Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

BLOG: The quality of mercy

After a robust Vision Expo East with a chance to look at a number of new technology options for the practice of optometry, I came away from New Yok with a bit of a concern.

Many of the vendors are advising aggressive billing of third-party carriers to recoup the very expense cost of their gadgets.

In addition to the sticker price, many of these instruments are burdened with annual service contracts and regular software updates that must be considered in your practice management equation. In addition, there are often hardware upgrades that are required that are even more expensive.

Traditional optometric equipment has a shelf life of about 50 years. Computer-based equipment has a life span more like 5 years, some even 3! During my stay in the Big Apple, I also learned that some of the gizmos that I bought last year will no longer work unless I update them to Windows 10. Again, this upgrade has a hefty price tag.

In my consulting work, I lead a team of optometrists in medical chart review. With our expanded scope of practice, many managed care vision contracts are written to the scope of licensure of optometry. I have noted an alarming trend among some providers to order more testing and to order testing more often on the same patient. Most of these questionable billing practices revolve around the use of these very expensive new ophthalmic instruments.

Too many of our colleagues are listening to the instrument sales team, taking a course in aggressive medical billing and getting paid for new high-tech medical services. Once the payments start rolling in, it becomes easier and easier to find more and more obscure diagnosis codes that are payable. This is a time bomb with a very long fuse.

Many health plans administer government-sponsored health insurance programs. These include Medicare, Medicaid, Veterans Administration benefits and military programs. Although these payments are made by a health plan, the dollars come from the federal government. With this in mind, I urge anyone who may be feeling a little uneasy as they read this or perhaps has an optometry friend with lots of gadgets in their office and suddenly a brand-new car to take pause. Please look at the definitions of fraud, waste and abuse on the CMS website. Be sure to follow through to the penalties associated with this latest form of white-collar crime.

I have heard some naive discussions around the fact that medical care is new to some optometrists and perhaps they may have been misled in a course that they took on billing and coding. Surely the Office of the Inspector General and the Department of Justice will have mercy on a little optometrist who is just trying to do a good job for their patients. After all, shouldn’t everybody be able to benefit from all this great new technology?

My question for my colleagues digesting this is: “Have you met anyone that works for the federal government?” Mercy is not in the job description.

So, before you start down a slippery slope, please do your homework. If you are already using this new technology you need to ask yourself a different question every time you use it. The question should not be: “Can I get paid to do this test?” The correct question is: “Is this test medically necessary to take care of this patient?”