Chip, I don't think Harry suggested model had anything to do with improving patient care or compassion for the patients - my interpretation was that it was an economic appeal.Originally Posted by chip anderson
That said, I don't think we're exactly harming any patients by covering our own asses and refusing to practice at a level that does hold the potential of harming patients.
Why should I expose myself and my patients to a system that could harm by my patient and my professional life?
Specific guidelines have been developed to assure a regular health evaluation of the eye by an OD or MD. We all need to work together to benefit each other. In many ways access will be greatly enhanced with Opticians doing refraction. In an earlier thread, someone mentioned that there were too many providers already, but if that were the case, supply and demand would necessitate a reduction in fees. In most articles I read, OD income continues to rise annually, not decline. The economic engine and control are the real issues here.
Guidelines? So far the only jurisdiction that allows independent optican refraction does not have any guidelines that ensure regular oculovisual health assessments.
How can access be any easier? There's an OD on every corner and mega mart in this country.
OD income is flat to negative if you consider inflation. We already are the lowest paid (on average) doctoral level medical provider out there.
Everyone must suffer through ophthalmic optics, geometric optics, physiological optics, and visual perception if they want to refract. Well perhaps except an MD
Man you think O.D. income is flat or decreasing, you oughta be an independent optician for the last few decades. Used to be a good reasonably lucrative business. Now you are lucky if you aren't 90 days behind on the bills.
Chip
I'm sure that's true, but be honest...opticians don't have 8+ years and well over $100k in student loans on average. I have some colleagues in larger practices that pay their opticians very well (those that have been loyal and stayed around a long time).
I thought your oculist skills were buying your Mercedes?
Indy:
I am an ocularist (amoung other things I'm called) an oculist is another term for ophthalmologist (they can afford Bentley's if they want).
And yes it seems to be the last vestage of the optical business that is still profitable. Now if I just had patients with money.
Chip
I thought it was interesting in an earlier post that paraoptometric staff were mentioned as part of the too many professions as refractionists. This profession is a baby in our field yet is already embraced. The reason why is that it falls directly under the control of the optometrist. An ophthamic technician is also a refractionists and again they fall under the control of the ophthalmologist. The one thing these professions have in common is that they cannot by definition practice independently, an optician can and always has. An optician under the control of another profession would be accepted more easily in the current system, but an optician by the title optician still has teeth.
Their is a paper in the download section from Dr Sheedy that discusses some of these issues, opticians will not be accepted by optometrists or even ophthalmologists unless we are no longer deemed a threat. The fact that refraction is closely guarded the way it is, is a purely economic reason. I propose that optometrists and ophthalmologists refrain from dispensing and devalueing materials, but I highly doubt tht is a real option. I think it is a natural progression for our profession to refract and apparently so too does many other professions and the public also has learned to embrace this. I invite all those that don't know how the process is performed to learn it. Either through the courses offered at schools, through associations, through OJT, or any other means available to you even the online phoropters or phoropter programs available through schools and associations. Learn the skills and upgrrade your education so when the time comes you can be one of the opticiasn that performs sight testing.
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Harry is right. Opticians groups should lobby to HELP optometry expand their scope instead of fighting them. If optometry's scope was wide enough, they might not need dispensing to succeed the way they do now.
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Odd but back when OMD's were ethical (didn't dispense) Opticians and contact lens fitters were concidered they greatest allies and source of referrals. Of course the reverse was also true.
Oh, my times they are a changing.
Chip
"The fact that refraction is closely guarded the way it is, is a purely economic reason. I propose that optometrists and ophthalmologists refrain from dispensing and devalueing materials, but I highly doubt tht is a real option. "
I don't understand how optometrists and ophthalmologists "devalue" materials. Could you please explain?
Yet, it seems you want to devalue a service...an eye EXAM. Of which, refraction is just one part. What is the true benefit of an optician refraction? Would you be able to do wet refractions? Would you take into account AC/A ratios? What would you do for amblyopes? The list goes on...
"I think it is a natural progression for our profession to refract and apparently so too does many other professions and the public also has learned to embrace this. "
What other professions? When and where does the public understand the difference between exams and refractions? I deal with parents weekly who believe that a school screening is an eye exam...
The delphi study done by a member of this board showed that a panel of ophthalmologist, optometrists, and opticiasn alike would agree that refraction is a reasonable expansion of our scope. The real issue comes down to how it will be implemented without steppin on anyones toes.
Devalue, Let's take VSP for example started by OD's for OD's. To take it the practice has to be 51% owned by an OD, every sale requires the OD disclose their wholesale cost on the frames with a stipulation that the practice cannot get more than 20% discount on the frame. The lenses are provided by the VSP lab so they have control over the cost of the lenses. In many cases the practice makes only a dispensing fee. That's devaluing.
Eyemed and the many other insurances once in a while require that you disclose your wholesale costs on certain products, the only practices that I know of that fill out those silly forms are optometrists and they don't factor into their costs labor, lease, and other costs, they just qute material costs which further lowers the reimbursements.
Opticians can't take insurances so most independent optician run shops are chargeinga fair price for glasses, contacts and other vision aids. Often times from what I have seen it is considerably lower than the insurances with more premium products when you factor in all the costs of the insurance like copays, monthly premiums, and reimbursements. So the insurance company takes a big chunk of the profit in the eyewear and the optometrists practice short changes the consumer by provideing sub par product.
The public doesn't understand the difference between an eye exam, a refraction, and a visual screening. On this you are absolutely right, if they did years ago they would have opted to skip seeing your profession and go right to the top OMD, at least in my neck of the woods they would have. Not too long ago OD's were not able to provide wet refractions, not too long ago OD's weren't able to provide treatment for various infections and conditions, it's new to you as refraction would be new to the profession of opticianry. It's foolish to argue with you ove these points as you profession overcame them so just read your history nd apply your solutions in the blanks provided.
I would like to ask you, does the public know that most OD's advocate non-licensed proffesionals to fabricate their eyewear? Do they know that historicaly optometry has fought for non-licensed opticiasn to keep the labor low in their offices? Then try explaining to the public what that refraction and prescription that comes from it is for. That's how materilas have been devalued.
I was hopign to hear more about how the professions can work together, I personally think that optometry will never be ready for opticians refracting, but I belive that ophthalmology can and is in many states. I would personally rather see our profession align with a more willign partner. There is already a model where opticians are performing refractions under the scope of ophthalmolgy and I see that as a great avenue, I would like to see that avenue extend to optometry as well, but if it doesn't happen that's no loss for me as their only really needs to be one door opened.
Last edited by HarryChiling; 05-20-2008 at 11:15 AM.
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Not true anymore. OMDs can be a VSP provider.
Harry,
I completely agree with you regarding insurances (or third party payers). Not only are the materials discounted, but so are the services. Some of these insurances do not reimburse much at all. It's a shame that they even exist...I look at it more from the reimbursement for services rendered portion.
How do you think refracting opticians will factor in with the insurances? I believe they will salivate at the opportunity to further cut costs...the downward spiral of our healthcare. (Plus, don't you work as part of the luxottica empire...associated with Pearle???).
At most places I've worked (except for one), a licensed optician was part of the team. In fact, I currently work for a predominantly optically based company. So, unfortunately I cannot relate to the employment of non licensed staff...
How do you think refracting opticians will factor in with the insurances? I believe they will salivate at the opportunity to further cut costs...the downward spiral of our healthcare.
Tell me how has medical eyecare provided by OD's affecting OMD's and their practices. No one is asking you to fall on your sword, thats why it would be best to have the three O's discuss a viable option that benefits all. What we can't do is let the insurance companies, corporations, or one profession of the group decide how this thing is going to be played out.
If I had it my way I would be refracting with no restrictions.
If you had it your way I wouldn't be refracting.
If OMD's had it their way then I would only be refracting for them.
If the corporate goons had it there way they would have us in lanes with maybe one OD checking our work.
If insurance companies had it there way then we'd all be broke, includeing the patient.
I can't say I know the solution, I knwo I've heard about every reason why I shouldn't and why I should be allowed to refract, now I'm lokkig for solutions on how it's gonna happen.
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Health care in the US is not subject to the traditional free market laws of supply and demand.
Shoot yeah, if there are too many MD's in a field they divide the field into as many sub-specialties as required. Then they can form a group, have each sub-specialist see the patient, perform different tests and bill for each doctor's time and tests.
Chip
Yes, I can give you lots of examples if you really need them.
Back to the original question/issue. This is not new. THink PAs and LPNs. We have these prescription writing professions in every little town around here. These towns don't have an MD or DO within 20 miles. I'm not sure these "overseeing" MDs ever come to visit "their" clinics in the rural settings. Patients all the time say that they see "Dr so-and-so" who is actually a "Mr so-and-so".
This loophole is exploited frequently. Actually I'm not sure it is a loophole, I think it is illegal. But I'm not a court of law whose job it is to determine the definition of "direct oversight".
Can "direct oversight" of prescriptions be conducted from the next county? I suppose it could via fax and internet - but is it being done. Let's see, the MD sees 60 patients/day, his LPN see another 40 and his two PAs in the next county see another 40 each. Direct oversight indeed.
Why does the AMA, state medical boards, and all the other boards allow these non-physician medical professionals to have precriptive authority? Because they make money for the MD. It's always about the money.
If you want to write prescriptions or even orders for ophthalmic goods, you will need to be able to line the pockets of someone who has the prescriptive authority currently.
Last edited by MarcE; 05-20-2008 at 10:06 PM.
New question:
COTs refract for OMD often. It's legal and widely accepted, right?
Can COTs legally refract for ODs? Is there a legal issue at all? If I were an OD and wanted to have my tech refract and then I come in and do a 7 minute exam and sign the Rx - are there any issues with this?
Feel free to chastize me if this requires a new thread.
I don't see a problem with this system. I've done 30 minute eye exams myself and then watched the surgeon finish'er off in 30 seconds in the same lane.
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But that is an MD. I know it's widely done. What about ODs? In the US?
Anyone could legally refract for an MD or an OD - no certification needed (but I'm sure it's helpful... less in-office training needed). It's rare, but there are OD's out there in the US that do delegate most refractions to ancillary staff.
So in summary; MD's and OD's alike can use whoever they want to use to collect data so long as they actually look at it and use the data appropriately.
In our state (at the O.D.'s submission) and O.D. cannot deligate any O.D. duties, including refraction, contact lens fitting, etc. This being done to prevent anyone but an O.D. being able to fit contacts and refract.
This is State law, law of course, drafted, submitted, and paid for by the State Optometric Assn.
Chip
And if you think about it, it's assinine. For iunstance they can't tell an OMD that they can't delegate their responsibilities, so they basically painted themselves in a corner with this law. If opticians and OMD's were to work togather we would have less conflict. They would never have to worry about us wanting medical privledges and we'd never have to worry abou them wanting to refract and provide eyewear, that's not something that they want to do it's somehting they're being forced to do with lower reimbursements on many of the conditions that OD's can now perform. Optometry is chipping away at both ends of the field with little regard for the consequences, IMO.
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This mass exodus of optometry from "vision" to "medical" is not going to happen anytime soon. There are still way too many obstacles in many states for optometrists to have access to medical panels and bill those plans successfully. There are perhaps going to be more and more ODs working in disease specific clinics as the years go by, and even more specialization, but the vast majority will continue to be providing refractive services and wellness eye evaluations a good deal of the time in to the foreseeable future.
I doubt there is a gap waiting to be filled, and if there is it will take forever to realistically open up. I'm not holding my breath.
I guess there is nothing like being prepared, though.
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