COT's refracting and charging???

[optical24/7]

Is this fellow holding the RX?

That is Illegal...yes?

I agree, very illegal if he refuses to release. We only have gogetter saying so ( I'm in no way knocking ya gg :D) What I want to know is what I asked above about advertising and exams.

Is he allowed to offer you a reduced fee if you buy from him? For all we know he is handing them thier Rx, the fee depends on whether they do business with him.

[HarryChiling]

One more thing I forgot to ask opinions on...

It concerns Eyeglass I and advertising. I know I've seen adds with something to the effect...." Eye Exam for $xx with the purchase of glasses". Is this illegal? In other words, regular exam is $100, with purchase of eyewear it's half that. You wanna walk with your RX, well, you don't qualify for the discount.

Not much different than 50% off frames with purchase of lenses. Don't buy the lenses, then full price for frame.

Thoughts?

(c) Charge the patient any fee in addition
to the ophthalmologist’s or optometrist’s
examination fee as a condition
to releasing the prescription to
the patient. Provided: An ophthalmologist
or optometrist may charge an additional
fee for verifying ophthalmic
goods dispensed by another seller when
the additional fee is imposed at the
time the verification is performed; or
(d) Place on the prescription, or require
the patient to sign, or deliver to
the patient a form or notice waiving or
disclaiming the liability or responsibility
of the ophthalmologist or optometrist
for the accuracy of the eye examination
or the accuracy of the ophthalmic
goods and services dispensed
by another seller.

If it is I don't see it in the Ophthalmic Practices Rule, although you cannot charge someone more money for an eye exam if they take it with them, I don't see anything about discounting the eye exam if they purchase the glasses at that location. If there is a conflict it could just as easily be reworded to state that the discount would apply to the eyeglass purchase and not the exam and whalla well withing the law.

Maybe it would be a good idea to run all this stuff by a lawyer in the state of TX if it's an issue that's gettign people this riled up, but IMO I don't think the guy is doing anything wrong except holding the Rx which is a no no.:finger:

[optical24/7]

If it is I don't see it in the Ophthalmic Practices Rule, although you cannot charge someone more money for an eye exam if they take it with them, I don't see anything about discounting the eye exam if they purchase the glasses at that location. If there is a conflict it could just as easily be reworded to state that the discount would apply to the eyeglass purchase and not the exam and whalla well withing the law.

but IMO I don't think the guy is doing anything wrong except holding the Rx which is a no no.:finger:

That was my take on it too Harry, but again, we don't know that the guy is witholding an RX. gogetter, care to verify for us?

[jediron1]

I agree, very illegal if he refuses to release. We only have gogetter saying so ( I'm in no way knocking ya gg :D) What I want to know is what I asked above about advertising and exams.

Is he allowed to offer you a reduced fee if you buy from him? For all we know he is handing them thier Rx, the fee depends on whether they do business with him.

Here's the real deal:

FEDERAL TRADE COMMISSION
PART 456--OPHTHALMIC PRACTICE RULES--


Sec. 456.2 Separation of examination and dispensing.

It is an unfair act or practice for an ophthalmologist or optometrist to:

(a) Fail to provide to the patient one copy of the patient's prescription immediately after the eye examination is completed.

Provided: An ophthalmologist or optometrist may refuse to give the patient a copy of the patient's prescription until the patient has paid for the eye examination, but only if that ophthalmologist or optometrist would have required immediate payment from that patient had the examination revealed that no ophthalmic goods were required;

(b) Condition the availability of an eye examination to any person on a requirement that the patient agree to purchase any ophthalmic goods from the ophthalmologist or optometrist;

(c) Charge the patient any fee in addition to the ophthalmologist's or optometrist's examination fee as a condition to releasing the prescription to the patient. Provided: An ophthalmologist or optometrist may charge an additional fee for verifying ophthalmic goods dispensed by another seller when the additional fee is imposed at the time the verification is performed; or

(d) Place on the prescription, or require the patient to sign, or deliver to the patient a form or notice waiving or disclaiming the liability or responsibility of the ophthalmologist or optometrist for the accuracy of the eye examination or the accuracy of the ophthalmic goods and services dispensed by another seller.

Revised as of January 1, 1999]
From the U.S. Government Printing Office via GPO Access
[CITE: 16CFR456.2]
[Page 453]

[LandLord]

FYI, it's not illegal for a sight-tester to withhold an Rx because IT'S NOT REALLY AN RX! It's a refraction.

Only doctors write Rx's.

[chip anderson]

Eyeglass I addresses prescribers discounting fees on condition of eyeglass purchase. It is specificly verboten.
463
Federal Trade Commission § 456.5
any provision is determined to be invalid,
it is the Commission’s intention
that the remaining provisions shall
continue in effect.
PART 456—OPHTHALMIC PRACTICE
RULES (EYEGLASS RULE)
Sec.
456.1 Definitions.
456.2 Separation of examination and dispensing.
456.3 Federal or State employees.
456.4 Declaration of Commission Intent.
456.5 Rules applicable to prescriptions for
contact lenses and related issues.
AUTHORITY: 15 U.S.C. 57a; 5 U.S.C. 552.
SOURCE: 57 FR 18822, May 1, 1992, unless
otherwise noted.
§ 456.1 Definitions.
(a) A patient is any person who has
had an eye examination.
(b) An eye examination is the process
of determining the refractive condition
of a person’s eyes or the presence of
any visual anomaly by the use of objective
or subjective tests.
(c) Ophthalmic goods are eyeglasses,
or any component of eyeglasses, and
contact lenses.
(d) Ophthalmic services are the measuring,
fitting, and adjusting of ophthalmic
goods subsequent to an eye examination.
(e) An ophthalmologist is any Doctor
of Medicine or Osteopathy who performs
eye examinations.
(f) An optometrist is any Doctor of Optometry.
(g) A prescription is the written specifications
for lenses for eyeglasses
which are derived from an eye examination,
including all of the information
specified by state law, if any, necessary
to obtain lenses for eyeglasses.
§ 456.2 Separation of examination and
dispensing.
It is an unfair act or practice for an
ophthalmologist or optometrist to:
(a) Fail to provide to the patient one
copy of the patient’s prescription immediately
after the eye examination is
completed. Provided: An ophthalmologist
or optometrist may refuse to give
the patient a copy of the patient’s prescription
until the patient has paid for
the eye examination, but only if that
ophthalmologist or optometrist would
have required immediate payment
from that patient had the examination
revealed that no ophthalmic goods
were required;
(b) Condition the availability of an
eye examination to any person on a requirement
that the patient agree to
purchase any ophthalmic goods from
the ophthalmologist or optometrist;
(c) Charge the patient any fee in addition
to the ophthalmologist’s or optometrist’s
examination fee as a condition
to releasing the prescription to
the patient. Provided: An ophthalmologist
or optometrist may charge an additional
fee for verifying ophthalmic
goods dispensed by another seller when
the additional fee is imposed at the
time the verification is performed; or
(d) Place on the prescription, or require
the patient to sign, or deliver to
the patient a form or notice waiving or
disclaiming the liability or responsibility
of the ophthalmologist or optometrist
for the accuracy of the eye examination
or the accuracy of the ophthalmic
goods and services dispensed
by another seller.
§ 456.3 Federal or State employees.
This rule does not apply to ophthalmologists
or optometrists employed by
any Federal, State or local government
entity.
§ 456.4 Declaration of Commission Intent.
In prohibiting the use of waivers and
disclaimers of liability in § 456.2(d), it is
not the Commission’s intent to impose
liability on an ophthalmologist or optometrist
for the ophthalmic goods and
services dispensed by another seller
pursuant to the ophthalmologist’s or
optometrist’s prescription.
§ 456.5 Rules applicable to prescriptions
for contact lenses and related
issues.
Rules applicable to prescriptions for
contact lenses and related issues may
be found at 16 CFR part 315 (Contact
Lens Rule).
[69 FR 40511, July 2, 2004]

[chip anderson]

Landlord:
The word Prescription means recipe not some code word for a doctor's holy inscription.

Chip

[HarryChiling]

FYI, it's not illegal for a sight-tester to withhold an Rx because IT'S NOT REALLY AN RX! It's a refraction.

Only doctors write Rx's.

In the states the only way the opticians can legally write the Rx is under the OMD's wing and you better belive that it will have the docs signature on it and as such would fall under the rule of Eyeglass Rule.

If we were to argue that it was written by a sight tester then the legality of the script comes into play.

[LandLord]

Chip,

It is an unfair act or practice for an
ophthalmologist or optometrist to:
(a) Fail to provide to the patient one
copy of the patient’s prescription immediately
after the eye examination is
completed.

Your post clearly applies to ophthalmologists and optometrists only.

I repeat, a sight tester would not be held to the same standards because:

a) sight testers are neither ophthalmologists or optometrists.

b) the results are not prescribed by anyone. The eyeglasses would technically be unprescribed.

Reading glasses sold at Mahmoud's Mini Mart or other retailers are not prescribed. Mahmoud himself may test the customer with a reading card to see which power is indicated, but there is no act of prescribing taking place. The customer who purchases a pack of Marlboro lights, a Playboy magazine and a pair of +1.50's doesn't assume they are eye-disease free because of the test and purchase. It is the same with sight testing. It's just a more complicated test and purchase.

[HarryChiling]

Chip,



Your post clearly applies to ophthalmologists and optometrists only.

I repeat, a sight tester would not be held to the same standards because:

a) sight testers are neither ophthalmologists or optometrists.

b) the results are not prescribed by anyone. The eyeglasses would technically be unprescribed.

Reading glasses sold at Mahmoud's Mini Mart or other retailers are not prescribed. Mahmoud himself may test the customer with a reading card to see which power is indicated, but there is no act of prescribing taking place. The customer who purchases a pack of Marlboro lights, a Playboy magazine and a pair of +1.50's doesn't assume they are eye-disease free because of the test and purchase. It is the same with sight testing. It's just a more complicated test and purchase.

Your missing the point, in TX he is not allowed to perform sight testing without an OD or OMD signng off on his/her Rx or refraction as you would like to refer to it. Either he's breaking the law by practiceing optometry or he's breaking the law by ingnoring Eyeglass 1 but you can't have it both ways. Technically he is not presrbing anything he is performing a procedure that the OMD he works for is using to prescribe lenses from so for all instensive purposes consider the script as comign from the OMD.

[wmcdonald]

Harry,

I live in BC, Canada. Wal-Mart is bringing in a "sight-tester" into one of their stores in Kamloops, BC. They are calling it a pilot project. So now we have a massive chain that no longer employs an OD (probably couldn't get one in Kamloops..too many great private practice opportunities), and will have an optician (maybe??) performing sight-tests.

Is this a rosy picture of the future of eye care in your opinion??

It should be just as scary for opticians who would like to see the return of professionalism, as it is for ODs, in my opinion.

What I wish ODs would realize is that this could be a great opportunity for them to be the referral site for this sight-testing Optician. He or she will need a place to refer medical care, and it is important forus all to work together.

[HarryChiling]

What I wish ODs would realize is that this could be a great opportunity for them to be the referral site for this sight-testing Optician. He or she will need a place to refer medical care, and it is important forus all to work together.

I am starting to realize that as well, it would be to our mutual benefit and by strengthening the foundations (opticianry) optometry in essence solidifies there position and insulates themselves from the eroding of the eyecare industry a bit more.

[LandLord]

Either he's breaking the law by practiceing optometry or he's breaking the law by ingnoring Eyeglass 1 but you can't have it both ways.

He's breaking the law by refracting, yes. But that's another issue, isn't it.

[HarryChiling]

He's breaking the law by refracting, yes. But that's another issue, isn't it.

Not if he's doing it for his OMD as a COT. That would be considered part of his job description as an Ophthalmic Technician. It also means that he can't do it without his OMD, that would be illegal. I think it's loop holes like this that opticians should be exploiting and doing it while staying professional. He's apparently been doing it for quite some time so kudos to him.

I also think that this sort of arrangement with OD's could benefit our industry. Come on docs think of it outside the box for a minute, satellite offices. Lets say an optician can open up his own store under your own little psuedo franchise, each OD or OMD can have 3 to 4 opticians working in this capacity, even the technology is there to implement this type of system and is being utilized in Canada. Why fight it, heck I know doctors that are selling eyeglasses online, one of them used to even solicit business here. It's a great opportunity that others are exploring for instance corporate optical, ophthalmology. The only one resisting is optometry, that doesn't look good if you ask me.

[orangezero]

Just one opinion.

It just feels odd there is so much disagreement and arguing about a procedure which the market has determined is essentially without value in our current society.

Does anyone think we have such a shortage of refractionists (optometrists, ophthalmologists, paraoptometric staff, ophthalmic staff, etc.) and such a shortage of access to care in north America that there is a demand for doubling or tripling the number?? Really?

I've heard people mention you could stop ODs (probably the main source of refractions) graduating for 5-10 years and there still wouldn't be a shortage of eyecare anytime in the near future.

You could drive around most towns and theoretically get 5 or 10 full eye exams within a day or two, most you could just walk in. You may be thinking its not that way in your, but I'm sure there is one down the road or in the next town.

Most of the opticians and optometrists on here agree it is the silly lowball mentality of this industry which allows these plans to survive and prosper. I'm certainly not implying opticians would all be lowballers (in fact I'm certain some could go boutique and charge a large amount just fine), but the reality is most new refractionists would probably be employed at places like walmart or a lux store and have no ability to set their fees or much control over how they practiced. But it would be hard to believe fees for a refraction wouldn't enter a free fall overall.

What a dream for vision plans and commercial locations! More patients being run through for less reimbursement, the vision plans would be more able to control the costs of materials, and eventually it would be cheap enough for every employee to have a vision plan (which most of us abhor). I really question whether this lowered fee structure could be "made up" by additional glasses sales.

We would all be left doing more work for less pay.

I hope I did this without offending anybody. Not the intent. Just a thought at the market ramifications.

[chip anderson]

I think the real need here is due topractioners that hold on to thier patients and won't release the Rx. We need to actually be able to get the patient in our office with his Rx. Some like you actually lead the patient into thier optical department to be sold while they are waiting for you to get around to actually seeing them for their appointment which I am sure you run at least late enough for them to be sold on some optical product.

Chip

(You can make your defence now and come and git me.)

[LandLord]

I've heard people mention you could stop ODs (probably the main source of refractions) graduating for 5-10 years and there still wouldn't be a shortage of eyecare anytime in the near future.

I agree with your assessment about the ramifications of an oversupply of any service. But you're not suggesting that competitors refrain from supplying a service so that the established suppliers can keep their prices up, are you? Isn't that a little self-serving?

[orangezero]

I agree with your assessment about the ramifications of an oversupply of any service. But you're not suggesting that competitors refrain from supplying a service so that the established suppliers can keep their prices up, are you? Isn't that a little self-serving?

Keep up their prices? $29 for an eye exam? Free with glasses purchase? Are you kidding me? To think providers of eye care are monopolistic in the least has got to be the best joke I've heard in quite a while. I just paid $75 to have two tires put on my car, and that guy probably gets paid close to minimum wage.

Just one example. Medicare is a rather heavily discounted insurance the vast majority of health providers are disgusted with because of low reimbursement. Eye exams on average are anywhere from 0-75% of those fees, which should say a lot.

I'm not interested in rehashing all the legal and educational ramifications. Been done to death. The bottom of the barrel is already here, but there is probably room to expand the bottom.

[IndianaOD]

Some of the statements on this thread are laughable. Technically we were informed that it is not legal to refract or provide any eye care unless a doctor was physically in the same building.

The MD signing off is a moron. He/she is legally responsible for any conditions missed. The liability is the same as if they preformed a comprehensive eye exam. Parents think that a nurse checking a kids eyes on an eye chart is an eye exam, you don't think this will be confusing?

As far as ODs reaching out to this illegal technician....umm I guarantee everything goes to the MD blind stamping the work.

Good technicians are worth their weight in gold, but comparing an OD with 8-9 years of post high school education to on the site training is like saying I should be able to do a kidney transplant.

[IndianaOD]

On further thought, what benefit would stand alone refractions by opticians serve to opticianry or the public?

Just as ODs performing LASIK doesn't benefit the profession. Now I think if ODs want to get post-doc training to do it then fine, but there are already ophthalmologists begging people to get LASIK from them. I probably get 3 pieces of mail, hear 20 radio ads, and 10 TV ads for LASIK in an average week. If every OMD and OD practiced LASIK then the price would drop until no profit could be realized...and everyone needs to eat.

If opticians refracted there would be 2-3x as many opticals out there competing until a living would be very difficult. Speed would be necessary and patients would suffer. Much fewer people would get eye exams routinely and would suffer preventable vision loss. I might even speculate that your income might decrease.

Lawyers would make millions, heck I'd be interested in getting my JD if that ever happened.

[LandLord]

Keep up their prices? $29 for an eye exam? Free with glasses purchase? Are you kidding me? To think providers of eye care are monopolistic in the least has got to be the best joke I've heard in quite a while.

I'm not saying exam fees are too high and I'm not saying providers are monopolistic. But please don't think opticians will stop refracting because you say no one needs the service. That is, unless you are willing to close up your office because there are more than enough optometrists in business.

[HarryChiling]

I have worked with many a doctor who has sold eyewear for next to nothing so they could collect exam fees which were usually high.

It's almost like when you go to buy a car, you could get a low ball offer on your trade in and a great price fro the new car and a great rate on your financing. Or any of the other numbers of combinations possible.

Insuracne companies don't allow opticians on their panels so most independent opticians charge a fair price for eyewear and have the patients submit it themselves and their is enough their to ake a living.

It was interesting that paraoptometric staff and ophthalmic staff was mentioned as refractionists. The achilles heal with these professions is that they cannot practice independently, they must perform their duties under their doctors OD and OMD. If opticians gained independent refraction then sure the market would have more refractionists than necessary but that's the case now and it's getting worst with new schols opening. Many doctors offices advertise one stop shopping exam and materials, and make it difficult for an Rx to leave an office. At the risk of offending the last federl register that discussed the issue of the ophthalmic practices rule had a fiure of greater than 30% of patients not recieving their Rx's as per the law requires.

Is it a loop hole that this guyis refracting under, YES. Is it illegal, we won't know for sure untill someone take shte guy to court and gets ruling, but I'll tell you this: I know the guys pratice info and I wouldn't dare share it with anyone and snitch as I have heard your profession call it on other forums on my peers.

I think it's going to happen studies that have been done that have polled OD's and OMD's think that refraction for opticians is gonna happen, it's not a matter of if it will happen but when and how it will be structured.

If opticians refracted there would be 2-3x as many opticals out there competing until a living would be very difficult.

From your perspective, independent opticals would actually do better and thrive in that kind of enviornment. The 2-3x more opticals would be optician owned opticals not optometrist owned opticals. The restraints put on the trade of opticianry by optometry would be reversed so the balance would be restored not screwed up as you seem to imply.

[LandLord]

"Originally Posted by IndianaOD
If opticians refracted there would be 2-3x as many opticals out there competing until a living would be very difficult."

IndianaOD's honesty is very refreshing isn't it? It is very, very rare that an optometrist will admit to financial concerns if opticans began refracting.

[Oedema]

I also think that this sort of arrangement with OD's could benefit our industry. Come on docs think of it outside the box for a minute, satellite offices. Lets say an optician can open up his own store under your own little psuedo franchise, each OD or OMD can have 3 to 4 opticians working in this capacity, even the technology is there to implement this type of system and is being utilized in Canada. Why fight it, heck I know doctors that are selling eyeglasses online, one of them used to even solicit business here. It's a great opportunity that others are exploring for instance corporate optical, ophthalmology. The only one resisting is optometry, that doesn't look good if you ask me.

Interesting idea Harry, but big problem here is risk assumed by the OD/MD in the relationship; malpractice risk and losing your license kind of risk. I'm not convinced that the risk to benefit ratio offers would offer much of an incentive to participate in the model.

For one, many jurisdictions already make this type of delegation professional misconduct. For example in Canada OD's are not supposed to be delegating offsite, and most provincial medical colleges have also come down on physicans that were rubber stamping optical Rx's for opticians (Same thing happened with the online Canadian pharmacies - US Rx is not valid so they paid Canadian physicians to write a duplicate).

Second, and most obvious is the risk of missed pathology and subsequent litigation.

[chip anderson]

Odd we seem to be more concerned with subsequent litigation than subsequent damage to the patient..
Does this show where our hearts really are?

Chip