the time of service. The patient would have to get reimbursed what they can from their insurance company. Maybe then insurance companies would be forced to have a faster turn around time on processing claims for their patients and be watched more closely for just rubber stamping a denial based on some frivolous billing exercise (or at the least the patient has to worry about it instead of me.) I simply provide the best care for the patient, recommending only the products and services that they need, since now I don’t have to worry about getting paid.

So Rob’s Blog has this to say to people about getting yearly diabetic eye exams. As if optometrists in a commercial setting don’t do the same thing, he tells a big lie here:

…these [private practice] doctors consistently have the longest relationships with their patients and provide the best care.

Rob, people aren’t buying what you’re selling anymore. I see VSP beneficiaries out of network all the time in my Wal-Mart setting. I guess they aren’t loyal to a practice setting, but rather they factor in price and convenience while assuming, correctly, that any doctor they see in my area is competent.

Oh, and I remember when Intel in the Hillsboro/Beaverton, Oregon area was buying your VSP, and then they switched to EyeMed. Does that mean they thought your private practice network of doctors couldn’t “provide the best care?”

But I see what he’s trying to do. Any roboconsultant will tell you that you need to differentiate yourself from the competition; however, I take exception when he lies.

Since starting my practice inside a Wal-Mart Vision Center, I’ve kept track on a spreadsheet the daily gross and the number of exams. I also track a few other items like glasses vs. contacts vs. medical visits, DNKAs, follow-ups, walk ins, and appointments scheduled.

I thought it might be nice to share with you all a pattern I’ve noticed about which days are better to work than others, listed best to worst.

2008 so far (January to April I worked Mon 10-7, Wed 10-7, Friday 10-7, and Saturday 9-5, and May to present I worked 5 days a week, Tues 9-6, Wed 10-7, Thursday 10-7, Friday 9-5, Sat 9-3):

1. Tuesday
2. Wednesday
3. Saturday
4. Monday
5. Friday
6. Thursday

2007 from April to December I worked four days a week (Monday 10-7, Wednesday 10-7, Friday 10-7, and Saturday 9-5):

1. Wednesday
2. Monday
3. Friday
4. Saturday

In 2007 Mon, Fri, and Saturday were almost identicle in revenue earnings, but Wednesday gross averaged $98 more than the other days. In 2008 so far Tuesday and Wednesday (TuW) are close and so are Saturday and Monday (SaM). TuW gross averages $71 more than SaM, and SaM averages $79 more than Thursday.

In 2007 my private practice appointment book would fill up fast on Tuesdays and not so much on Thursdays. At the Wal-Mart, they told me I’d missed quite a few walk-in opportunities on Tuesdays, but not many on Thursdays.

Anyway, my take home message is this:

• I advise O.D.s looking for fill-in work to stay away from Thursdays and Fridays and try to get in on the action for Tuesday and Wednesday. (Conversely, if you are an optometrist looking to hire fill-in work, then switch what I just said.)
• If you need to take a random day off, Thursday or Friday is a safe bet

Your mileage may vary. For instance, from what I’ve heard, everywhere else in my district (Salt Lake to Ogden area) is gangbusters on Saturdays. I think that in my Northern Utah town the people like to go play on Saturdays and not worry about having to spend time at the doctor’s office. We notice that Saturdays are better in the winter than the summer because our area has lots of good hiking, boating, and other summer fun activities nearby.