Whatever you say...Originally Posted by orangezero
Whatever you say...
Oops! Sorry about that! I forgot that this is a worldwide forum. I'm not sure if your location ( Ill.) is a province in some communist country, or possibly a dictatorship where it is written in the law that everyone must have an eye exam, but here in most of the US, it is up to the discretion of the patient as to when (or if) an eye exam is performed. Of course, in some states, the government has decided that parents do not have the sensibilities to know when to have their childrens' eyes examined, and has made it a condtion of entering school. Conveniently, the governments of these states now pay (great news for ODs!) for these exams.
You really can mandate prescriptions ? You're right...I can't understand that.
I think mandate was a word you initially used, but the truth is we can write a prescription with an "early" expiration" if there is medical, functional, or even purely visual reasons behind it. Sorry if you don't believe me, but I've personally never written a prescription for less than 2 years for spectacles. Although, I do warn people all the time (pregnant ladies, post cataract surgery, etc) that there vision may change significantly. I realize a lot of the reasons for writing a short expiration seem dastardly and only money driven, but there could and probably usually are valid reasons you aren't aware of (not trying to make it seem as if I'm above you, but its true)
Its mostly semantics (which I've noticed is what generally leads to long discussions on virtually any forum). I really think this is somewhat of a pissing match now, and I'm sorry if I ruffled too many feathers. I just think its sad that some opticians view ODs as the enemy in all of this. Whos going to be happy when an elderly patient buys a pair of glasses for $450 and then finds out they won't work because she just had surgery?? I would agree there are some eye care practitioners who are shady (won't release Rxs still), but you guys appear to be casting me in that light just because I write a prescription that expires in two years and stand up for those ODs who use their professional judgement to determine earlier is needed. Or for contacts that expire in one. And I try to stick up for the profession as a whole when it gets discredited and undermined in this forum. Opticians (much like optometrists) have much bigger enemies than private practice optometrists.
To make this more constructive, please elaborate with me on what some of these docs are doing that *****d you all off. I know it is required in any state to release the prescription when its finalized. I can only assume a lot of the older docs may not want to change this. It never even occured to me that an optician might get an Rx and be upset because I wrote an expiration date on it... for whenever..
and where is it "legal" to neutralize and make a pair of glasses from that?? I'd like to know..
Last edited by orangezero; 06-18-2006 at 12:50 PM.
New York for one place...and I suspect many others. This legality was something that was lobbied very hard for by certain special interests.
just wondering, cause here in Illinois we get tons of people that come in wanting us to "just read them off of these," and I've never heard of that being legal in any of the states I've been in.
thanks,
I think (but do not know for sure) that neutralization and duplication is legal everywhere but one must duplicate exactly. Same lens type, P.D., Rx, etc.
Chip
I am sure that if it still legal everywere the O.D.'s will see that the various legislatures change this "in order to protect the public."
Chip
It's always been legal in VA.
Also legal in Colorado.
Days where my gratitude exceed my expectations are very good days!
Actualy, without ODs, I would not be able to make the living I do. If I was able to refract(by law), I'd still hire someone else to do it. What they charge in this area for exams ($45-60) is definitely not worth the aggravation. I have 7 Ods that work for (with) us , and they do a great job, and we all make a good living because of it.
In Fla, (or at least when I passed the boards there) it is legal to duplicate any pair of glasses a customer hands you. The same holds true for Ohio. I think it makes no sense, but I don't write the laws.
As far as what ODs (and MDs) do to upset optician...
-I have known some to purposely give erroneous Rxs to patients that are "walking" with the Rx.
-I've received Rxs that simply say "no change" , but have no other instructions.
-I've received Rxs that say "Balance OU" (This happened last year. The guy was a -5.40 OU)
-I've gotten Rxs from ODs with the left eye written in plus cyl, and the right eye written in minus. When we call they say,"fill it as it's written".
-And of course, we get CL rxs with no brand or base curves.
-Not to mention the 3 month expirations.
Most of these are not just one time occurances, but habitual with certain Ods that (presumably) feel threatened by their patients taking the rx to shop around.
Johns:
The contact lens Rx with no brand, no curves is the best of all situations and the only one I will accept. Here I am able to use what I think best and change it without submitting it back to someone else when the "prescribed" lens (translation: fitting from some silly mfg. chart) doesn't work. As you know many "practioners" fit CL's with a "one size fits all" approach and if that doesn't work they just tell the patient "I guesss uou can't wear contact lenses." Of course if you can't fit contacts what advantage to you offer over mail order or discount houses?
Chip
What the doctor is saying with an unspecified fit is: "The patient is healthy enough for contacts, and you may do what you think best. I am responsible for what you do." What could be better?
Chip,
I hear what you're saying, but in this case, the patients are being charged for an eye exam, a fit, and follow-ups, and they think that the rx in their hand will allow them to purchase contacts.
I also am a contact lens fitter, but when I tell them that I the rx they gave me requires me to fit them, they're not happy. Especially when I tell them I don't work for free (although probably cheaper than what they just paid)
Thanks for the further info. I would hate to have to work next to those ODs. I think the worst that I have to deal with is unhappy patients that got their prescription from a ophthalmologist tech that hasn't ever learned the word accommodation.
If I were you, I'd very nicely call at a convienent time and at least ask the doc why he thinks a 3month expiration is necessary. At the very least it would be amusing, right?
Also, no way in h*ll would I ever release a contact lens prescription without the parameters listed.
Just curious...
Yo men: how many of you automatically bend over and 'assume the position' while your GP is snapping on the rubber gloves when you actually went to his office to have that RX for Ranitidine (used to treat gastric problems) refilled? Uhhh, I bet not a one of you. You might even have had your pharmacist call his office to have the refill issued. You're gonna be on that RX likely for the rest of your life, as you need to keep those gastric juices reduced even when you're asymptomatic. But you don't go in for a full body work-up each time you need a refill, do you?
I fail to see the logic in 'requiring' a spectacle wearer who is between 19 and 65, otherwise healthy, not presenting any symptoms of anything other than requiring corrective lenses, to undergo a full occular examination each year or two, (or more frequently as I'm reading here) when all they're needing is a new pair of specs.
Look at how many Ophthalmologist don't even refract any longer! They see their patient for the medical eye health exam, treatment of a condition if present, then send them off to an OD's office WHERE THEY UNDERGO MANY OF THE SAME TESTS AND IN SOME CASES EVEN MORE, THEN ARE REFRACTED, AND ISSUED A SPECTACLE RX. The refraction and occular exam are completely separate in the eyes of the doctors, but not in the eyes of the OD's. Now, why would an OD need to perform an exam AND a refraction, when the patient is there only to obtain new spectacle lens powers? Could it be, that delicately whispered word MONEY ? That same word is whispered amongst themselves, or inferred to, even when a healthy person with a healthy pair of eyes is examined. That person who's wanting to get themselves a new pair of glasses may have some nasty cancer cells lurking somewhere in their body, but at their last visit to their GP to treat that infected cut on their finger that possibility was not addressed, and they walked out of the office happy as a clam clasping the RX for their antibiotics with fresh dressing over their wound.
Now, as for ethics:
I once had a local OD write an Rx for a fellow for whom we had previously made glasses for. He was, at that time, a myope with a couple three degrees of prism OU, and he was without glasses due to some misfortune. Now, this OD specified on the RX this man's PD as being 56. I knew, from the record of his file, his PD is actually 65. And interestingly, there was no longer any prism prescribed. I questioned the client about this, if there had been any discussion about eliminating the prism, and he firmly stated there had not, and he still had double vision without his glasses. I knew, straight off, what this OD was up to as a quick calculation confirmed that the prism would be exactly as it had been before. If this guy had gone to another dispensary, he very possibly, if not probably, would not have received the required prism. Many opticians would have assumed that the OD had a dyslexic moment and reversed the numbers of the Pd. And, if my memory serves me right, the OD had specified that he wanted the glasses returned to his office for verification.
Last edited by Cindy K; 06-19-2006 at 11:05 AM.
OD had a dyslexic moment..........................
......and maybe he was smart and the reversed PD would have provided the necessary prism.
Most (I'm sure) opticians would have recognised the fact this guy's eyes are set further apart than the stated 56, and likely would have called the OD to confirm what he was intending to do. However, I firmly believe this OD was attempting to make a customer out of this patient. Can't think of another reason he'd advise that the glasses be returned to him for verification of accuracy.
ummm....mandate can also be an official order...like an expiration....also a Gay magazine (from Google). It is up to the different State boards to set expiration dates. eg:Glasses 2 years, CL's 1 year.
Cindy K,
By law, I am held to the same standard as their ophthalmologist. If they have any eye disease and its not diagnosed by me, AND they have a happy lawyer, my name will be thrown in with the rest and I'll be in for a long ride. This is one of the main reasons I do a full exam on patients even if they just were seen by another doc. Saving the patient 10 minutes won't mean much to a jury...
I also am not sure if you guys realize this or not (not from lack of knowledge, but just from not being there for that part of the timeline), but most patients I see can have their prescription adjusted and see better. By and large, most people that come in for eye exams do so because they want to see better, not because they feel morally obligated to come see me every year. I also think that an educated patient does understand why contacts need to be checked every year.
Like I said before, I do think there are some eye doctors that do some shady things, but I find it hard to believe its the norm.
And for the PD comment, you dont' think we as ODs care if the glasses get made according to the prescriptions?? Have you ever seen a prescription get made at walmart, and then the patient comes back to us because they can't see???
and finally, its interesting how money hungry ODs and ophthalmologists are and the main thrust of this forum topic is to free up the "unneccessary restrictions" so you guys can sell more glasses... I'm done commenting on that:)
Last edited by orangezero; 06-19-2006 at 12:01 PM.
Orange
Good points, all of them. However:
I realize the medical system in the US is vastly different from ours here in Canada though we are soon approaching the same system as what is in place in the US. I don't believe it is proper and correct for an ophthalmologist to bill the medical system his fee then the optometrist perform a refraction AND a full occular exam AND BILL THE SYSTEM ONCE AGAIN FOR THE SAME PROCEDURE AS THE PATIENT HAS ALREADY HAD PERFORMED, AND BILLED TO THE PROVINCIAL MEDICAL SYSTEM. Yes, I realize I may be shouting but this appears to me, and to many of my clients as well, a misuse of funding. Our medical system is in dire need of repair, and double billing of this nature is only contributing to the demise of our dearly beheld medical system.
Regarding RX's being tweaked annually, I see plenty of RX's written by both doctors and OD's where there is no change. Yes, there are those persons who are more sensitive and receptive to small changes but really, is a +/- .25 going to make an appreciable difference? I also see plenty of these issued. Very rarely is this change noticed. As for contact lens wearers, that is an entire different situation and yes, absolutely, their eyes need to be evaluated regularly. We all know what the potential is for a non-compliant client.
Speaking plainly, the story I related about the 56/65 pd clearly indicates that this OD was almost certainly attempting to make a customer out of his patient. Here in BC a PD is not part of the RX, but is sometimes given by the OD (and sometimes incorrectly I might add, so we invariably check pds ourselves) . As for ODs wanting their RX's made correctly, we as opticians want the RXs we fill to be correct as well, not only on our end but from the RX source. Have you not had to redo an RX due to an error on your part?
I've always felt, in the nearly 20 years I've been in this industry, how very unfortunate it is that physicians are not permitted to dispense the RXs they write but OD's can. And do. To as many of their patients as is possible. The dispensary is a grand source of revenue and patient retention does not only mean keeping that person as a patient for their eye exams, but also keeping them in their dispensary.
Yes, I know there are many ODs out there who will tell their patient that there is no change required, or if there is, simply hand them their prescription without first eliciting a feeling of obligation from the patient to purchase their eyewear at their dispensary. Unfortunately, the opposite is also true. Its not so much about 'removing unnecessary restrictions' to enable us to sell more glasses, rather, that it should be the patient's choice as to the frequency they wish to have an eye exam and/or refraction. I have a copy at the office of the recommendations of the American Acadamy of Ophthalmology regarding recommended frequency of eye exams. Why does it differ so greatly from the frequency most ODs subscribe to?
FWIW
A routine eye exam for people between 19 and 64 is no longer a benefit of the Medical Services Plan, regardless of whether it's an optometrist or an ophthalmologist doing the exam. Most ophthalmologists in the Lower Mainland no longer do refractions because it isn't worth their time or the money. And the service fee that ophthalmologists get paid for a basic eye exam, if billable to MSP, is more than optometrists get paid.
Are you sure that MSP will pay out twice? I've have billings come back refused when patients had an exam done elsewhere within 24 months. Hence the reason I ask when a patient's last eye exam was; I don't want to be the one telling my bosses they won't get paid when a billing is refused.
Just curious...are you equally as upset over the frequency that your dentist calls you in for a cleaning and check up? I personally dread the call every 6 months because I get guilt tripped into making an appointment when I really can't afford the $100+ visit. And that comes out of my own pocket, without recourse to the extended medical plans from which most people can claim back their vision and dental expenses.
In Ontario the ophthalmologists have a totally different series of billing codes than optometrists. I've spent time in several ophthalmology offices and been in awe over what they can bill for. I've also seen what they do for an "eye exam" and anyone who thinks having a routine exam following a problem specific exam is a waste is risking their own health. This is not meant as a put-down to ophthalmologists but simply the facts. They spend at most 5 minutes per patient around here and I highly doubt even the most ignorant will claim that is enough time for a comprehensive exam.
We now have an Ophthamolgist do our refractions. He is very fair. Does not abuse the system. He also does not rush through his exams.
Of course, I think he is different from the others out there.
I can on some levels agree with some of your arguments. Didn't optometrists start off as opticians anyway? Some time ago (please don't make me look up my history of optometry lectures from school) there was a split into dispensing and refracting opticians (ie optometrists). We slowly developed a more medical model, but yet we spend countless hours learning about optics, dispensing, etc. So, in a way, you are saying opticians shouldn't be allowed to sell glasses. interesting. Plus, I think there are valid reasons that can be made for why the patient would benefit from purchasing the glasses from the same place as the the prescription is filled. Otherwise, why would opticians want to work side-by-side with optometrists..
And I would have to agree with the other poster. Sure, MDs can't sell their own drugs, but they certainly can sell surgery. How many pediatric ophthalmologists do you know that won't slice an ocular muscle at the drop of a hat? There was an interesting article some time ago on the internet about some orthopedic MDs that were making over $900,000 simply on "devices" and other MDs making only 100k or 200k. Dentists have a lot of selling, the difference is that it generally all goes in your mouth and has to be applied. So they get paid for the services and the "equipment" right? Who decides what is put in there? The dentist.
I would agree, there are many problems with medicine as a whole, US or canada. I just talked to my sister tonight and its about $2000 to $8000 for one night in the hospital if someone doesn't have insurance. Every penny counts, but should we really be discussing the importance of exams every 1.25 years vs. every 2.2 years when in most cases its less than $100 for a routine exam. Please try and explain how vision is less important than teeth... Plus, you know how much we pay for each person that goes blind because of undetected glaucoma, has to go on disability, and needs costly low vision devises? Or how costly dialysis is for an uncontrolled diabetic that never had regular exams? Its amazing and crazy...
and I agree with fjpod. Why does any health care system want to have ultra specialist surgeons performing routine health care? Opthalmologists are some of the most talented and intelligent surgeons in the country, and I think generally most dont' want to be dealing with routine. However, despite their negative view of optometrists for "selling things" they still have many recent articles exclaiming the virtues of in house dispensories.
Just to bring this closer to home, I'm looking to start a practice in a very rural hospital medical complex. People will have access to eyecare that otherwise would have to drive 30+ minutes. Plus, I'll be there for medical emergencies and ocular trauma, nursing home, etc. However, I dont' think there is a way to make it work without a dispensory. People just expect an optometry office to have frames to pick from. Some of its one stop shopping, some is that people really want to trust where they make major purchases. I don't feel I'm cheapening what I do by selling frames. Or being less of a doctor.
Orangezero.
I know many pediatric ophthalmologist who are not knife happy in fact, most resort to all sorts of things before surgery.
As to haveing a dispensary in the doctor's office so "it can be trusted." This is one of the main reasons people don't trust doctors anymore and why the "second opinion" is becoming not just commonplace but required.
Why you young folks never seem to get it, when starting out your main source of referral will be the optician. Other doctors aren't going to send thier good practice to you except the ****, the middle of the night stuff, the patients who don't pay, those who smell bad etc.
Of course you can start the modern concept of "ethics" and not dispense for two years, live on referrrals from opticians and then open a dispensary "for the convienence of your patients."
Chip
The only reason a prescriber ever opened or was entangled with the ecconomics of and optical dispensary was to make money! All other arguments are BS. It really doesn't hurt patient's to stop at an optical dispensary on the way to or from the doctor's office. Brake wear won't be that much on thier vehicle.
Last edited by chip anderson; 06-20-2006 at 06:34 AM. Reason: Mo' comment
The only reason opticians disparage prescribers who sell glasses is that they want to sell more glasses themselves. It's strictly an economic thing.
Most of you who know me by now on this board, know that I don't truly believe the above statement...but do you understand how rediculous it sounds? I said it to get your attention. I think most people who dispense something...glasses, medicine, surgery, advice, are honest.
This concept that prescribers who dispense are inherantly dishonest is ludicrous!
I agree with above..........it is just the age old sense of competition between the three O's that makes some dipensing opticians act up.
The dispensing optician, not able to prescribe, should make up with services that the 2 other O's can not provide, be the artisan with at least a decent setup to do the basic optical lab jobs, repairs and lens treatments. This way he can provide a better service than the other two.
As the doctors MD or OD offices have to be run by on site trained people a properly educated and expirienced optician still has a big advantage to the prescriber run store or office by giving a much higher level of service.
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