Question for an ophthalmologist

[chip anderson]

My mother in law and other patients I have known have gone to the doctor for long time follow-ups after cataract surgery. A capsule opacity was found. Up to here I understand what's going on. But in every case the patient is told to return for surgery at a later date. Now I could be missing something but as I understand this the problem is taken care of by putting the patient in front of a laser which greatly resembles a slit-lamp, aims the laser and pushes a button one or more times to zap the offending opacity and the patient goes home seeing. I don't even think any prep beyond dillation is needed.
Now my question is: Why isn't the patient just marched over to the exam room with the laser and zapped? Why schedule another visit? I understand that not all offices have the laser on site, but in large multi-physician practices why not do it now?

Chp

[ESuffolkIDoc]

You are probably referring to use of a Yag Laser to remove the section of usually posterior capsule sac, which occurs every so often no matter how well the sac is scraped.

Since the laser is destroying tissue, you can cause inflammation, something that the body does to protect itself, but can wreak havoc on the eye.

So, the followup is to look out for any uveitis, inflammation, neovascularization, and closure etc.

On closer reading you ask why not just yag,

Well probably insurance, approval, some procedures can't bill with certain visits,

But in this rush environment, maybe there's more time to rule out contraindications and not over burn the capsule, remember it holds the IOL and you are cutting a hole in it

[Speed]

$1100.

[chip anderson]

Thank you for both of your replies. I suspected it might be something like when I see an eye patient, I can bill for enlarging it, or reducing it or polishing it, but only one of these per visit (silly third party payments of course). It would of course be much easier and cheaper for me and the patient if I did whichever and the polish in a single trip. I do of course polish the damn thing and not charge for this part of the service when one of the other proceedures is done. But were I willing to let the patient go out the door with the eye unpolished and have them return later for same, I'd be paid better.

Chip

[fjpod]

Wow Chip...the way you are describing YAG capsulotomy...you make it sound like any idiot can do it with one arm tied behind his back. Maybe we should start letting optometrists do it?

[mshimp]

Not a bad idea. As long as you could bill for it.

[DragonLensmanWV]

I just had my left eye done this way. I returned to the OMD after 6 months to check the right eye. Not ready yet, got an appointment in 9 months. They are not always ready for both of them.

[chip anderson]

I had an OMD tell me that Kentucky just passed a law that appearently allows OD's do almost anything an OMD can do, including invasive proceedures, all drugs, etc.

Chip

[Johns]

I live w/in an hour's drive of Kentucky, and there's been quite a bit of talk about it around here. Here are some links:

http://optometrystudents.com/kentuck...for-optometry/

http://www.theatlantic.com/national/...equired/71758/

http://www.kyeyes.org/faq.html


Of course, some of the links are opinion based, but the bottom line is that yes, they can do it. Ironically, I was filling in for an office in the Cincinnati area, and an OD there was bemoaning the fact that this move might be actually opening the door for opticians to refract. (Of course) He was totally against it, but to me it was a case of wanting your cake and eating it too!

[DragonLensmanWV]

They passed similar legislation here last year, so the ones who want to do it are now taking classes so they can be certified for it. It's not like you can just start doing it with no training. Don't they have something like that going on in Ohio?

[sharpstick777]

Its a matter of the differences between MD and OD practices. Private Practice OD's see 12 patients on a good day, an MD could easily see 60. I worked with one MD who saw 104 patients in one day, after performing 34 cataract surgeries the day before. Crazy. If an MD gets behind even a few minutes its a train wreck for the rest of the day, so we scheduled even the smallest proceedures in minute increments. It was the only way to handle that many patients. OMD practices are just different animals.

[chip anderson]

Where you comin from man. I have never heard of an ophthalmologist who didn't start at least an hour late. Even when the good doctor was a close friend and I was the patient. Many patients complain about the doctor seeing them up to four hours after appointment time. I think they were all trained by Sam Johnson who someone told that people didn't think a doctor was any good unless the waiting room was full. He booked appts starting at 7:30 and didn't get to the office until at least 9:00.
I even had one tell me that the OV charges were for two hours time (actual time with the doc, 10 min.) but he felt the time in the waiting room should be paid for.

Chip

[fjpod]

I had an OMD tell me that Kentucky just passed a law that appearently allows OD's do almost anything an OMD can do, including invasive proceedures, all drugs, etc.

Chip

Not true. The law specifically excludes surgeries which involve opening the globe, and injections into the globe. I believe it also excludes laser refractive surgery.

ODs have been using most of the drugs they need for the last 25-30 years.

[fjpod]

Do you really feel comfortable seeing a doctor that sees 60 - 100 patients per day? (even with ancillary help).

[skt]

no

[AustinEyewear]

Why schedule another visit? I understand that not all offices have the laser on site, but in large multi-physician practices why not do it now?

Chp

Hey Chip - like already mentioned, could be because the Opt can't bill to insurance same day. We've had this issue with further diagnostic testing that is required upon eye examination in slit lamp. Best to just ask the office why - they should know and provide the answer. I guess the room could have been already booked that day too?