Saw optometrist when given ophthalmologist referral.

[platinumcaps]

In NYC, when there's a referral from medicare, is it legal for an ophthalmologist to assign that work to an optometrist while billing for an ophthalmologist visit?

My grandpa had a condition that quickly worsened over time because the optometrist wasn't qualified to diagnose the condition. The assigned ophthalmologist on the referral never did any exams in person. He always gave out the work for optometrists.

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[PBEA]

the answer to your question is yes, as well in, their own offices or when employed by an MD, optometrists regularly see and treat (and bill) medicare pts for ophthalmologic services.

I'm sorry to hear about your grandfather but it is simply untrue to say that "the optometrist wasn't qualified to diagnose the condition".

 

[DrZeke]

the answer to your question is yes, as well in, their own offices or when employed by an MD, optometrists regularly see and treat (and bill) medicare pts for ophthalmologic services.

I'm sorry to hear about your grandfather but it is simply untrue to say that "the optometrist wasn't qualified to diagnose the condition".

I have to agree with PBEA. Our residency works with a hospital that employs both ophthalmologists (subspecialty) and optometrists. In general our optometrists refer out anything that requires sub-specialty services, isn't straight forward or when they are unsure. In a system where there are both types of care providers this usually happens and there isn't much competition for one person to see the patient over the other.

It is possible for someone - ophthalmologist or optometrist - to miss a diagnosis/finding, particularly if it is rare in that population or unusual... However, given the lack of specifics on your situation it is hard to speculate on what actually happened.

 

[Dusn]

So this is a very contentious issue and ophthalmologist have spent a lot of effort lobbying the government to say that optometrists are not the equivalent of ophthalmologists. Optometrists have lobbied that they ARE equivalent and they have largely won in the realm of medical diagnosis and management of eye disease. They have 4 years of school as opposed to 8-10 years of medical school/residency/fellowship but they bill the same. The also practice independently. So this situation is not the equivalent of a physician assistant working for an MD where the MD has the PA see the patient and then signs the note and bills as though the MD saw the patient. In this case the optometrist taking care if your grandfather has taken complete responsible for your grandfather's care if he/she is the only one doing exams on your grandfather. Medicare doesn't care if your grandpa sees an ophthalmologist or an optometrist because medicare thinks they're equivalent.

Yes, many ophthalmologists feel that this compromises patient safety but it's the government that makes the rules. We've fought hard for many decades (and are still fighting) but have largely lost. It's up to the optometrist to realize the situation is beyond his/her training and send your grandfather to an ophthalmologist or it's up to your grandfather to realize the situation and to walk to one of the many other ophtho practices in NYC and see an ophthalmologist.

 

[MstaKing10]

Forgive my ignorance, but can ophthalmologists bill for optom exams, testing etc like GPs billing for NP's or anesthesiologists for nurse anesthetist or the like? My understanding is they cannot. Does anyone see a scenario where this could happen?

 

[PBEA]

So this is a very contentious issue and ophthalmologist have spent a lot of effort lobbying the government to say that optometrists are not the equivalent of ophthalmologists. Optometrists have lobbied that they ARE equivalent and they have largely won in the realm of medical diagnosis and management of eye disease. They have 4 years of school as opposed to 8-10 years of medical school/residency/fellowship but they bill the same. The also practice independently. So this situation is not the equivalent of a physician assistant working for an MD where the MD has the PA see the patient and then signs the note and bills as though the MD saw the patient. In this case the optometrist taking care if your grandfather has taken complete responsible for your grandfather's care if he/she is the only one doing exams on your grandfather. Medicare doesn't care if your grandpa sees an ophthalmologist or an optometrist because medicare thinks they're equivalent.

Yes, many ophthalmologists feel that this compromises patient safety but it's the government that makes the rules. We've fought hard for many decades (and are still fighting) but have largely lost. It's up to the optometrist to realize the situation is beyond his/her training and send your grandfather to an ophthalmologist or it's up to your grandfather to realize the situation and to walk to one of the many other ophtho practices in NYC and see an ophthalmologist.

4yrs vs 8-10 yrs?

That is a lie.

OD's do 8-9yrs (with residency) and MD's do 8-10yrs (or 11 with fellowship).

 

[MullerCell]

I think he meant we do 8-10 years after finishing undergrad, while optometrist do 4-5.

 

[KHE]

We are all on pins and needles waiting to hear what this condition was.

 

[DrZeke]

Glaucoma or wet amd?

 

[deleted480308]

(place holder as I'm also curious about what condition it was)

 

[OPPforlife]

I think he meant we do 8-10 years after finishing undergrad, while optometrist do 4-5.

Not to mention our 8-10 years post undergrad are vastly different from their 8-10 post high school.


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[dantt]

The nightmare is GCA.

 

[ophthope]

4yrs vs 8-10 yrs?

That is a lie.

OD's do 8-9yrs (with residency) and MD's do 8-10yrs (or 11 with fellowship).

No it is not a lie. Why do I hear this all the time? Either you are intentionally misrepresenting our education differences or ignorant of the differences between our educational pathways.

Counting from AFTER UNDERGRAD:

OD education:
4 years Optometry School
+/- 1 year residency (optional, with most graduates not doing a residency and a maximum of 25% possibly doing a residency based on # of slots / # grads [~400/~1600])

MD education:
4 years medical school
4 years residency (required)
+/-1-2 years fellowship (optional, with ~50% doing fellowships currently)

At the bare minimum for each of us, OMDs have twice the amount of training of ODs (8 years vs 4 years). At both of us max'ed out with residency/fellowships, OMDs have twice the amount of training of ODs (5 years versus 10 years). This should not be seen as an inflammatory or hateful comment as I am literally just adding up numbers here, do not take this as vitriol because it isn't.

The only way you can make our education anywhere near equal is to count the four years of undergraduate for Optometrists and NOT count them for Ophthalmologists which makes absolutely no sense. Not to mention that anyone who has gone through both Optometry school and then Medical School and Ophthalmology residency will tell you, the intensity of training is very different. I've met one person who did this, and he would agree because frankly it is obvious. OD students don't get up at 4:00 AM for 8 months of the year to pre-round, get pimped all day, and hopefully get home by 10PM. You also don't routinely work the weekends. We did. We went through that and learned a lot from it even if we routinely downplay the importance of our broader medical education.


I think most of us here would agree that most Optometrists are fine eye care providers, we work with ODs, co-manage with ODs, and discuss cases with ODs. Why in the world do you guys try to downplay our education so often online? I don't know many younger ODs in practice so perhaps that is the difference, but the ODs I know appreciate our greater education because frankly they need someone they can count on to know more than they do when they refer patients to us, and we're happy to work with them for the good of our patients.

 

[PBEA]

you are correct, I am wrong. For some reason I was just thinking of "eye training" but that's besides the point. Sorry for the confusion. I would never, and have never, downplayed your training. Quite the opposite in fact, but again besides the point.

 

[ophthope]

you are correct, I am wrong. For some reason I was just thinking of "eye training" but that's besides the point. Sorry for the confusion. I would never, and have never, downplayed your training. Quite the opposite in fact, but again besides the point.

You are right that post of mine was off-topic, sorry for that. Going to go down this train though, because I often see those almost exact numbers quoted. Even a cursory youtube search shows some ridiculous stuff about our profession. I searched "Optometry versus Ophthalmology" and this is the second video:

"The only difference between an Ophthalmologist and an Optometrist is that my Ophthalmology colleagues, they are able to do surgeries. and matter of fact that's the only reason anyone needs to see an Ophthalmologist is for surgery." Somebody better tell all the Optometrists and comprehensive Ophthalmologists to stop referring to retina for any diagnosis, peds for any diagnosis, or neuro-ophthalmology for basically anything. And I guess uveitis fellowships just shouldn't exist, somebody call Wills Eye.

I'm sure there are some videos out there by Ophthalmologists saying that ODs are inferior that are just as absurd but I can't find them. I'm sure other OMDs get as miffed as I do when I see this stuff. If you're a young MD on the web and are somewhat social media savvy and try to stay on top of social news and trends - you will find this misinformation not infrequently posted in articles or comments sections often by Optometry students, and the public seems to accept the misinformation. It's quite bothersome. And hopefully if I keep commenting every time I see it then when people search the web for more information they'll stumble across posts like mine and be informed correctly.

Last off-topic post for a while I promise, back to OKAP studying. GLC1B in LA County, right?

 

[DrZeke]

Now that is a terrifying video. Defensive much?

Edit: God this video is still pissing me off...

 

[LightBox]

Eye care providers must be fighting for scraps in California if they have to make videos like this! This guy must have been stuffed in a lot of lockers in high school to explain his overcompensation now!

 

[PBEA]

I could only stand the first minute or so but.......are those several lightsabers attached to the wall?

 

[DrZeke]

Eye care providers must be fighting for scraps in California if they have to make videos like this! This guy must have been stuffed in a lot of lockers in high school to explain his overcompensation now!

I can also picture his parents standing on each shoulder while he talks...

 

[310]

I don't think there's a condition in existence that "quickly worsens over time."


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[Apollyon]

I don't think there's a condition in existence that "quickly worsens over time."


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Acute angle closure glaucoma?

 

[310]

Acute angle closure glaucoma?

No, that just quickly worsens.


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[dantt]

I don't think there's a condition in existence that "quickly worsens over time."


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life?

 

[TheLesPaul]

I don't think there's a condition in existence that "quickly worsens over time."


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Are you for real??

 

[Slide]

Are you for real??

+1. There are several ophthalmology-related conditions that will worsen quickly over time.

 

[MstaKing10]

I don't think there's a condition in existence that "quickly worsens over time."


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Holy cow...you have a lot to learn

 

[310]

Since a lot of you can't seem to understand what I'm talking about, I was pointing out a nonsequitur.

The condition either progressed "quickly" or "over time." It didn't do both because it's impossible.

Unless the condition is life, which seemingly can progress quickly for the duration of a person's life, never hitting rock bottom until the final moments.

Thanks.

 

[Meibomian SxN]

No it is not a lie. Why do I hear this all the time? Either you are intentionally misrepresenting our education differences or ignorant of the differences between our educational pathways.

Counting from AFTER UNDERGRAD:

OD education:
4 years Optometry School
+/- 1 year residency (optional, with most graduates not doing a residency and a maximum of 25% possibly doing a residency based on # of slots / # grads [~400/~1600])

MD education:
4 years medical school
4 years residency (required)
+/-1-2 years fellowship (optional, with ~50% doing fellowships currently)

At the bare minimum for each of us, OMDs have twice the amount of training of ODs (8 years vs 4 years). At both of us max'ed out with residency/fellowships, OMDs have twice the amount of training of ODs (5 years versus 10 years). This should not be seen as an inflammatory or hateful comment as I am literally just adding up numbers here, do not take this as vitriol because it isn't.

Yeah and look at how many nonsurgical malpractice cases MDs have compared to ODs. Seems those "extra years" are just fluff?

 

[backrow]

Yeah and look at how many nonsurgical malpractice cases MDs have compared to ODs. Seems those "extra years" are just fluff?

One could also compare the number of plane crashes when a pilot is at the controls vs when a flight engineer is at the controls.....

 

[Bernoull]

Yeah and look at how many nonsurgical malpractice cases MDs have compared to ODs. Seems those "extra years" are just fluff?

just wow...

 

[MeetJoeBlack]

Yeah and look at how many nonsurgical malpractice cases MDs have compared to ODs. Seems those "extra years" are just fluff?

If only I could fill my clinic with all of your optometry patients then I could comfortably cancel my malpractice insurance. Surgical or not, those aren't the patients optometry refers to medical doctors equiped with extra years of fluff.

 

[Bernoull]

Quick YouTube summary of Ophthalmology vs Optometry vs Optician

 

[speyeder]

Yeah and look at how many nonsurgical malpractice cases MDs have compared to ODs. Seems those "extra years" are just fluff?

This is coming from someone who said a retrobulbar hemorrhage needs a retina referral. Enough said.

 

[Ignatius M.D.]

Yeah and look at how many nonsurgical malpractice cases MDs have compared to ODs. Seems those "extra years" are just fluff?

Flawless logic that takes into account all variables.

 

[KHE]

Did we ever find out what this "condition that quickly worsened over time because the optometrist wasn't qualified to diagnose the condition" was?

 

[DrZeke]

Did we ever find out what this "condition that quickly worsened over time because the optometrist wasn't qualified to diagnose the condition" was?

For serious... The OP made a stink and now is nowhere to be found.

@platinumcaps we are dying to know...

 

[Meibomian SxN]

This is coming from someone who said a retrobulbar hemorrhage needs a retina referral. Enough said.

Hahaha, nice memory; sort of the same mundane memorization your first 4 years...

I'm not trying to start a flame war, my patients are always happy to see me and if I treat them medically its a bonus. More and more patients are unhappy with the care and "knowledge" of the all knowing MD; sorry that's just reality.

Again, if I did a surgical residency I'm sure I could cut out an M&M or play zap em with a laser or (drum roll) inject into the vitreous. And for proof, we have the cases of retina oMDs who are utilizing nurse practitioners to inject anti-VEGF drugs.

MDs have an ego that'll never go away, and there's no trying to convince them.

 

[LightBox]

Ok, can someone close this thread down now. Yet another troll starting a flame war. Thanks!

 

[Meibomian SxN]

Ok, can someone close this thread down now. Yet another troll starting a flame war. Thanks!

It should have been closed once the one who asked the question never followed up; yet every all knowing MD flamingly commented on. Smh. Bye

 

[ophthope]

...I'm not trying to start a flame war, my patients are always happy to see me and if I treat them medically its a bonus....MDs have an ego that'll never go away, and there's no trying to convince them.

If we treat patients 'medically' it's not a "bonus", it's standard of care. Many MDs do have big egos, but have you ever heard the one about the pot and the kettle?

 

[Meibomian SxN]

If we treat patients 'medically' it's not a "bonus", it's standard of care. Many MDs do have big egos, but have you ever heard the one about the pot and the kettle?

Close the thread please, thanks. Too many MDs flagging as "inappropriate".

 

[ophthope]

I don't know why you quoted me on that - I haven't flagged anything.

 

[Visionary]

What's up, folks? Looks like not much has changed over the years. Same old arguments.

 

[Meibomian SxN]

If we treat patients 'medically' it's not a "bonus", it's standard of care. Many MDs do have big egos, but have you ever heard the one about the pot and the kettle?

And here's yet another case of ophthalmology grafting and corruption, I wasn't just being a "pot called kettle"; its rampant in their profession.
And there is no need to flag me because not every oMD is corrupt...
http://abcnews.go.com/Politics/us-senator-robert-menendez-indicted-corruption-charges/story?id=30046251

Sen. Bob Menendez said he's "outraged" by federal corruption charges he's facing stemming from his interactions with a Florida eye doctor.

 

[Bernoull]

And here's yet another case of ophthalmology grafting and corruption, I wasn't just being a "pot called kettle"; its rampant in their profession.
And there is no need to flag me because not every oMD is corrupt...
http://abcnews.go.com/Politics/us-senator-robert-menendez-indicted-corruption-charges/story?id=30046251

Sen. Bob Menendez said he's "outraged" by federal corruption charges he's facing stemming from his interactions with a Florida eye doctor.

I would be careful about broad-brushing an entire profession as being "rampant with corruption". There are bad apples in EVERY human enterprise be it within medicine or beyond. When money is involved, there'll be corruption, it's just human nature!

A cursory google search of any profession + corruption will yield thousands of unsavory characters... case in point Jim Black (optometrist, former state house speaker, convicted felon).
http://www.wral.com/news/local/politics/story/8613683/


It's simply not a productive exercise to go down this road.. Let's elevate the discourse a little here.

 

[Meibomian SxN]

I would be careful about broad-brushing an entire profession as being "rampant with corruption". There are bad apples in EVERY human enterprise be it within medicine or beyond. When money is involved, there'll be corruption, it's just human nature!

A cursory google search of any profession + corruption will yield thousands of unsavory characters... case in point Jim Black (optometrist, former state house speaker, convicted felon).
http://www.wral.com/news/local/politics/story/8613683/


It's simply not a productive exercise to go down this road.. Let's elevate the discourse a little here.

I already said not every oMD is not corrupt so you're being redundant...

 

[Iladelphia]

Actually Meibomian SxN, you are being redundant:

"I already said not every oMD is not corrupt so you're being redundant"

I won't comment on your aptitude for passing the verbal section of the written MCAT, but it appears you've used a double negative here (i.e. being redundant). So actually by your statement alone you are implying that every oMD is corrupt.

After reading your comments for what seems like years, I've promised myself I would abstain from entering into discourse with you. And now I've done it - and I hate myself for it.

Please just leave our forum - for good - please. You offer nothing but inflammatory diatribe and you bring out the worst in people.

Please. Leave.

 

[AlPachena]

:troll:

 

[OPPforlife]

Actually Meibomian SxN, you are being redundant:

"I already said not every oMD is not corrupt so you're being redundant"

I won't comment on your aptitude for passing the verbal section of the written MCAT, but it appears you've used a double negative here (i.e. being redundant). So actually by your statement alone you are implying that every oMD is corrupt.

After reading your comments for what seems like years, I've promised myself I would abstain from entering into discourse with you. And now I've done it - and I hate myself for it.

Please just leave our forum - for good - please. You offer nothing but inflammatory diatribe and you bring out the worst in people.

Please. Leave.

I don't know. I kinda like this guy, reminds me of how immensely more superior my profession is.


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