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Thread: FTC Contact Lens Rule Change?

  1. #26
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    Quote Originally Posted by Uilleann View Post
    I think we can all agree heartily that if ANY aspect of our profession is in desperate need of MORE regulation, preventing harm to consumers FROM numerous UNSCRUPULOUS 3rd party CL vendors who love to change CLRXs at will, or dispense even on expired scripts, or incorrectly entered parameters, etc etc. Enabling that sort of "access" is not healthcare. It creates problems, and undermines doctors abilities to prescribe safely and effectively. The FtCLCA could use a SERIOUS remake - this time, include doctors and healthcare professionals who can explain the direct health risks to the public in allowing things to continue unchecked as they are.

    As far as glasses are concerned, in 3 decades, I have NEVER worked for, or known or even heard of a Doctor refusing to release any SRx. Ever. With the only rare exceptions being a pt who refuses to pay for services. It's a manufactured "problem" that the chains, and big box Rx destroyers pushed ages ago, and that act doesn't reflect reality today either.
    +100

  2. #27
    What's up? drk's Avatar
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    Here's the bottom line with this new FTC thing, and you can call me a quack if you want.
    1. The onliners have initiated and nurtured this for awhile.
    2. I don't know how a regulatory agency is on the take, but they are.
    3. The AOA is a bunch of idiots.
    4. The whole point of this stupid exercise is to intimidate optometrists to "PROVE THAT YOU GAVE YOUR PATIENT A COPY" whenever there's a dispute. "SHOW ME THE SIGNED RECEIPT FROM THE PATIENT!".

    Look, if a patient wants their records, they get them, after due process. If they want their prescriptions and want to invite a third party to get involved in their visual treatment plan, that's absolutely their right. And it should be (and is) my right to decide if I want to have patients that I share their CL care with some faceless, unlicensed, possibly foreign CL supplier that has no track record. I may just decide that's not how I like to take care of patients.

    Same way if I share care with spectacle correction. Same way if I prescribe meds or send for a surgical consult or whatever. I'm not sending my patient to a butcher, or a quack, or an incompetent, or a pirate. And I think 99.99% of patients appreciate that. But patients are free to do what they want. It's a free country. Always has been.

  3. #28
    What's up? drk's Avatar
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    The red is the original I highlighted. The blue is my commentary.


    FTC Announces Final Amendments to the Agency’s Contact Lens Rule

    June 23, 2020
    Changes will help more patients comparison shop for contact lenses
    FOR RELEASE
    TAGS:




    The Federal Trade Commission today announced the approval of a final rule amending the agency’s Contact Lens Rule, which facilitates shopping for contact lenses by requiring prescribers to automatically provide a copy of a patient’s prescription to the patient and to verify or provide prescriptions to third-party sellers.

    THIS IS NOT NEW

    The Final Rule requires prescribers to request that their patients confirm that they have received their prescription, and allows flexibility in the way the prescription and confirmation are provided.

    THIS IS NEW. HAVE A PATIENT SIGN A PAPER THAT THEY'VE RECEIVED THEIR PRESCRIPTIONS? WHAT GOOD DOES THAT DO?

    “Eye doctors are required by law to provide every patient with a copy of his or her contact lens prescription, allowing patients to comparison shop for lenses,” said Bureau of Consumer Protection Director Andrew Smith. “This rule change will help to ensure that eye doctors fulfill their obligations, and will facilitate FTC enforcement of these important requirements.”

    HOW DOES THIS NEW DUMB RULE MAKE ME MORE LIKELY TO FOLLOW THE ORIGINAL DUMB RULE?

    Issuance of the Final Rule follows an extensive review and consideration of thousands of public comments and materials received by the Commission between 2015 and 2019, including surveys, studies, analyses, and information generated at an FTC workshop devoted to the Rule and the evolving contact lens marketplace. It also incorporates changes made in response to public comments received following a supplemental notice of proposed rulemaking published in May 2019.

    As detailed in a final notice of rulemaking to be published shortly, after a contact lens fitting, prescribers will be required to do one of the following toconfirm that a patient received their prescription:

    AGAIN, WHY WOULD WE BE INTERESTED IN CONFIRMING THAT A PATIENT RECEIVED THEIR PRESCRIPTION? IS THIS SO, IF SOMEONE SAYS THEY DIDN'T RECEIVE IT, IT CAN BE "INVESTIGATED" AND THE INVESTIGATORS CAN SAY "SHOW ME THEIR SIGNATURE THAT THEY RECEIVED IT" AND IF WE CAN'T PRODUCE IT, THEN IT'S ASSUMED WE DIDN'T RELEASE IT, AND WE GET FINED OR SOMETHING? SO WE JUST GET SCARED TO NOT HAND OUT PRESCRIPTIONS?


    • request that the patient acknowledge receipt of the contact lens prescription by signing a separate confirmation statement;
    • request that the patient sign a prescriber-retained copy of the prescription that contains a statement confirming the patient has received it;
    • request that the patient sign a prescriber-retained copy of the sales receipt for the examination that contains a statement confirming the patient received the prescription; or
    • provide the patient with a digital copy of the prescription, and retain evidence that it was sent, received, or made accessible, downloadable, and printable.

    Prescribers must maintain proof that they satisfied the confirmation of prescription release requirement for at least three years. If a patient refuses to sign a confirmation, prescribers must note this and save it to record their compliance.

    The Final Rule also will affect prescribers in several other ways. First, it adds a new definition of the term “provide to the patient a copy,” which will allow (GEE, THANKS) the prescriber—with the patient’s verifiable consent (MRS SMITH, CAN YOU SIGN THIS FORM FOR ME TO RETAIN FOR THREE YEARS THAT SAYS YOU CONSENT TO ME EMAILING YOU YOUR PRESCRIPTION? SHEER ADMINISTRATIVE LUNACY) —to provide the patient with a digital copy of her prescription instead of a paper copy. When seeking a patient’s consent, prescribers must tell the patient the specific method of electronic delivery they will use, and must keep a record of the patient’s consent to that method for three years. The Final Rule will also require prescribers to provide patients or their designated agents with an additional copy of their prescriptions on request within 40 business hours. GOSH. I WONDER IF HUBBLE CONTACTS IS A DESIGNATED AGENT? IF I NEED A CONSENT FORM TO EMAIL A CLRX TO A PATIENT, I THINK I'D NEED A VERITABLE POWER OF ATTORNEY FORM TO CONFIRM THAT HUBBLE CONTACTS IS, INDEED, AN OFFICIAL DESIGNATED AGENT. I MEAN, HOW DO WE KNOW? IT COULD BREAK A RULE SOMEWHERE IF WE PROVIDED A CLRX TO A NON-DESIGNATED AGENT, YOU KNOW.

    The Final Rule includes several new requirements for sellers as well. To address concerns about sellers verifying prescriptions by leaving incomplete or incomprehensible automated telephone messages with prescribers, sellers who use automated telephone messages for verification must:


    • record the entire call and preserve the complete recording;
    • start the call by identifying it as a prescription verification request made in accordance with the Contact Lens Rule;
    • deliver the verification message in a slow and deliberate manner and at a volume that the prescriber can understand; and
    • make the message repeatable at the prescriber’s option.

    The Final Rule also includes modifications designed to reduce illegal prescription alterations by sellers. Under the Final Rule, sellers must make prominently available a way for consumers to present their prescriptions, and must clearly disclose that method. The method of presentation and related disclosure must be provided before requesting the prescriber’s contact information to verify the prescription. WHAT THE HECK DOES THAT MEAN?

    The Contact Lens Rule already prohibits prescription alteration, but the Final Rule defines “alteration” to include sellers providing, as part of a verification request, a brand or manufacturer other than that prescribed to the consumer. There are exceptions, however, for when the seller provides, as part of the verification request, the manufacturer or brand named by the consumer in response to the seller’s request for the manufacturer or brand listed on the prescription. DOES THIS MEAN THAT HUBBLE CAN'T SUBSTITUTE THEIR LENES, BUT THE PATIENT CAN REQUEST A NEW LENS, AND THAT WILL SHOW UP ON THE VERIFICATION REQUEST? These changes should reduce the incidence of sellers selling consumers lenses other than those that were prescribed. The Final Rule also clarifies that the only permissible substitution involves private label lenses; private label and brand name lenses can be substituted for each other when they are identical lenses made by the same manufacturer.

    The Rule changes go into effect 60 days after publication in the Federal Register notice.

    The Contact Lens Rule

    In place since August 2004, the Rule imposes obligations on both eye-care prescribers and contact lens sellers. The prescriber must automatically provide the patient with a complete copy of the contact lens prescription after completion of a contact lens fitting, and also must verify or provide the prescription to authorized third parties. The Rule also requires that contact lens vendors sell contact lenses only in accordance with a valid prescription the seller has received from either the patient or prescriber, or has verified via direct communication with the prescriber.

    The Commission vote approving publication of the final notice of rulemaking in the Federal Register was 5-0, with Commissioner Rebecca Kelly Slaughter issuing a separate statement. The final notice will be published shortly.





  4. #29
    What's up? drk's Avatar
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    It's just a farce, anyway.
    1. Anyone can fake a CL order. Just google some dumb doctor who doesn't verify, if you get rejected.
    2. Anyone can order from a website that doesn't need a prescription, anyway. Just go to Canada or UK or whereever.
    3. You can get a fake CLRx on their stupid websites, anyway, with their newfangled stupid remote systems. Why the fuss to bother us?


    I think the ultimate way to deal with the inordinate requests for medical records, etc. is to have a portal and upload your EMR's exam report/Rxs etc. and let the patient pull it down as much as he wants. I'm likewise tired of PCP offices wanting me to send reports so they can make HEDIS money or whatever the incentive is.



    And if I find out any individual patient is self-prescribing, then I will give them one warning. Then if they continue, what's the point of the Dr.-patient relationship?


    At some point, I'm going to need to surcharge an adminstrative fee, if they keep up all this garbage.

  5. #30
    Master Jedi King of the Lab's Avatar
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    Good answers and explanations above, Thanks Doc.
    Erik Zuniga, ABOC.

  6. #31
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    There are MANY Instances of attempting to keep Rxs from walking out the door of the local, main street optical’s “ecosystem.”

    The most egregious is the concept of “capture ratio.” Such a lovely term for such an unfortunate metric.

    Drk: You were brought up and bought into a framework that says strict accuracy is what optical is all about.

    I WAS TOO. But I’ve moved on. I will make it just as squishy as it needs to be to make MY Paying customer happy.

    Just let them enjoy freedom of choice.

    B

  7. #32
    What's up? drk's Avatar
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    "Capture" is a retail concept not at all unique to any business. Look it up.

  8. #33
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Quote Originally Posted by drk View Post
    "Capture" is a retail concept not at all unique to any business. Look it up.
    Yes. But when combined with a “Rx hand-off” strategy, becomes indistinguishable from steering.

  9. #34
    What's up? drk's Avatar
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    "Capture" and "steering" are metaphors, you know.

    Have you experience that says that granny is being steered into a corner of the office and captured and mugged?

    I mean, 30 years of experience tells me that I'm getting mugged.

    You're drawing a big cartoon on the back of the kiddie menu with three fat crayons and you're not even staying inside the lines.

    But hey, whatever motivates you to get out of bed.

  10. #35
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    Quote Originally Posted by Barry Santini View Post
    ...But I’ve moved on. I will make it just as squishy as it needs to be to make MY Paying customer happy...
    You don't really mean that, do you, Barry? That is really taking it a step too far. There has to be a limit, otherwise professional integrity is thrown right out the window.
    Last edited by Lelarep; 10-24-2020 at 06:29 PM.

  11. #36
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    Quote Originally Posted by Barry Santini View Post
    There are MANY Instances of attempting to keep Rxs from walking out the door of the local, main street optical’s “ecosystem.”
    I've worked big box and private practice and if a patient asks for their Rx it doesn't matter what office I've worked in they have always been able to get it no matter what (with the caveat that they have paid for their exam). I have never seen or heard of a doctor not releasing an Rx. And by chance there is an crazy doctor out there who flat out refuses to give a patient an Rx aren't there are already ways to fix this? If you have paid for a doctors services and they haven't provided them talk to the BBB, talk to the state's board of optometry, sue them in small claims court, and also leave a negative review on social media. How common do you feel the practice is that doctors are not giving the prescription to their patient and do you have any studies to show your feeling to be correct?

  12. #37
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Around me, for ODs it’s almost the norm.

  13. #38
    Master OptiBoarder optical24/7's Avatar
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    The common theme of this thread is that copies of scripts are freely given “ when requested by the patient.” If I’m not mistaken, a copy is to be given upon completion and payment of the exam. Not if “requested”.

    All ECP’s wish to “capture” current/prospective patients. But there are patients, that for various reasons, don’t want to purchase from the exam provider. I haven’t had a patient in years that *couldn't”* get a copy of their Rx. My beef is with offices that won’t release them without an elaborate hipaa compliant release form. I’ve had patients that had to personally go back to sign “in person” their release.

    Blantant, “if you’re not buying from us, screw you” attitude, which some adhere to. I would suggest if that’s the way you feel, you should up front, tell the client your position... You’d rather they get their exam elsewhere if they aren’t buying from you.

  14. #39
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Quote Originally Posted by Lelarep View Post
    You don't really mean that, do you, Barry? That is really taking it a step too far. There has to be a limit, otherwise professional integrity is thrown right out the window.
    Optics is an exact science.

    Ophthalmic optics—when combined with people—is not.

  15. #40
    What's up? drk's Avatar
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    Give us an example of your "squish" tolerance.

    Clearly, you wouldn't adulterate a distance Rx, would you? I mean, you add minus routinely, you say (not that that doesn't create distance blur, actually) but do you add plus, and pass it off as filling their distance correction?

  16. #41
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Quote Originally Posted by drk View Post
    Give us an example of your "squish" tolerance.

    Clearly, you wouldn't adulterate a distance Rx, would you? I mean, you add minus routinely, you say (not that that doesn't create distance blur, actually) but do you add plus, and pass it off as filling their distance correction?
    Yup. And often to give mature prebyopes the exact priority of distance visual utility they’re seeking.

    Especially during a pandemic.

  17. #42
    What's up? drk's Avatar
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    If you're overplussing for indoor utility and telling them they can drive in them, you'll lose whatever license you have.

    If you're merely dispensing indoor progressives, you're doing something good.

  18. #43
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Last time I checked, almost the entire world’s motor vehicle screening standards center on 20/40 acuity, which a +0.50 hit rarely surpasses.

    B

  19. #44
    What's up? drk's Avatar
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    Last time I checked, prescribing glasses for driving by opticians is not allowed in New York.

  20. #45
    Eyes eastward... Uilleann's Avatar
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    Quote Originally Posted by Barry Santini View Post
    Last time I checked, almost the entire world’s motor vehicle screening standards center on 20/40 acuity, which a +0.50 hit rarely surpasses.

    B
    Good Lord Barry - I respect your knowledge and experience, but 20/40 is "good enough" for driving? Really? I certainly don't want to share the road with hundreds of thousands of people who can just see 20/40 at best (worse at night of course, but the DLD doesn't check night acuity at all so far as I'm aware). That's suicide. And to Dr K's point...altering Rx's at ALL without OD/MD at the end of your name isn't legal last I checked. Nor does it seem wise, however altruistic your intentions may be. Does the NY license allow for this action? If so, yet another reason NOT to trust in the "untouchable" sanctity of the vaunted optician license in this country. YIKES.
    Last edited by Uilleann; 10-27-2020 at 04:32 PM.

  21. #46
    What's up? drk's Avatar
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    And when you combine overplussing with, say, mild cataracts or, say already reduced best-corrected visual acuity from, say, early macular degeneration, you're blurring the already blurry.

    How do you know the overplus is only giving a loss of a line of acuity? What if they're already borderline 20/30 from cataracts? What about disability glare? That's way common. I don't need some cowboy optician adulterating my plan on his own. If I found that out, there'd be hell to pay at the board level.

    It's A-OK to get creative, but at least consult with the prescriber. Maybe your idea kicks butt. Frankly, ODs are less creative than they should be. But you need the whole picture. Collaborate.


    And that returns to my beef with your original comment, Barry: "ODs got what was coming to them". How about we work together to do good stuff, and realize that I'm not the enemy? Clearly you want to do what's best for your patients, too--I know that! We have real enemies that don't give a damn about doing good stuff, but making money deconstructing the patient safety edifices that have been built over time.
    Last edited by drk; 10-27-2020 at 12:11 PM.

  22. #47
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    I’m all with you on working together with ODs.
    just follow the law and tender them a copy of their Rx after the exam is done—not just upon request.

    That’s my essential “must have.”

  23. #48
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Quote Originally Posted by Uilleann View Post
    Good Lord Barry - I respect your knowledge and experience, but 20/40 is "good enough" for driving? Really? I certainly don't want to share the road with hundreds of thousands of people who can just see 20/40 at best... YIKES.
    Yes. But I dont make the rules or determined the DMV acuity screening thresholds. Many drivers see 20/40 and worse.

    But having no consequential data to crunch relating vision to accidents or even near misses, all you can make is an inference.

  24. #49
    Master OptiBoarder OptiBoard Silver Supporter
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    Quote Originally Posted by Barry Santini View Post
    I’m all with you on working together with ODs.
    just follow the law and tender them a copy of their Rx after the exam is done—not just upon request.

    That’s my essential “must have.”
    Great. The law was already in place. No need for extra BS on top of a law that any ethical doctor would already follow.

  25. #50
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Quote Originally Posted by Kwill212 View Post
    Great. The law was already in place. No need for extra BS on top of a law that any ethical doctor would already follow.
    If all opticals/docs were inherently ethical, there wouldn’t be any laws.

    B

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