Tennessee Optometrists

[Roy R. Ferguson]

Hi All:

This presents the optometrists point of view about a bill being introduced in Tennessee. Comments?

Senate Bill 855 (Jackson)
House Bill 1116 (Shepard)

This bill is modeled after a law passed in Texas in 1999, which is referred to as the, "Optometrists' Bill of Rights."

Historically, retail stores such as Sears and Wal-Mart and optical stores such as Lenscrafters and Cole Vision have leased space to optometrists, with the intent of selling eyeglasses, frames, and other optical goods to the optometrists' patients. These leases often contain provisions which compromise the professionalism of optometrists who work in these settings.

T.C.A. §63-8-l 13(c)(6) makes it illegal for an optometrist to "practice or offer to practice optometry in, or in conjunction with, any retail store or other commercial establishment where merchandise is displayed or offered for sale." Although this provision has been in the Law since 1967, it was not enforced until the mid-1990's, when the Board of Optometry took disciplinary action against a Davidson County optometrist who was practicing in a Lenscrafters store in Rivergate Mall. The Board's action led to a series of court cases interpreting of the Optometry Law.

In December 2000, the Tennessee Supreme Court held that the prohibition in T.C.A. §63-8-l 13(c)(6) applies to all types of retail stores, including those stores like Lenscrafters that sell only optical goods. Lenscrafters, Inc. v. Sundquist, 33 S.W. 2d 772 (Tenn. 2000). In January 2003 the U.S. District Court in Nashville upheld the constitutionality of T.C.A. §63-8-l 13(c)(6) and observed that the words "in conjunction with" in the statute have a broader meaning than the word "in". Lenscrafters. Inc. v. Wadley, No.3:98-0150 (M.D. Tenn.).

Senate Bill 855/House Bill 1116 helps to clarify the meaning of "in conjunction with” by
setting forth in section 2 a list of provisions and practices which may not exist in the relationship between an optometrist and a manufacturer, wholesaler, or retailer of ophthalmic materials because they represent an attempt to control the professional judgment or manner of practice of the optometrist. This bill is also needed to protect the privacy of patient records and information, as required by the federal HIPAA.

If this bill is passed, an optometrist will still be allowed to lease space from a manufacturer, wholesaler, or retailer of ophthalmic materials, so long as the space is physically separate from the place of business of the manufacturer, wholesaler, or retailer of ophthalmic materials and so long as the lease or other agreement does not contain any provision which violates section 2 of the bill.

Section 2( e )-(g) contains provisions which allow the Board, the Attorney General, or individual optometrists to go to court to seek enforcement of the bill.

[Homer]

that the practice of optometry has nothing to do with the manufacturing, wholesaling, or retailing of ophthalmic materials!


If this passes, may we never see an optometrist advertise any name brand products in their Yellow Page, Newspaper or brochure ads since this would indicate impaired judgement, since they indicate that they are pushing one product overe another. (probably because they get a spiff or premium or free samples from that manufacturer or wholsesaler)

[docwatson]

Homer said:
that the practice of optometry has nothing to do with the manufacturing, wholesaling, or retailing of ophthalmic materials!

If this passes, may we never see an optometrist advertise any name brand products in their Yellow Page, Newspaper or brochure ads since this would indicate impaired judgement, since they indicate that they are pushing one product overe another. (probably because they get a spiff or premium or free samples from that manufacturer or wholsesaler)

Uh, are we reading about the same bills? I don't think these have anything to do with private practice optometry. Note that nowhere does it mention that it's illegal for an optometrist to own and operate his or her own optical. These bills are simply an attempt to keep the large opticals from getting their grubby fingers into optometrist's supposed independent practices.

I've been there. It's a bad situation. Wal-Mart or any other commercial interest has no rights in telling us how to run our businesses. If you have a business, no one else should have their fingers in it either! It's hard as you know to build a practice up. It takes time, money, and a lot of patience (and patients!). It's not good when a commercial optical chain or huge corporation like Wal-Mart kicks you out for no good reason or because they attempt to lock you into demands that you can't possibly meet. One particular doctor I know got kicked out after several years because he was expected to sign an agreement that says he was expected to make copies of all of his charts and hand them over. How could any doctor be expected to do that? For one thing, it's impossible to comply with physically (can you copy 10,000 charts in less than one year?), in many states it's outright illegal, and besides even it it's not illegal, those charts belong to the doctor. It's his sweat and tears!

Comments? Rip away! :D

[Homer]

You are correct again! It is not illegal for an OD to own and operate his own optical, as you have stated ! However, in stating it in that fashion, you have distinctly separated the optical from the practice of optometry!

That is all I'm doing.

Whether it is ethical for a prescribing doctor to own his / her own "pharmacy" within his / her own office and give the impression that this is also the practice of optometry, is for you to decide. What I think should not keep you from practicing optometry ethicly.

I have had serveral MD friends who think it is unethical, especially when they go to see the OD and then are made to jump through several fictious hoops to obtain their Rx. Some have said, "to hell with it" and we have figured out what they needed in my office.

Anyway, I appreciat the debate and am hoping not to demean you as a person.

:) enjoy :)

[docwatson]

Homer said:
I have had serveral MD friends who think it is unethical, especially when they go to see the OD and then are made to jump through several fictious hoops to obtain their Rx. Some have said, "to hell with it" and we have figured out what they needed in my office.

Anyway, I appreciat the debate and am hoping not to demean you as a person.

:) enjoy :)

Made to jump through several fictious hoops to obtain their Rx??? Can you explain what they are talking about?

Don't worry about starting an argument. That's why I visit the forums!! This may not come out right but sometimes it's kinda fun to get people mad. That's when the real debate starts...

No, I'm not looking for a fight. Don't get me wrong. ;)

I think we know where we are coming from now so don't worry about "demeaning me as a person." I think we are both very passionate about our professions and we aren't about to start calling each other names. We agree again! We have to stop doing this--someone has to get mad sometime... :o :angry:

Cheers... :cheers:

[Homer]

you may be stimulated by the exchange, doc, but not me! ;)

Hoops, like being told to pick out her new eyewear while she is dilating, before the exam is finished, as if this is part of the exam.
Being, "cornered" on the kind of lenses and lens treatments she want, during the process.

Having to pay the bill before the Rx is released, but when the OD comes to her office expects to be billed for the visit.

Having to enter and exit through a retail facility (optical shop) that makes the customer / patient feel as if they are cheating their friend the optometrist because the want to take their Rx to their friend the Optician.

Or .... having to ASK for their Rx before they leave.

Or .... if they left without the Rx because of not making a decision on the glasses during the "dilation process" they must actually return to the office and sign a release to obtain their prescription at a later date.

This is complet BS and it really makes the patient mad and often keeps them from coming back. It is really a stupid policy on the part of an optometric office. It is like trying to make your lover love you! Get a clue! :hammer:

[Joann Raytar]

Homer said:

Having to enter and exit through a retail facility (optical shop) that makes the customer / patient feel as if they are cheating their friend the optometrist because the want to take their Rx to their friend the Optician.

Are you saying Optometrists shouldn't lease space from independent Opticians either then?

[Homer]

In those cases, most people are getting an eye exam to get glasses and the OD's office is marked as separate from the commercial optical business through which they entered - required by optometric law!

[Joann Raytar]

Ahhh. I got you. Different business cards et al. Clearly defined in my mind but is it in the consumers?

Either way - I agree, the white coat may be intimidating for patients. There has to be a careful line drawn between "recommendation" and "prescription." I have run into my share of patients almost everywhere I have been who had a bad relationship with their provider. I almost always feel bad for them because you can discern a real sense of guilt coming from the patient. It is a shame that some practices can put so much pressure on a patient to purchase in house that they feel guilty if they walk away with their prescription in hand. Even worse is when they don't walk away with a prescription in hand and felt so much pressure to purchase that they get upset when you offer to call the prescriber's office for their latest Rx. They are afraid the Doctor's office will "get mad" if they find out they are in your office. Even where I am now, we get quite a few outside Rx's in; it is a shame to still hear the same old stories generated from certain offices.

Out of curiosity, how do you folks in Optometric practices draw that line?

[bren_03825]

Luckily, I have had the good fortune of working for a private OD, who always referred the patient to MD's if there was a medical issue beyond his scope of practice, and to Opticians, for anything regarding the eyeglasses. I also worked for Walmart and managed the optical shop, while the OD working there did the same. (By the way the records are his by legal right, and if he leaves he does get to take them with him). Now I work in the adminstrative offices of a private chain, which employs OD's. They too, seem very professional, and keep themselves to the "Optometric" part, leaving the glasses to the Opticians. I may be very fortunate in that the places I have been employed have had OD's and Opticians with "higher moral standards", and in none of the offices, has any patient been "pressured" to keep their business in those offices alone, in fact, they have been encouraged to make "informed" decisions. This may sound idealic, but i would like to think that all of us (Opticians, Optometrists, and Opthamologists), entered into these occupations with a sincere desire to help people. I have, over the years, heard many a horror story, from patients and professionals alike about the monopolizing of the patients choices, and to me that just seems like those that do it are "small" people, who need to make themselves feel better about being "in control" all the time. In order to lighten my diatribe up a little though....:hammer: ......

Eye Exam

A guy goes to his eye doctor for an examination. They start talking as the doctor is examing his eyes. In the middle of their conversation, the doctor casually says, "You need to stop m**********g."
The guy replies, "Why Doc? Am I going blind?"

The doctor says, "No, but you're upsetting the other patients in the waiting room."
:D :D :drop: :drop: :D :D :cheers:

[dfisher]

My impression of the intent of the legislation is two-fold. One is to prevent corporate dispensing entities such as the one listed in this post

http://www.optiboard.com/forums/show...t=chain+busted

from dictating the clinical practice of the optometrist. The corporation above has previously been fined in some states for requiring that all patients seen be given a prescription even when no change was required.

I once considered working for that chain until they sent an employment agreement which included as part of the optical managers job description the requirement of making sure the Dr. was fully booked, that he gave every patient a prescription, and he actively steered his patients into the corporate optical for their eyewear.

The other purpose of the bills is to prohibit the hiring of optometrists by an optician or even a partnership arrangement with an optician.

[Homer]

"I once considered working for that chain until they sent an employment agreement which included as part of the optical managers job description the requirement of making sure the Dr. was fully booked, that he gave every patient a prescription, and he actively steered his patients into the corporate optical for their eyewear."

So you go to work for a private OD who requires you to do the same things ! :hammer:

[dfisher]

No, homer. It is NOT the same thing. You're just OD bashing again. Dust off your old turntable and put on Firesign Theater for a while.

[shanbaum]

dfisher said:
No, homer. It is NOT the same thing. You're just OD bashing again. Dust off your old turntable and put on Firesign Theater for a while.

"We are march-ing, march-ing to Shibboleth..."

[Jeff Trail]

I can actually post and maybe Homer and DocWatson can BOTH get a chance to jump on me from "another point of view"..being in wholesale (as well as a retail owner twice :)), I have seen the field change fairly drastically over the last 12 to 15 years and OD's losing ground both do to ins. as well as the growth of "chain/corp." type stores replacing "private practices". So now when most OD's I know that come out of school they end up having to work for a chain or corp.. I can go back and remember how the OD's had more business sense and "learned" that side from going into private practice. They learned the importance of knowing frames, lens and how the staff worked, now? The chains and corps. do all this and the OD is just a "refractionist".. so when they do try to go out on their own they fail more often than succeed. I also have seen this same style of business drag down opticians as well.. shoot I even agree that sponsorship is NOT working. I see far more people that "memorize" things to pass the test but do they understand it? NOPE
When I got into opticals back when just about EVERY optician I worked around or with had or came up through a lab and understood what the theoretical side was as well.. while the chains, etc., do NOT care if they know anything about optics as long as you sell WHAT we want to push..i.e. I had a "lic." optician try to explain to me that featherweight was NOT a poly carb, and that internal distortion was a "good" sign like seeing a maltese cross in glass (this was explained to her by a "corp. rep" ).. had another explain to me that their was a "poly as well as a high index poly" .. well the corp. had two prices so that made it true..
I have seen most of my friends that are OD's hours increase and wages decrease.. mostly due to third party plans.
I guess you two are looking at it as a "territorial" thing.. me? I think you should be able to do WHAT you want and how you want to do it. An optician an and OD want to partner up..got no problem with that, you work for a "chain" as an OD you should EXPECT them to want you to push that store..you don't want to do that? than DON'T work for them...as long as you are ethical, willing to invest and take the chances than you reap the rewards. More or less it looks like they are trying to rewrite the structure of the laws because the structures of the business has changed.. I just think they are looking at and blaming the wrong group.. they just figure it is easier to bash opticians than fight the chains/corps. .. in the letter they talked about opticians as a "problem" but notice the wording of the amendments all have to do with problems from chains and corps. ..

Homer,

I see no problem with going to an optical and they actually are doing WHAT they are there to do and that is "sell" glasses.. if no one is interested than all you have to do is say "I'm here for an exam only" that seems fairly simple to me..I have NEVER seen or been in ANY office that would release the RX until they were paid so I did not understand what your point was their calling that "jumping through a hoop.".so the optical was not supposed to sell anything and the script was supposed to be handed over at no cost?

You can trace most of these problems back to two things, chains/corps. and Ins. .. both of these things are NOT going to be put back in the bottle so now what? Everyone is fighting for a piece of the pie, and in the rulings listed above as well as the other thread, blaming the "price" to the consumer being higher because of opticians salaries is asinine. an OD is NOT required to employ an optician, so if you do not think it is helping than DON'T but the odd part is they still charge the same for glasses and frames as the ones that do..

I think back a number of years, yes, optics was more ethical. BUT you are not going to make sweeping changes one way or the other no matter what we do now because the whole structure of how the industry works as a whole has changed.. so I say either change with it and adapt or you get left out.. I deal with dozens of other lab owners who sound like a broken record when it comes to talking about Essilor, Hoya and now SOLA getting into wholesale.. forget it, they are here, accept it and either fight or give-up but stop crying about it.. It's a free society (business wise) upto the point of being a monopoly.

NOW you two can bash me for a while, who would have thought that you guys would be "buddies" :)

Jeff "ooohh I love a good debate" Trail

[Homer]

shanbaum said:
"We are march-ing, march-ing to Shibboleth..."

That's Sibboleth on this side of the river :D

[shanbaum]

Homer said:
That's Sibboleth on this side of the river :D

Fellow kid,

That may be, but when the Firesign Theater sang it, it was "Shibboleth".

[docwatson]

Jeff Trail said:
I can actually post and maybe Homer and DocWatson can BOTH get a chance to jump on me from "another point of view"...
....NOW you two can bash me for a while, who would have thought that you guys would be "buddies" :)

Jeff "ooohh I love a good debate" Trail

Why would I jump on you when we completely agree?

Homer and I ARE NOT BUDDIES! We just have an understanding. Siskel and Ebert had an understanding too, as did Stalin and Hitler--that is until Hitler decided to take matters into his own hands. You figure out who is who. :D

I'm fairly easy going--I don't get too militant (hah!). I can respect someone for their opinions even if these opinions are completely different than my own. We all live in a free country (well, those of us in the USA anyway), so everyone has the opportunity to do whatever and whenever. Just don't: Make our professions look because it comes back on us in some way, do harm to people, or do what's not in the best interest of the customer.

Probably the only time I will lose it if someone makes completely absurb statements.

Again, Homer and I have an understanding. We both appreciate quality and we want to do what's right. I can respect that. So he can do whatever he wants to do to run his business, and I'll do whatever I want.

We do disagree on the issue of steering patients into the optical. I actually think it's okay. We all have to make a living. I draw the line on telling patients that their eyes will be harmed unless they visit our optical or something to that effect though. That's going too far. The way I look at it is that I think we do a better job. So they are better off seeing us. I think we have the best selection, the highest standards, and the best value than anyone in town. Darn tootin'!!

[shanbaum]

Homer said:
That's Sibboleth on this side of the river :D

Oh, now I get it.

[Traci]

Jeff,

Amen!

We do disagree on the issue of steering patients into the optical. I actually think it's okay. We all have to make a living. I draw the line on telling patients that their eyes will be harmed unless they visit our optical or something to that effect though. That's going too far. The way I look at it is that I think we do a better job. So they are better off seeing us. I think we have the best selection, the highest standards, and the best value than anyone in town. Darn tootin'!!

Steer? Shouldn't that be the patients choice? They should WANT to stay with you because of the service and product quality you offer. HOWEVER, one should have the freedom of choice to go where ever he/she wants to.

The "best selection" is in your opinion, do your patients think so too? The "highest standards" is debatable with optometrist's opticals as a whole. Yours most likely is, but many are not. Oh yes, I think Optometrist values are higher than chains any day! But if we are going to talk "Highest Standards", then I think Independent Opticians will provide the highest quality ratio to any of the other choices out there.

[Homer]

out West we know that as a beef with no balls.


Traci, you make some great points on the quality issue. I have seen optical techs think that they had really high standards - and they were, compared to their peers - but then go to work for a really good optician (in a doctor's dispensary or not) and find out that they bearly had a clue.

Quality is quite relative and is like beauty, it is largely in the eyes of the beholder / consumer.

[Joann Raytar]

Traci said:

Steer? Shouldn't that be the patients choice? They should WANT to stay with you because of the service and product quality you offer. HOWEVER, one should have the freedom of choice to go where ever he/she wants to.

Traci,
If a customer looked around for an hour, asked you questions and then said they were going to shop around and start to walk out, would you just let them go or would you try to get them to shop in your optical?

[Homer]

but optometrists are not retailer they are professionals ! ;)

[Traci]

If they are in my store looking around for an hour and asking questions, then they are shopping. Choosing to buy is another thing.

I want people to feel comfortable and relaxed when they are here, not to try to capture a one time sale and never see them again. I find out what they like / dislike and try to accomodate them.

If someone chooses to leave without buying, then that is their decision and I respect that. I remain friendly and always thank them for coming in and invite them back at anytime!

When you (meaning everyone) are out "shopping" do you want the freedom to be educated about what you are buying and where you buy it from? And to not feel pressured about being able to shop (just look around) in a store?

[Joann Raytar]

Thank you Traci. Between the above and other posts you have made, I now understand where you are coming from.

You make a fine point in your reply. Treat your patient/customer as you would want to be treated.