How I explain *why* I don't accept insurance

[orangezero]

just to be silly, in this day and age would a MD really want to own a pharmacy??

perhaps they wouldn't mind selling medical equipment that has a high markup, but i doubt most would want to deal with selling generic htn meds. in fact, I've seen many cases where MDs do sell things. a dermatologist in my area has no problem selling his own facial creams, at extremely high prices i might add.

You think dentists don't "sell" you those nice fillings? or clear braces for your child, instead of the metal ones? And how about those nice teeth whitening products... I guess if it goes in your mouth its easily forgotten...

I think the big difference in some of those cases, is that generally there isn't another group of people to go to outside of their office to buy products such as clear braces. For some things, such as teeth whitening products, there are OTC alternatives. However, some feel the need to have a professional opinion and service and don't mind paying for both the service and the product from the same person.

are all of these examples conflicts of interest?

[drk]

Examine your argument, 24/7. The bigger argument is "should physicians be allowed to diagnose but not treat?". Glasses are a treatment. Contacts are a treatment. Drugs are a treatment. Surgery is a treatment. Physical therapy is a treatment. So, the argument breaks down, doesn't it?

M.D.s can run optical dispensaries, so I don't think there are ethical violations that the public is being protected from by them not having pharmacies. Hospitals have pharmacies, BTW.

Do you think the government should protect the public from an O.D. providing treatment for his/her patients? Contacts, too, or do you just care about glasses money? Do you have evidence of some damage to patients?

Thanks! Toodles!

[mike.elmes]

In our office we have the Eyelogic System for refraction. It allows us Opticians to do the refraction. We have compared our results to MANY MD'S and OD'S rx's.
The general concensus is we can deliver visual acuity equal or better than most rx's we compare to.:bbg:

[Ory]

In our office we have the Eyelogic System for refraction. It allows us Opticians to do the refraction. We have compared our results to MANY MD'S and OD'S rx's.
The general concensus is we can deliver visual acuity equal or better than most rx's we compare to.:bbg:

Does it measure phorias? Would it know what to do with them?

[mike.elmes]

The Eyelogic system does not detect phoria of any kind...we screen each person.The requirement is the person mut be over 18, under 65, and has been tested by an OD or MD within the past 5 years. They sign a waiver to that effect.This is strictly a refraction for the purpose of making eyeglasses. No prism.

[Ory]

Testing the need for prism is an integral part of determining an eyeglass prescription. I think you've just helped prove drk's point.

[mike.elmes]

I guess if the previous doc missed the phoria we should be expected to catch it eh??

[OPTIDONN]

To be honest I don't know why opticians want to refract so bad. I see very strong points on both sides. However I feel that OD's graduating from today's schools are leaving with a great deal more medical knowlegde then before and a lesser understanding of optics (keep in mind this is my observation not a fact!). This leaves a very important aspect of this field void. Opticians should start filling the role as THE experts in optics and lens design. Example: you don't see the pharmacist chomping at the bit to prescribe medicine, thats the role of the Dr. instead the pharmacist is THE AUTHORITY when it comes to medication. Same should hold true for us we should push our selves to be THE AUTHORITY of optics, lens design etc.

[Ory]

I guess if the previous doc missed the phoria we should be expected to catch it eh??

Ah, yes, but what do you have from the previous doc? If you had an emerging presbyope wearing sv distance glasses, how will you know if they need prism at near?

The need for prism is not something that necessarily stays constant, and an exam from 2 or 3 years ago may no longer have an accurate phoria measurement. There really is more to this than just flipping a few lenses.

[Ory]

I feel that OD's graduating from today's schools are leaving with a great deal more medical knowlegde then before and a lesser understanding of optics (keep in mind this is my observation not a fact!).

I would say that a more accurate statement, at least regarding the school of optometry in Waterloo is we have an excellent knowledge of optics in theory but we are certainly not lens specialists and don't have a great practical knowledge. When I graduated a couple of years ago I didn't know much about lens brands except what the manufacturers pushed at us while giving us dinner. I knew a lot more about general lens types and their properties.

I'm happy to say that I know a lot more now. I often get new ideas from this board also. I'm still young and idealistic so I'll try most new things.

[AEOC]

I don't think there is enough uniformity in opticians' education in the US right now. I've seen brilliant posts on this site and I've seen opticians do things that really made me scratch my head. The difference in technical knowledge and skill between optician A and optician B can be ASTOUNDING! Unfortunatley, I think this is an overall detriment to the profession and the engines of opticinary need to help make sure that all the cars down to the caboose are safely on the right track before the trains is going to go anywhere.

[Barry Santini]

To be honest I don't know why opticians want to refract so bad.

I want to refract because I believe not only can I do it/(and more importantly) listen better than the refracting* offices around me, but also because I want to participate in and initiate a movement to move the current reafractive procedures into the past, and integrate the latest technolgies into a refractive procedure for the future. To do this, we first need to:

1. remove insurance from the equation
2. Recognize that the current reafractive paradigm is outdated and ineffective
3. Move eyewear from "need" based purchasing to "want" based purchasing

With all the discussion here about Eye exams and hidden health issues, ultimately it's the wearer today who can still decide whether they want to wear a give correction at anytime...or not. Heck, they can have a "current" Rx (I hate that word!), but decide to use an older/different pair/spare pair at any time. What do you all feel then is up with the "health" of that patient under those circumstances?

It's not refraction that is the issue: it is vision screening that needs to mandate that anyone driving a motor vehicle be certain to have a minimally acceptable "sharpness" (acuity + contrast!) for this task. I believe making "refraction" available separately would facilitate this goal greatly. Again, unless we as a society are ready to *mandate* eye EXAMS yearly in the public's best interest, I believe revised acuity + contrast standards beyond Snellen (so 19th century!), along with the ability to measure/test such, quickly and conveniently at a given moment (My Vision Today, or MVT!), are easily institutable and in society's best interest.

On the other hand, if there is a consensus that too many eye health issues will go undiagnosed through such a new,refractive paradigm,then let's be uniformly consistent and eliminate not only OTC readers, but also retrieving/disposing-of any older, "spare/extra" glasses that have...well... I guess the word is "expired" (yikes!)

I'll go along with either way, because in the end, more eyewear will be dispensed and not "sold", and that's what I, as an optician (or as any dispensary owner, OD, MD. etc?) would like. And the public good is served through a public that will more completely recognize the importance of sharp vision when driving...which is the *most significant* ultimately negative *societal* consequence of less-than-optimal vision

It boils down for me to "free" market, *or* controlled market... there's clearly compelling discussions for either one, and I'm *ok* with either one.

What do you all think?

Barry Santini, ABOM

[HarryChiling]

With all the discussion here about Eye exams and hidden health issues, ultimately it's the wearer today who can still decide whether they want to wear a give correction at anytime...or not. Heck, they can have a "current" Rx (I hate that word!), but decide to use an older/different pair/spare pair at any time. What do you all feel then is up with the "health" of that patient under those circumstances?

Well said.

On another note I no longer listen to OD's talking about medical diagnosises because you are not medical doctors. I think that it is far scarier for our healthcare system to have OD's playing doctor. If you ask me I think that MD's should focus on the health of the eye, OD's focus on the refractive errors in the eye, and opticians focus on the corrective equipment for the eye, but since MD's and OD's have an arguement for having dispensaries in their offices and taking money out of an opticians pocket all under the guise of patient care, than why should we not have the right to try and push our proffesion to the next level.

The only people that think opticians should not refract are OD's, it would kill their proffesion. I personaly don't need opticians to be able to refract, whenever I want I can ask my doctor (MD real doctor) that I want to screen for him that day and then guess who is doing the refractions. Od's want the world to believe that refraction is this crazy complicated thing and that the minute a phoropter is placed in front of the patients eyes that the magic begins.

If by refracting you are checking the health of the eye, than what is the dilation for? Why do some places charge extra for dilation? Are these places not doing a thorough enough eye exam, are they skipping the health part of the eye exam? What about wal mart and americas best, when they give a patient a 5 min eye exam are they checking the health of the eye? If they are checking the health are they that much better than the private offices, or are they seasoned veterans at refraction?

It's time for OD's to let go of refraction in my eyes, but that is my opinion and to be honest with you I didn't go to college one day in my life. Guess what, I am highly educated, but if opticians were to gain refraction I don't believe that I should be allowed as an optician to refract, because that would be irresponsible to let people straight out of high school have the opportunity to refract. I do know of a boat load of highly educated opticians that should be allowed to refract and my proffesion is full of them. Opticians did not choose to have dim wits amoung their ranks, these dim wits were put their by corporate store, OD's, and MD's. The doctors and businesses have trivialized our business, but some how as trivial as glasses are the specific curvature of the lenses coems into question. This is REFRACTION. Every time I say that opticians should be allowed to refract, I hear some thing about health from psuedo doctors.

[OPTIDONN]

Well said Barry. Like I said I really flip lop on this issue. Too many good points on all sides.

[mike.elmes]

With the right equipment, education, and ethics any Optician should have the right to persue refraction as a non medical means to improve acuity for the consenting general public.

[orangezero]

your correct mike, generally they are called optometrists. :)

The three points harry brought up don't make a whole lot of sense to me. As long as there are companies like luxotica, vsp, vision insurance will never be separated from refraction. Its not optometrists you have to fight with on this.

I will agree with several people on here, there ARE too many refractionists, not a shortage. A divided profession such as opticianry will never have the will power to change any of these things.

[drk]

Harry and Barry, sitting in a tree....

You guys are too much. If you saw it from my perspective (20 yrs of optometry), you'd know that you are wrong. But I guess you think I'm biased.

Oh well. Keep on tilting at the windmills.

[orangezero]

Harry, you flat out just dont' understand what you are talking about. Your derogatory comments about optometry do nothing to help your cause. I take what you say as an insult and its just plain stupid.

The ER doctors you must hold in such high regards because they are "medical" rarely get their diagnosis correct in regards to eye problems, or pediatricians for that matter. If someone comes in with some type of problem that I am not able to handle, I will certainly refer them to the appropriate physician or allied health professional. However, despite the fact that these medical doctors dont' know what they are doing (in regards to eyes), they are legally allowed to prescribe these medications and do so without much thought.

It doesn't matter than generally the problems caused by this are not severe healthwise, it just doesn't make sense to have patients spend money on useless drugs because their health provider is ignorant of the condition and current treatment. Its just plain stupid for an optician to recommend a customer of theirs sees a medical doctor for an eye problem, or to see a corneal specialist or retinal specialist for a red eye simply because they are an MD. They have better things to do... like their specialty.

To do so is a disservice to your customers.

[HarryChiling]

Harry and Barry, sitting in a tree....

You guys are too much. If you saw it from my perspective (20 yrs of optometry), you'd know that you are wrong. But I guess you think I'm biased.

Oh well. Keep on tilting at the windmills.

This is always what this conversation boils down to, the supposedly educated individual stooping to a low level to make it personal. This comment has no purpose in a discussion and shows that you have no valid points that need to be addresed.

Harry, you flat out just dont' understand what you are talking about. Your derogatory comments about optometry do nothing to help your cause. I take what you say as an insult and its just plain stupid.

In the begining of the thread it was you that was going on about opticians not being able to refract in canada and later you admit this was an unsubstantiated claim. I took real offense to that because like all the optometrists on this board know

A divided profession such as opticianry will never have the will power to change any of these things.

My point keeps being that REFRACTION IS NOT A MEDICAL THING. The only reason opticians are not refracting is not because some of us are not knowledgeable enough to do so, but that we don't have the strength that optometry does. I would appreciate it if optometry stops masquerading refraction as a medicla thing.

What is a shame is that all the optometrists are sticking together and the opticians on this board are split and some are viewing and will not comment on things like this. It is not a matter of medical vs non-medical, it is a matter of POWER. I don't even want to refract, but I sure don't want another proffesion that is a spin off of opticianry to tell me that I am not qualified to do it. I hate the fact that your proffesion is trying to increase more of what it can do and at the same time keep our proffesion down in the gutter.

[orangezero]

I don't know too many optometrists that really want to do lasik. I highly doubt that will happen. Our scope of practice will most likely increase to include medications necessary for treating common eye problems. I hope the powers that be (we are not as borg-like as you suggest, we do have leaders doing things that not everyone agrees with) don't decide its in the best interest of optometry to start to perform laser procedures.

That being said, I've tried to give a valid argument for why I believe the refraction is a part of the exam, but can't really be separated. Almost all optometrists would agree with me that a refraction (while separate for billing purposes) should not be independent. There are a wide variety of reasons for this. You're probably right, some of it is defensive posturing to keep our piece of the pie.

I also think, however that perhaps you only see one side of the story. You might only see those patients that pass through an optometrist or ophthalmologist and are defined as healthy, they just need glasses. Perhaps you do (I'm guessing you do) work with some eye care providers that do have some pathology come through their doors.

Economically, I'm just not sure there is a need for it. Most patients I see are ashamed (not because of me, I make no judgements) because of how long they go between eye exams. I have a general feeling that most would rather have an exam, and only a few few have ever mentioned to me they wish they could just have a quick refraction and

I don't want to degrade what you do anymore than is necessary. How have would you like to go? Would you do accommodative testing, vergences, phorias, PRA, NRA, x-cyl, ductions, pupil testing, cover test?? where do we draw the line?? What is just good enough to not need you to have liability coverage? You think you can just have the customers just sign a form and your liability is gone?? And then what, if refracting opticians have to pay for the extra liability I'm sure they'll expect extra compensation (which I would probably agree with actually). I don't think refracting opticians would be horrible, especially if they are educated like you hope and assume would happen. And then what if they see something that is amiss? Eventually they will feel silly sending them out to an optometrist or ophthalmologist for a consult. Why?? because they have the education. I'm not trying to sound dumb, but please tell me with a straight face that this person who is educated in optics, vision, contacts, development, medications, etc... is not really (just) an optometrist...

thats part of the problem I see with this. its already been done. Refracting opticians are around you all the time, the are optometrists. a great number of these refracting opticans got together and decided its in their best interest and their patients best interest to know as much of the eye as possible, to know about optics, and yes to know about the dirty word of medial and medications.

It seems silly to try to reinvent the wheel. Its ironic on some level that you have no problem disparaging our profession and its education as being lacking but won't spend the (little amount of training and) time to become one of us to be legally allowed to do what we do.

My point is that and eye exam is an eye exam. Refraction is one part and has many different meanings depending on the person, not all of them are correct.

[Dannyboy]

Opticians do see the benefit of independent refraction. What happens is that most opticians in todays enviroment are employees and not self employed at least here in the US. I guess there is more interest in providing the service when one owns the place. Refraction is a non medical procedure. What happens is that in order to push eye health evaluations refraction is held hostage. I'll bet that many prescribers do a refraction even though the patient has no complains, sees 20/20 and is close to a plano to -.50. humm wonder why. & yes there is a charge for refraction. Instead of requiring a refraction done by an optician. Real doctors should require an ophthalmoscopy done by a real doctor and leave the menial refraction to the opticians who actually do use the information.

As far as numbers go I think that eventually all of them Non medical prescribers) will be employed by Wally Mundo at least thats what I recently read. I have decided not to worry about this any longer as they will all be employed by Wally. And I am far more efficient than Wally and have guaranteed my survival.

Todays refraction status is like a mechanic requiring a wheel aligment when filling your tire with air and for safety concerns does a break check. nothing wrong with that picture...

Refraction is not an eye health exam. The public knows that.

By the way there are only 3 radio stations in Tofino eh? I was glad to see that the Optician equation (prescriber) was balanced in Canada. It might take some time but eventually it will be here too! Way to go Canada!


Dannyboy:o
notice that I have not mentioned the profession that feels every time I post something is a bashing?

[Dave Nelson]

I wish I had a dollar for every time an ophthalmologist wondered why optometrists want to expand their scope of practice into the domain of ophthalmology by prescribing medicine. The same arguments you use to question why opticians don't simply become optometrists is the same argument they use to question why optoms don't become ophthalmologists. Many high ranking B.C. politicians have asked me why B.C. optometrists ask to expand their scope of practice to include TPAs while simultaneously opposing a scope of practice change for opticians to include refraction.

[HarryChiling]

I don't want to degrade what you do anymore than is necessary. How have would you like to go? Would you do accommodative testing, vergences, phorias, PRA, NRA, x-cyl, ductions, pupil testing, cover test?? where do we draw the line?? What is just good enough to not need you to have liability coverage? You think you can just have the customers just sign a form and your liability is gone?? And then what, if refracting opticians have to pay for the extra liability I'm sure they'll expect extra compensation (which I would probably agree with actually). I don't think refracting opticians would be horrible, especially if they are educated like you hope and assume would happen. And then what if they see something that is amiss? Eventually they will feel silly sending them out to an optometrist or ophthalmologist for a consult. Why?? because they have the education. I'm not trying to sound dumb, but please tell me with a straight face that this person who is educated in optics, vision, contacts, development, medications, etc... is not really (just) an optometrist...

You are absolutely correct, that is optometry, but for most this is not enough. VSP is created by optometrists for optometrists, for a patient with VSP to get glasses they need to go to a despensary 51% owned by an optometrist. This cuts us opticians out of the glasses, oops sorry we are dim wits. The fact that optometrists have dispensaries at all is a little bit offensive, but when optometry hires uneducated individuals to staff their dispensaries what then? Why is it OK for me to make your patient a pair of glasses if I work for you, but if I was to work for myself I can't do it. I am supposed to be expert on glasses, right. Whenever their is any legislation that would benefit opticianry it is usually optometry that swings the ax. Opticianry should hate Optometry, your profession has made great strides towards the positive, but you always have the boots on ready to kick opticianry in the cashews. Opticianry has a big part of the blame we as a whole will not stand by each other such as the OD's do, I am not that optician. I make my point of view known, always have and always will. I like to hear what you have to say because thats how I know what your profession thinks. I have seen you debating back and forth with me as well because you as well need to know my opinion to see the other side.

I don't want to degrade what you do anymore than is necessary. How have would you like to go? Would you do accommodative testing, vergences, phorias, PRA, NRA, x-cyl, ductions, pupil testing, cover test??

I do most of that now, I work for Dankner Fiergang Eye Associates, our office specializes in strabismus and pediatric eye care. As a COA I can do all of this and am considered an allied health care professional, but as an optician I am considered scum. I just don't get it, even optometry has paraoptometric staff and they are allowed to do some of the aforementioned, WHY CAN'T AN OPTICIAN. Some countrys still respect our profession and when you took what I saw as a pot shot I was very offended.

I don't want to degrade what you do anymore than is necessary.

How much is necessary considering the state of my profession? Any lower and I might as well polish shoes for a living. I am argueing with you over an issue that my profession has already lost. By all means I am not going to walk away from this thread feeling like I won some prize or something, heck even a few posts back I am being mocked for my opinion. The sad truth is that no matter what my education is the title OPTICIAN is tainted.

[orangezero]

harry:

"anymore than is necessary" was part of a sentence that didn't get edited properly because I had a patient coming up soon. sorry. i will edit that sometime.

I'm not even sure what I meant to say, but I think it was something along the lines of not wanting to seem like I am degrading your profession.

I can understand how someone in your position at work would be irritated a lot, I get enough myself simply because I look young.

Don't get me started on VSP, and I have never even accepted it yet.

I also highly doubt wallyworld will take over optometry. Lots of private practice ODs I know mention how it actually helps their business after people are accustomed to it and their shady materials and services (I was a walmart doc too at one point, and some of their optical people are good, no offense to anyone who knows what they are doing there).

I dont' really see this highly coordinated optometric force such as you guys describe. It might seem that way. In Illinois we've been slapped down by organized medicine on oral meds for quite a while. only one of five states that can't prescribe orals. Does it help optometry as a profession that each state has different laws? I don't see how it could. I think Oklahoma is a very strange beast, never in another state, and I doubt I'll eat my words on that for a long time.

Opticians do have an even harder time with organization, at least from what I've read here.

The question has to be asked, why do you guys think you deserve the right to refract only, and totally change the paradigm of the US eye care system?? Optometry has answered, up to this point, those questions sufficiently. Opticianry varies even more than optometry from state to state. Despite how some might not understand optometry, the general public has even less understanding of opticians. I don't think refracting opticians would help. The amount of advertising alone that would be needed to set the public straight is reason enough for this to fail. And do you really think your neighborly eye care provider (of any skin) is ever going to say your refraction is as good as theirs? I doubt the ophthalmologists (especially those with dispensories) would really be as supportive as some on this board believes.

And really if we want to go to the probable conclusion, I could really see walmart firing all its optometrists and getting two part time refracting opticians (in your supposed idealised future) for each store and paying them $15k a year with no benefits. Who wants that??

And in the US there are only about 6% of independent opticians anyway.

I keep pointing this out, but optometrists are a subset of opticians in some regards. There are definitely some similarites, but an optometrist is really an optician plus "extra stuff". That extra stuff is not just a refraction capability, but more. Because we realize the benefit.

Yes, people can die from a vision problem, and probably more often than not they "see" 20/20. Please stop saying it doesn't happen.

Do you think if we were all that highly organized we would ever have optometrists working in places that force them to do $39 eye exams, or even free ones in some cases.

I haven't been in this business long enough probably, but I've learned way more than I've wanted about the commercial and retail aspects of optometry and the greater eyecare world. I just honestly don't see the economic benefits of it for you guys. There is an oversupply in many areas. Too much of it is being soaked up by commercial places. Lots of patients seem to be unhappy with their last exam. Reimbusement is low. Why do you guys want to fight so hard for it?? Why do I not want to give it up, you're probably asking? because this is what I was trained and educated to do, this is what I've wanted to do since I was in high school. I didn't want to be an optician, I wanted to be an optometrist because I thought I could help patients the most doing that.

I can only dream of the time when most patients were private pay and we could make 3x markups on frames, buy contacts for $10 and sell them for $200. Most professions have a lot of baggage, but we seem to have too much.

You'll never get me to agree that refractions by themselves are a good thing for any of my relatives. Thats usually my standard for if its good enough for my patients.

My advice::
Get into plumbing or something else where you can charge $100 an hour if you want to make lots of money (just kidding).

have a good weekend guys.

[HarryChiling]

And really if we want to go to the probable conclusion, I could really see walmart firing all its optometrists and getting two part time refracting opticians (in your supposed idealised future) for each store and paying them $15k a year with no benefits. Who wants that??

I don't want that, but if my profession keeps getting draged through the mud then why not this would only create more job opportunitys for opticians and maybe breath some life into this profession. Don't just assume since it is bad for optometry that it is bad for opticianry. If opticians could refract yes wallie world may hire opticians and get rid of their OD's, but guess what independant opticians will thrive again because we could start offering one stop shopping. I know we are not ready for it, I will never argue that, but I do think that their are some that are qualified to do it. If health is such an issue then what about optometry in it's infancy, your profession was not medically oriented. I aplaud you for wanting to be an optometrists since you were in high school. My problem is opticians have been so degraded that no one says they want to be an optician in high school. We get the bottom of the barrel, some of the OD's on this board ave probably hired the bottom of the barrel and then gave them the title optician. I grew up next to a lab and broke down boxes for them when I was young and now I am what I always envied.

Yes, people can die from a vision problem, and probably more often than not they "see" 20/20. Please stop saying it doesn't happen.

It was never me that said that although I somewhat agree, I don't think the extreme cases count, but I also see your point their are alot of things that can go systemic and can lead to death, but so can stubbing a toe or a paper cut.

Get into plumbing or something else where you can charge $100 an hour if you want to make lots of money (just kidding).

It's electrical, and I have tained 12 people so far for their licenses and would be in the field myself if getting shocked didn't hurt so darn much.

I also am further pursueing ophthalmic assisting. I may no longer have a place in optometrys world, but their is still a place in ophthalmology and as an ophthalmic tech I will be refracting so this arguement is moot.