Good summary, ready to me either around the 20/40 level or when a patient finds their activities of daily living are affected.Originally Posted by chip anderson
The new techniques for breaking the lens up (fermatosecond laser) probably won't change that in my area. Might make refractive lens exchange a more common refractive procedure however if it demonstrates less post-op inflammation.
All the OD's are all up in arms saying Chips comparisons are over done. Well talk about over done read this, talk about over charging, wink wink! Ya right, it's got to be medically
Correct,I would love to audit his files.
TomOD said:
Nick,
I LOVE Medicare. I would have an ALL-MEDICARE practice if I could. They pay great ($116 in 2002 for a comprehesive eye exam). They pay for fundus photos ($57), anterior segment photos ($52), Visual fields ($48), Epilation ($87), Punctal plugs ($178), Dilation and Irrigation ($154) etc. All with medical justification of course. Most private insurance companies don't even come close to Medicare.
And they don't cover eyeglasses (except after cataract surgery). The patient pays cash for them. You just have to make sure you have some pretty big, ugly horn-
rimmed granny glasses on hand.
We have a 98% reimbersement rate for Medicare. They are my bread and butter. (AND I like the ocular disease........and they provide me plenty of it).
Last edited by jediron1; 01-26-2011 at 09:25 PM.
Whats wrong with that? I'm not certain b/c I don't practice in the USA, but the fees seem about right. As for overcharging, the allowable fees are not set by the OD, medicare sets the maximum payable, blame Obama if you want. Yes, its a hell of alot more than I'm paid under Canadian health care (whole other conversation), but it's inline with private pay exam fees here.
You're making a giant leap assuming that because he likes Medicare that his billing is inappropriate. For one, if his patients have medicare of course medicare will be billed. Finally, as long as his documentation is consistant with the level of coding it really wouldn't matter if his billing was overzealous, I know you'll jump all over this statement, but at the end of the day when the payer audits your files all that matters is that the documentation meets the requirements for the level of exam coded.
Whats with the grudge against OD's anyways, sounds more like it was the MD you worked for that had unethical billing/practice patterns?
I used to think that 20/40 was about the ready time, but it really has more to do with how badly the patient thinks they see, and whether, for example, they have given up driving. Many older folks with reduced VA from cataracts will still have reasonably good near vision with good lighting, so if they are the homebody type, then 20/50 or 20/60 may be OK.
If one eye is amblyopic or has otherwise reduced acuity from another pathology like diabetes, I would tend to put off surgery on the eye with the cataract. When I went on a VOSH mission a few years ago, the definition of a ready cataract was hand motion. There is no one rule that applies to every patient...IMHO anyway.
Given the observation that a senior with an incipient cataract may, at present, have no mitigating health issues, i can see no reason to *not* consider surgery, particularly if it helps avoid increasing amounts of anisometropia. Further, central opacities impact people's near vision far more in tbe early progressions. I again see no reason that i should wadte even more of my time allaying their concerns that their glasses, made by me, aren't doing the job anymore, and that there must be something wrong. When i raise the question of cataracts, they'll say yes, but their Dr. Told them there's nothing to worry about for a long time.
Really?
B
Another concideration: If the patient sees 20/70 with cataract, one does surgery and he sees 20/30 after. He's probably happy. Now I know no one here has ever heard of surgical results being less than optimum but. If one operates on a 20/40 eye and the results are less than 20/20 (which the patient expects). You have a very unhappy patient and maybe a very happy lawyer.
I once had shoulder surgery. Before I couldn't raise my arm beyond 90 degrees. After I could raise it completely. I was pleased. However if I had been able to raise it only 10% better than before or God forbid, less. I would have been less than happy.
Chip
There are tons of unhappy cataract patients, many are unhappy because they didn't achieve a great deal of improvement for whatever reason. The thing to remember is that it is surgery, and anything can happen in surgery. Many patients with cataracts will have AMD, epi-retinal membranes, dry eyes, and post-op inflammation that affects the outcome.
Personally, I try to convince patients to go for the cataract consult as early as possible. No use waiting when 1) they're vision could be better, and 2) they aren't getting any younger - if you wait too long you may not be medically stable enough to undergo surgery when it really does become the difference between seeing and not seeing, or they may not be capable of appropriately handling the post-op drop regiment.
Cataracts that develop unilaterally, and cause significant aniso...yeas, they usually have to come out sooner rather than later. And commonly, these are in younger people. PSCs, or polar cataracts...not so common, but yes, they tend to be more debilitating. The most common though are the nuclear sclerotic cats that usually develop bilaterally, usually in older folks who have cut down on their lifestyle for other reasons. Typically these folks see well near (second sight) and when you talk surgery with them, they shy away.
Like Oedema, I see a lot of unhappy post cataract patients years later. And I've seen my share of cases where the patient had developed a unilateral cataract, had surgery, then developed CME and permanent macular degeneration...now what do you do with the other eye when it too gets a cataract? Risk another blind eye?
It's a tough balancing act. Surgery is permanent. I always go over the relative risks and benefits with every patient.
I have had patients come in after cat. surgery and proceed to tell me the doc. said I don't have wear glasses only if i want to see up close i should get them. rx reads od -.25 -.25 x45 and os -2.50 -.75 x 145 add +2.50 he says doc said I only have to wear them for reading! REALLY. :hammer:
Jediron1:
If the doctor thinks monovision is good enough for the patient in contact (I don't but then who am I?). He probably thinks monovision is acceptable for pseudophakia (I don't here either).
Chip
What they hey, the patient has two eyes. Using both of them to see the same thing is a waste anyway. Binocular vision is probably overendowment from God anyway.
Chip that's a blast! Lol.
Were they also told that they could use OTC readers, as well?
Actually most of ones I get are told just to get some readers and use as needed. Then you wonder why many complain of headaches and eye strain and wonder why? I tell them they should wear glasses, then they tell me my doctor told me I don't have to, since cat. Out, they say I see 20/20, ya 20/20 one eye other 20/70, but they say why would my doctor say I don't need to wear them, can't say why? I get a lot of patients who come in with OD +1.25 +1.25 x 90 OS +.75 + 1.25 x 45 with a +2.50 add and are told just get readers, REALLY!
Oedema said:
Whats with the grudge against OD's anyways, sounds more like it was the MD you worked for that had unethical billing/practice patterns?
I've got no grudge, I have worked with a few that were quite good and others who were as money hungry as the MD's.
Uncut said:
Were they also told that they could use OTC readers, as well?
Well I had a customer come in with rx that read OD: +2.50 +.75 x 65 OS +1.75 + 1.00 x 160 and he told me the doctor said he could just wear readers. REALLY! I want the Docs to answer how can they in good conscience recommend just readers as opposed to full glasses and wearing only for reading as opposed to wearing all the time. Come Docs give it your best shot!
Last edited by eye2; 02-01-2011 at 08:32 AM.
First, patients are always right, 60 % of the time. I have patients who in walking 35 feet from the exam chair to the dispencing table completely distort near everything I told them.
Second, take up your concern with that OD, because I would never recommend a NVO unless they are near emmetropia...
What about a board review of OD's that want to preform Yag procedures? Technicians working for OMD's have a very good system for training and qualifying techs. What are the standards and tests that are in place in Oklahoma for certifying OD's to do laser procedures?
The JCAHPO certification is ideal when it is used for employment purposes....for one certified tech there is an army of uncertified techs working for the OMD. The value of any certification is in reality related to what they can legally perform. Someday Medicare and all insurances will require that each procedure is treated by an individual who is certified to perform a procedure, that will put the playing field in all professions in the era of socialized medicine. The incident to a physicians rule is simply hogwash if they do not require certification. An OMD can use this rule to delegate many aspects of the practice to non certified techs but the government has never enforced requiring certification, hopefully that will change...As far as Ods doing yags ...why not if they are certified... I am in the opinion that if licensure is not required for filling an Rx for spectacles then why require a license to perform a refraction.
CNG
There was an earlier post from a fresh faced OMD that caught my eye. He or she stated how s/he had to deal with the mismanagement of various issues from various ODs. It made me instantly think of all the foolish things that OMDs tell their patients after their failed attempts at a refraction.
My favorite is: Tell them you only need your left lens replaced. Now mind you the patient hasn't had new glasses in over 10 years, has a 150 add in the current pair, which he bumped up to a 250 in the new Rx. The old script only had a diopter of power difference between the lenses now there is 7 bc he only cut 1 of her eyes and doesnt have another appointment for 8 months. Oh by the way did I mention its an old lady double gradient with the blue on top and pink on the bottom good luck matching that beaut.
I am not sure how i feel about ODs expanding their scope, but as I wish OMDs would limit their scope to surgery and follow-up and leave the refraction to the ODs and the selling and dispensing of eyewear to the opticians I can see the OMDs wanting the scope of ODs limited.
Dead horse........beaten
What I was saying is that reading these quotes it seemed that said OD was charging for these procedures whether they needed them or not. ( this I got from reading all the quotes in this OD community board )
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