Danger Danger Danger

[IndianaOD]

There would be MUCH more pathology for ODs to treat if they would refer to each other. If Joe "refraction monkey" OD referred everything out to capable OD down the road instead of an OMD it would be much better for all.

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[Ben Chudner]

There would be MUCH more pathology for ODs to treat if they would refer to each other. If Joe "refraction monkey" OD referred everything out to capable OD down the road instead of an OMD it would be much better for all.

I think you are reaching here Scott. Do you know how much OD referred disease an OMD sees on a daily basis that can actually be handled by an OD? The answer is very little. I'm not saying that OD's can't handle what a general OMD sees on a typical day, but the majority of the stuff that gets referred by OD's now is surgical in nature. There are exceptions of course, but not to the extent to which you imply.

 

[eyestrain]

I think you are reaching here Scott. Do you know how much OD referred disease an OMD sees on a daily basis that can actually be handled by an OD? The answer is very little. I'm not saying that OD's can't handle what a general OMD sees on a typical day, but the majority of the stuff that gets referred by OD's now is surgical in nature. There are exceptions of course, but not to the extent to which you imply.

Well, at my last rotation site as a student I worked in a pathology only OD practice. He had probably 20 or so doctors send him their difficult cases (ie: stuff that would have wound up at the OMD had he not been there). I learned really quickly that there are a ton of ODs who will refer basic, straightforward stuff out. Probably 90% of the patients I could figure out and treat effectively as a fourth year. Some of the stuff I saw was pathetic and made me sad knowing that in most areas, these patients would be sitting in an OMD chair.

 

[IndianaOD]

I think you are reaching here Scott. Do you know how much OD referred disease an OMD sees on a daily basis that can actually be handled by an OD? The answer is very little. I'm not saying that OD's can't handle what a general OMD sees on a typical day, but the majority of the stuff that gets referred by OD's now is surgical in nature. There are exceptions of course, but not to the extent to which you imply.

Ben, there are VERY few conditions that need referred to an OMD. If it doesn't involve surgery it doesn't need to be sent. There are scads of ODs (commercial > PP) that won't even take care of a red eye.

Things might include: red eyes, monitoring ARMD, glaucoma and suspects, monitoring diabetic retinopathy, palsies, uveitis, foreign bodies, pre-septal cellulitis and other localized infections..the list goes on and on.

Very few conditions outside of cataracts actually needs an OMD.

 

[Ben Chudner]

Well, at my last rotation site as a student I worked in a pathology only OD practice. He had probably 20 or so doctors send him their difficult cases (ie: stuff that would have wound up at the OMD had he not been there). I learned really quickly that there are a ton of ODs who will refer basic, straightforward stuff out. Probably 90% of the patients I could figure out and treat effectively as a fourth year. Some of the stuff I saw was pathetic and made me sad knowing that in most areas, these patients would be sitting in an OMD chair.

As I said, there are always exceptions, but this doctor's situation is rare. Just for clarification, how many difficult cases did you see per day?

For the record, I think that regardless of how much disease actually ends up in our chairs, this is a great profession. I know there is a lot of negativity here, but that happens in every profession. Listen to Ken. Make sure you know what you are getting into when you become an optometrist and you will always be happy.

 

[Ben Chudner]

Ben, there are VERY few conditions that need referred to an OMD. If it doesn't involve surgery it doesn't need to be sent. There are scads of ODs (commercial > PP) that won't even take care of a red eye.

Things might include: red eyes, monitoring ARMD, glaucoma and suspects, monitoring diabetic retinopathy, palsies, uveitis, foreign bodies, pre-septal cellulitis and other localized infections..the list goes on and on.

Very few conditions outside of cataracts actually needs an OMD.

I agree Scott. And I would reiterate that on a national level, relatively few of these conditions are being referred out. There are absolutely doctors that do refer every condition you mention, but even if all of them referred to OD's it would not amount to enough disease to make a substantial difference.

 

[eyestrain]

As I said, there are always exceptions, but this doctor's situation is rare. Just for clarification, how many difficult cases did you see per day?

For the record, I think that regardless of how much disease actually ends up in our chairs, this is a great profession. I know there is a lot of negativity here, but that happens in every profession. Listen to Ken. Make sure you know what you are getting into when you become an optometrist and you will always be happy.

Not that many, but that was my point. Too much easy, run-of-the-mill path was being punted by too many docs. One example that always sticks out in my mind is the referral by some schlock for "unexplained decreased VA OU". It took me exactly two swipes with a ret to figure out the patient had keratoconus. And that was by no means an isolated incident. I left that rotation thinking that at least half of all optometrists must be ******ed.

And yes, his situation is rare, and I used it as example to point out the borderline delusion of the disease-only students.

 

[VA Hopeful Dr]

Personally I would like to make my focus on neuro rehabilitation with stroke and traumatic brain injury patients, and I find myself even leaning towards focusing a lot on this as research/patient care...but I would like to go into a private practice setting and not necissarily on my own unless I buy out a succesful practice and if that does not entail an optical I will not invest in one rather direct my patients to a colleague in the area I trust will give my patients the quality service they deserve...I would never direct them to a commercial optical for that reason. If I am not clear on this again, rip me apart, as thats the focus of these forums all the time.

This part kind of caught my eye. Let me preface this by saying I'm honestly speaking out of ignorance, not trying to be snotty about it. How big of a role do ODs play in stroke rehab?

Here's what I'm somewhat thinking. ODs complain, often, of how hard it is getting referrals from medicine. This tends to be basic stuff - DM, red eye, and so on. How much success do you expect getting referrals for something like stroke rehab?

Again, honest curiosity here, nothing more.

 

[KHE]

This part kind of caught my eye. Let me preface this by saying I'm honestly speaking out of ignorance, not trying to be snotty about it. How big of a role do ODs play in stroke rehab?

Here's what I'm somewhat thinking. ODs complain, often, of how hard it is getting referrals from medicine. This tends to be basic stuff - DM, red eye, and so on. How much success do you expect getting referrals for something like stroke rehab?

Again, honest curiosity here, nothing more.

Excellent question. This is an extreme sub specialty in optometry but the ones who do it almost all do it well and are highly sought after. Here's a link to an article about a doctor in my home state:


http://www.zwire.com/site/news.cfm?newsid=19044986&BRD=1630&PAG=461&dept_id=7736&rfi=6

Some other helpful information here:

http://www.nora.cc/

 

[Ben Chudner]

This part kind of caught my eye. Let me preface this by saying I'm honestly speaking out of ignorance, not trying to be snotty about it. How big of a role do ODs play in stroke rehab?

Here's what I'm somewhat thinking. ODs complain, often, of how hard it is getting referrals from medicine. This tends to be basic stuff - DM, red eye, and so on. How much success do you expect getting referrals for something like stroke rehab?

Again, honest curiosity here, nothing more.

Ken beat me to it, but this is a great question. I know of an OD in Nashville that is doing it. There are very few OD's that get involved in Neuro rehab, but those that do get lots of referrals because no one else wants to do it. Medicine is happy to refer these cases out to an OD willing to take the patient.

 

[DrRobs]

This part kind of caught my eye. Let me preface this by saying I'm honestly speaking out of ignorance, not trying to be snotty about it. How big of a role do ODs play in stroke rehab?

Here's what I'm somewhat thinking. ODs complain, often, of how hard it is getting referrals from medicine. This tends to be basic stuff - DM, red eye, and so on. How much success do you expect getting referrals for something like stroke rehab?

Again, honest curiosity here, nothing more.

I don't expect that it will be easy to have success based solely off this...I know ODs hands in this are rare, but I don't see that as a downfall. To me this area is personally fufilling as I find those patients we see now for this type of rehab benefit...if nothing else they learn how to cope with their field loss better and use the vision they have. I would love to go into research mostly on this subject. Our office just signed on with NovaVision to be a treatment center (www.novavision.com), which is showing success rate in 70+% of patients. What I was wondering mostly, and read into some of the research posted on the site is why not that other 30% or so of patients who they can't figure out why they didn't see improvements, as they show no major trends. I think mostly they are not focusing on this because they are mostly just trying to prove this therapy as a success...but I find it very interesting and would like to do more. Not only with this but with other therapies and neuro optometry...so thats why I can also really see myself doing research on the subject for a few years. As a person who had a traumatic brain injury I am very lucky not having residual effects like field loss or other physically disabling consequences. However I do find I can sympathize with patients and a lot of them appreciate my encouragements and overall caring for them...as it is very hard for someone to relate to the fact that you "are not going to be the same person you once were". Its hard for me to explain...but to me I have found this area to be the most rewarding.

We see a lot of therapy (low vision, visual perceptual, patching, and neuro) in our office in addition to the "routine" eye exams, so I know I can not make this my primary form of success...however some of these referrals end up becoming "routine" or bringing other patients in, in general because they know that anyone can recieve thorough care. Its kind of like being the "space filler" to offer these...in that opth. don't want to do therapy because they want to fix everything with surgery, other opt don't want to do this because they don't want to work with insurance or whatever the reason is. I think we get most OD referrals because the doctor just choses not to do a cycloplegic on a kid, or does not want to treat a medical case, ect. Opth. refer mostly low vision or contact lens patients.

So it can be done, but you have to be willing to put the time, money, work, stress ect. to do it, but to me, I have a role model who has made me want to be the "space filler" between ODs and MDs too...whatever failures/successes you have in your life are a direct reflection on yourself and how hard you try to do what you can to get to what you want.

 

[DrRobs]

Excellent question. This is an extreme sub specialty in optometry but the ones who do it almost all do it well and are highly sought after. Here's a link to an article about a doctor in my home state:


http://www.zwire.com/site/news.cfm?newsid=19044986&BRD=1630&PAG=461&dept_id=7736&rfi=6

Some other helpful information here:

http://www.nora.cc/

That was a great article, thanks for posting it!

 

[KHE]

I don't expect that it will be easy to have success based solely off this...I know ODs hands in this are rare, but I don't see that as a downfall. To me this area is personally fufilling as I find those patients we see now for this type of rehab benefit...if nothing else they learn how to cope with their field loss better and use the vision they have. I would love to go into research mostly on this subject. Our office just signed on with NovaVision to be a treatment center (www.novavision.com), which is showing success rate in 70+% of patients.

. As a person who had a traumatic brain injury I am very lucky not having residual effects like field loss or other physically disabling consequences. However I do find I can sympathize with patients and a lot of them appreciate my encouragements and overall caring for them...as it is very hard for someone to relate to the fact that you "are not going to be the same person you once were". Its hard for me to explain...but to me I have found this area to be the most rewarding.

We see a lot of therapy (low vision, visual perceptual, patching, and neuro) in our office in addition to the "routine" eye exams, so I know I can not make this my primary form of success...however some of these referrals end up becoming "routine" or bringing other patients in, in general because they know that anyone can recieve thorough care. Its kind of like being the "space filler" to offer these...in that opth. don't want to do therapy because they want to fix everything with surgery, other opt don't want to do this because they don't want to work with insurance or whatever the reason is. I think we get most OD referrals because the doctor just choses not to do a cycloplegic on a kid, or does not want to treat a medical case, ect. Opth. refer mostly low vision or contact lens patients.

So it can be done, but you have to be willing to put the time, money, work, stress ect. to do it, but to me, I have a role model who has made me want to be the "space filler" between ODs and MDs too...whatever failures/successes you have in your life are a direct reflection on yourself and how hard you try to do what you can to get to what you want.

Well, that's a tender notion but does it put food on the table and keep the lights in the office on?

Have you discussed with your current employer the economics of these subspecialty fields? How much revenue for the office is generated from these "neuro rehab" type exams vs more traditional VT vs traditional optometric exams? Do you have a concept of what the various 3rd party payors are reimbursing for these procedures?

If you have asked, can you share the results of your questioning? If you have not asked, why not?

 

[DrRobs]

Well, that's a tender notion but does it put food on the table and keep the lights in the office on?

Have you discussed with your current employer the economics of these subspecialty fields? How much revenue for the office is generated from these "neuro rehab" type exams vs more traditional VT vs traditional optometric exams? Do you have a concept of what the various 3rd party payors are reimbursing for these procedures?

If you have asked, can you share the results of your questioning? If you have not asked, why not?

I have indeed discussed this, actually I did billing for a year for the practice and I have been intimately involved still with billing matters as well as optical sales and my teching duties. We are a small practice so its easy to remain involved as when it comes to the VT and neuro patients it can get a little complicated, especially because a lot of our referrals come from blindness and visual services.

With that said, a lot of our neuro patients are a result of "low vision" referrals from the state, therefore most of their treatment/devices are generally covered (so as long as they are still working, then funding becomes more limited from the state). Insurance covers the exam visits for therapy, however most therapy is not covered, in home or in office no matter if its a binocular vision or neuro. We recently got NovaVision, and that therapy is not covered however we did sign on several patients willing to pay out of pocket as it is important and worth the expense (and a few the state is going to provide funding).

With that also said, more patients are more inclined to pursue any therapy if they have funding from another source (the state/insurance), or if they have funds on their own and realize how much it may help in the long run. I would say that only about 5-10% pursues therapy with most of those patients doing some sort of in home therapy with subsequent office visits.

Most of our revenue comes from insurance for exams, as we will submit to insurance when we can...so someone with diabetes, cataracts ect may not have problems although they can automatically go to insurance due to these diagnoses. Most "routine" stuff goes through one of the few vision plans we participate with and most "out of pockets" are routine patients who are willing to pay out of pocket for their yearly exams as they are getting thorough care. A good portion of course comes through optical sales as well, and selling low vision devices (usually because the state pays for these).

So yes, I know what I'm in for and have "asked about it". I find that if we can utilize a medical plan also, people are much more inclined to come to us for that reason. We also see a lot of post-op care patients from opthamologisits and post-op glasses as there are not many places that will utilize insurance to pay for these services.

A lot of the success comes from our intense marketing, and we have targeted specific specialty doctors (my doctor also goes to healthsouth once a week and picks up most of our neuro patients) and developed good relationships with them. The doc is big on marketing anywhere u go, social or work related functions as well as writing letters or putitng out ads in papers to highlight specialty services as well as the "routine". I could probably go on about this more but I think this post is long enough so if you have more questions just ask.

 

[VA Hopeful Dr]

So yes, I know what I'm in for and have "asked about it". I find that if we can utilize a medical plan also, people are much more inclined to come to us for that reason. We also see a lot of post-op care patients from opthamologisits and post-op glasses as there are not many places that will utilize insurance to pay for these services.

A lot of the success comes from our intense marketing, and we have targeted specific specialty doctors (my doctor also goes to healthsouth once a week and picks up most of our neuro patients) and developed good relationships with them. The doc is big on marketing anywhere u go, social or work related functions as well as writing letters or putitng out ads in papers to highlight specialty services as well as the "routine". I could probably go on about this more but I think this post is long enough so if you have more questions just ask.

Ophthalmologists. Anyway, I'm surprised more ODs in your area don't use insurance for glasses. If nothing else, I remember DMERCK or whatever being huge back when I did billing for an OD. Every vision plan had an allowance for that, and, at least where I"m from, very few insurances offered their own vision insurance.

Second, and I know I'm stealing KHE's thunder, for your idea to work you must be in an area where ODs can get reimbursed by medical insurance. That is still very hard for many places.

 

[DrRobs]

Ophthalmologists. Anyway, I'm surprised more ODs in your area don't use insurance for glasses. If nothing else, I remember DMERCK or whatever being huge back when I did billing for an OD. Every vision plan had an allowance for that, and, at least where I"m from, very few insurances offered their own vision insurance.

Second, and I know I'm stealing KHE's thunder, for your idea to work you must be in an area where ODs can get reimbursed by medical insurance. That is still very hard for many places.

Yea its hard, I don't know what state to state policies are...but I know a lot of insurances we weren't able to get on because of too many "OD's in the area already on their plan"....aka like 2...but when you have the extra services you can use that to fight your case. Maybe we just need more people fighting for it, but seems to me a lot of ODs would rather refer to someone who does the insurance end than doing it themselves. There are other ODs in the area that utilize insurance, mostly vision plans...but vision plans give crappy reimbursements...may be different if you are seeing a majority of these and just want to pump out quantity...but I don't want to do that...but I'm not going to hack those who do. I would rather know my patients and follow the example I have been set...there is a need to change this attitude about ODs ONLY being able to give glasses...and I don't think every OD should do medical cases if thats not what you want. But if if is you have to find the area, be willing to fight with insurance, be willing to "sell yourself" as a good doctor in any type of case if you want to bring patients in the door. To me I look for a doctor that is attentive and gets to know me, you can do that no matter what the case...but you have to have some good social skills to talk and relate with your patients if you want to do that...and you have to sacrifice seeing less patients in a day...but u know what a lot of people will appreciate you more and more likely send more people to you. Word of mouth I think is the best source of patients...and if you don't take the time to talk to them you won't get that source. Again I could elaborate but if you would like to ad to your synicial view go ahead...I just think I am unique in the fact that I want to do whatever it takes for the sake of my patients and if you work hard, find the right area/practice, you can succeed. Unfortunately a lot of people do want the easy way out...and a lot of those people voice that and it needs to change for the sake of optometry in general.

 

[eyestrain]

AAAAAAAaaragh, paragraphs, man! Too hard to read.