Article Date: 7/1/2002

Practice Pulse
Tips, Trends & News You Can Use

Forewarned is Forearmed
By Bob Levoy, O.D.

In May, I sounded an alert about a disturbing trend reported by Harris Interactive, that a sizeable minority of the public has begun "haggling" with physicians, dentists and hospitals to lower their bills -- approximately half of whom are succeeding. And they predict that as healthcare costs continue to rise, "the practice is likely to increase."

Recently, one website posted an article entitled, "Sickened by doctor bills? How to haggle for a lower price," by Vicki Lankarge.

"According to The Foundation For Taxpayer and Consumer Rights (FTCR)," she writes, "everything in health care is negotiable, even the bills from your doctor, pharmacist and hospital." FTCR's patient guide states: "You're paying the bills, not only as a consumer, but also as a taxpayer who helps fund the medical system.' So don't be cowed by your doctor's sparkling white lab coat or by your hospital's credentials. Establish the price you believe is reasonable and go for it."

Here are some tips that Lankarge offers on "how to bargain:"

If you or your staff are getting such requests from patients, discuss the subject and reach a consensus on how to best deal with the problem.


Paragon Vision Sciences recently received FDA approval for its Paragon Corneal Refractive Therapy (CRT) contact lens. The len is indicated for overnight contact lens corneal reshaping for the temporary reduction of myopia.

The approved indications cover individuals with up to 6.00D of myopia with or without astigmatism up to 1.75D. The approval also mandates that practitioners be trained and certified in the fitting and prescribing of the CRT.

Tiger Woods Foundation Helps Kids

Approximately 12.1 million school-aged children have some form of vision problem but unfortunately, not all of their parents can afford or know the importance of vision screening. Fortunately, many organizations are educating the public about vision testing for children.

Last month, Prevent Blindness America (PBA) and Allergan, Inc. presented the Tiger Woods Foundation with an Award of Recognition for organizing a free vision screening for children who attended the Coca-Cola/Tiger Woods Foundation Junior Golf Clinic in Orlando.

More than 2,000 children between the ages of 7 and 17 attended the clinic. PBA and Allergan hosted a booth and conducted free vision screenings for the children.

Allergan also provided free samples of Refresh Tears, coupons for the product and patient education literature for those who stopped by the booth for a screening. Qualified children also received Sight for Student vouchers from PBA in cooperation with Vision Service Plan.

Survey Says . .  . . consumers buy eyewear at time of their exams.

According to a recent survey by Vision Council of America (VCA), 55% of customers prefer to purchase their eyewear when they have their eye exam; only 35% didn't. Most respondents (73%) planning to purchase from an independent location said they would purchase at the time of the exam. Seventy-six percent of people who intended to buy their eyewear from a chain optical store said they'd buy at the time of the exam compared to 17% who said they wouldn't.

Corneal Thickness Could Affect Treatment

You've known that thick corneas (> 550 µm) lead to false high readings of intraocular pressure (IOP). Well the results of the National Eye Institute's recent Ocular Hypertension Treatment Study, which were released in the June issue of Archives Opthalmology, showed the significance of measuring corneal thickness in treating this condition.

The study was conducted at multiple sites across the United States where individuals who have elevated IOP (b/w 24 mm Hg to 32 mm Hg) were randomized to either therapy or a placebo. Researchers followed the individuals over time using fields and optic nerve photographs.

The study uses 5-year data and shows that treating ocular hypertension makes a substantial difference. In the study, 9.5% of control subjects developed damage versus 4.4% of those who were treated. For individuals who had IOPs of 25.75 mm Hg or higher, the risk of damage is 36% at 5 years for those who have an average or thin cornea versus 13% for those who have a thick cornea (>565 µm). This study gives evidence that corneal thickness measurements allow practitioners to decide which individuals deserve treatment or careful follow up.



Akorn announces executive changes. Dr. John Kapoor, who has been acting interim CEO for Akorn, will now maintain that role permanently in addition to his position as chairman.

In other Akorn news, President and COO Tony Pera is leaving the company for personal reasons.

J&J Lens Group president to step down. Val Brunell, president of Johnson & Johnson's Spectacle Lens Group, will retire from her position in early 2003.

Former President of Johnson & Johnson Sales and Logistics Co. John Hogan will take over Brunell's responsibilities. Brunell will stay on until the year's end for a smooth transition.

O.D. recognized by AOA. For his extraordinary leadership and involvement within the profession, Jerald Combs, O.D., of Martin, Ky., has been granted the Distinguished Service Award by the American Optometric Association.

Oliver Peoples restructures executive staff. With 17 years of experience in the optical industry, William Barton has become president of Oliver Peoples. He'll work directly with co-founder and chief designer Larry Leight.

Tracy Song has been named vice president and national sales manager. Michelle Cifuentes is now international sales manager for the company. Lastly, Patty Perreira has been named vice president of design and development.

Rodenstock makes a change. Karen Jacobs has been appointed vice president of marketing for Rodenstock North America. She takes over the duties of both Dave Delle Donne, former VP of sales and lens marketing, and Adelle Erdman, VP of marketing, frames, both of whom are leaving the company.


CIBA lens wins award. CIBA Vision's Focus Dailies disposable contact lenses won the Pont d'Or award as contact lens of the year in France. The award also recognized the company's Focus Dailies progressive lenses for presbyopia.

Rockwell collection to come. Lawrence Eyewear has secured a license from The Norman Rockwell Foundation for a Norman Rockwell Eyewear collection of ophthalmic frames. The first eight styles are expected to be available by August.

Essilor awards grant. Essilor of America, Inc. is honoring its French heritage by promoting the study of the French language and culture. The company awarded a 4-week study grant at the University of Caen in Caen, France to Dallas-based college student Carmen Petrick. The college junior is studying Math and French.

Corning restructures. Initiating its restructuring plan, Corning has eliminated 1,500 jobs and is offering early retirement packages to about 600 employees.

LensCrafters names vendor of the year. LensCrafters recently named Ocular Sciences, Inc. as its "Contact Lens Vendor of the Year" for 2001 and has named Ocular's 1- to 2-week Disposable Sphere market under the Versaflex brand as its Disposable Product of Choice. The award was presented based on numerous criteria including a superior quality and high-value product.

Study Findings Connect Arteriolar Narrowing to Development of Diabetes

A new study reported in the May 15th issue of The Journal of the American Medical Association suggests that arteriolar narrowing precedes the onset of diabetes.

In the study, Dr. Tien Yin Wong from the National University of Singapore and his colleagues took photos of the retinas of nearly 8,000 healthy men and women aged 49 to 73 years and measured the extent of narrowing in the small vessels carrying blood to the eye. Over the next 3.5 years, nearly 4% of the group was diagnosed with diabetes. The rate of the disease was higher among those who had narrower vessels.

Interestingly, individuals who had the most narrow retinal arteries were 71% more likely to develop diabetes than those who had the least amount of narrowing, regardless of their blood sugar and insulin levels, family history, blood pressure or other risk factors.

The researchers conclude that their findings suggest that microvascular processes may play a role in the development of diabetes. Further studies are necessary to confirm that small vessle damage is a cause rather than a result of diabetes.

Internet Lens Retailer on Shaky Grounds

As many of you are aware, Johnson & Johnson (J&J) is in the midst of a legal dispute with 1-800 Contacts because J&J's Vistakon unit refuses to supply 1-800 Contacts with its replacement contact lenses for sale via 1-800's phone and Internet outlets.

According to a recent Dow Jones Newswires column, 1-800 Contacts has been sending out mixed signals about its status. The Dow Jones column reveals that in its filings in the court case, 1-800 Contacts suggests that its business could suffer a "slow death" if J&J gets its way.

1-800 Contact's financial statements are allegedly emiting mixed signals too. The company is facing a huge bill by pursuing its legal fight and it's been buying back its own stock with the available cash it has and it's buying even more shares by borrowing on its credit line.

What's in store for 1-800 Contacts? It's probably not possible for anyone to predict the outcome. But stay tuned and we'll keep you informed.

Web Site Alleges Malpractice

TLC has filed a Strategic Lawsuit Against Public Participation against Ron Pasqulino, a laser-assisted in situ keratomil-eusis patient.

Pasqulino put up a Web site stating that following LASIK, he had a cornea transplant in one eye and needs one in the other eye "as a result of the negligence of Dr. Braverman and TLC . . . including but not limited to what appears to be a deliberate attempt to manipulate the records."

Pasqulino has counter-sued TLC, alleging malicious prosecution. He claims that all the company's financial records, stockholder reports and patient records will be subpoenaed.

Oakley Develops Eyewear for Armed Forces

Many of you may not be aware of this, but Oakley has sold its products to the military for 15 years. Now the company has recently partnered with the U.S. military to supply protective eyewear and footwear to the armed forces.

The new eyewear technology, which will be fitted to the company's existing "M" frame, is designed to protect against infrared rays, which are emitted from military targeting equipment. The laser lens and the new boot are the first products developed specifically at the requrest of the armed forces.



In our May 2002 story, "Electronic Medical Records and You," we provided the wrong information in the table regarding Charting Plus/MediNotes. The company doesn't charge per workstation -- it charges per user license. The initial optometric license is $2,295 and each additional optometrist license is $995.

More Vision Plan Woes
By Gil Weber, M.B.A.

Last month I discussed how issues I encountered years ago -- ones that had seemingly fallen out of favor with third-party plans -- are showing up again. Here are some more examples, and what you need to watch out for to make sound decisions about whether to participate in a given insurance plan.

Hidden agendas

The vision plan documents doctors sent me after my practice management lectures about insurance plans contained other troubling issues. Sometimes it's a bit difficult to understand the nature of a problem when it's wrapped within an obtuse paragraph. Take this, for instance.

From one vision plan's provider manual:

Read this over.

Filing fees: According to the (plan name) Panel Agreement, your payable fees may be reduced if it's determined that you're receiving lower fees than those accepted from (plan name). The determination to lower your fees may come from several sources, including: quality improvement reviews, telephone surveys, advertisements or acceptance of lower fees from other vision care plans.

Did you catch it? This is the infamous "most favored nation" clause, back again. This clause says that if you sign a provider agreement containing a "most favored nation" provision and have previously accepted or in the future accept lower fees from another vision plan, you can be required to amend this new contract to match those lower fees paid by another plan. That "trap" precludes your ability to selectively negotiate fees based on your determination of a plan's value to your practice.

Say you're offered a deal to receive $38 for an exam from Plan A. You might have an existing agreement with Plan B paying $44 for the same service. Assume that Plan B has a most favored nation clause in its provider agreement.

Is Plan B's deal paying $6 more a better deal than A's? What if A pays consistently in 14 days, while B consistently takes 45 to 60 days? What if A's administrative protocols are simple, while B's leave your staff frustrated at the hoops they have to jump through? Which deal is better in its entirety?

Wouldn't you want the freedom to take A' s lower fees because you'll get paid faster and your staff will have less hassle? Might that make a lower reimbursement worth considering? But if B's provider agreement contains a most favored nation clause, you have to give it the lower fees paid by A and take the slow payments and hassle. Your freedom to negotiate with other payers is stripped away.

And consider this nasty surprise: Assume you signed a deal with A 3 years ago paying $38 for an exam. You sign a deal with B paying $44, and a few months later B finds out about the old deal. Now B can demand that you match the lower fee even though that rate is 3 years old and may not make sense now. A most favored nation clause can obligate you to accept the nonviable reimbursement from B.

From another vision plan's provider manual:

Quality improvement program -- in-office reviews: Each review has the following objectives:... Confirm that the doctor's examination records for randomly selected private (non-plan name) patients are receiving the same level of examination and quality of care as (plan name) patients.

This old-time plan protocol could put your practice at significant risk. Here's why it's dangerous.

You know that protecting a patient's privacy and medical records is one of your most important duties. The penalties for failing to do so can be significant. And with the new government regulations under the Health Insurance Portability and Accountability Act umbrella, they're going to get tougher for those who fail to comply.

Involuntary violation

The provider manual's provision would make you violate that privacy by affording a vision plan's auditor access to confidential records. You can't allow any vision plan to audit the records of patients who aren't participants in that plan.

Despite what their protocols may say, vision plans don't have a right to inspect any patient records except those of their members, and then only with the patient's permission. Note that permission may have been given when the patient first signed up for the vision plan, but your private-pay patients certainly haven't given such authorization.

This is why it's important to have qualified counsel review plan documents and help you revise or remove language that could put your practice at risk.


Optometric Management, Issue: July 2002