Twilight DVD Giftset Giveaway!

We are giving away the Twilight DVD Ultimate Collector's Giftset. Click on the image below for the details. Our staff has had so much fun with Twilight, we thought we would share some of the excitement with you.

NEWS: Restasis. Expensive Medicine, or Cost Effective Treatment?

Restasis (cyclosporin ophthalmic drops) is a highly effective theraputic treatment for dry eyes. Presumably, it stimulates tear production by controlling inflamation of the tear producing glands. We have dry eye patients who report dramatic relief from its use. The big complaint however, is "why does it cost so much?"

Here the report of a study that factors in the "cost of dry eye to society," that claims Restasis is cost effective. Click here.


Here is the link to the manufacture's website for additional information. Click here.

NEWS: We Finally Got Paid!

Barri, our Accounts Manager and Billing Specialist, just informed me that we finally got paid on an insurance claim after Two and One Half years of concerted effort by us and the patient to get reimbursed. It was about a $350 claim. Never mind that it cost us more than we received to collect it. I can tell you its a one way street. If the insurance company thinks they overpaid, you will reimburse them YESTERDAY, with interest! But it doesn't really matter when they finally pay you for services rendered... and they don't pay interest when they are late.

I just found this interesting article in today's news and thought, "how apropos."

NEWS: Why does Health Care keep getting more Expensive?

As reported in the Review of Optometry, January 15, 2009 issue, by the Nachimson Advisors, a health information consulting firm, just one of the incoming regulatory changes in the works for medicine is set to cost the average small practice like ours $83,290. Mid size practices (10 docs) will spend $285,195 on the upgrade, and large practices (100 docs) will spend an estimated $2.7 million.

At issue is medical coding. Currently, we use ICD-9 codes which define and describe a doctor's findings which are then linked to the procedure/office visit codes that get billed to your insurance company. In short, ICD-9 codes supply the "reason" for testing and office time for which the doctor is trying to get reimbursed. The problem, according to the Department of Health and Human Services (HHS), is that sometime next year, they will run out of codes in the ICD-9 set.

So HHS is getting ready to adopt a new coding system, the ICD-10 set. The goal is to have it in place by October 2011. Insider analysts think implementing the new ICD-10 coding will be the most costly event medical practices will ever experience.

Here is how it pencils out for us. Rough calculations that include our current costs and average revenue-per-patient collected indicate that our practice would have to see our next 757 patients just to pay for the switch to ICD-10. Of course, like any business, medical practices will need to recoup the added cost of this new mandate to stay solvent. But unlike the regular market place, medical practices can't just increase the rates they charge insurance companies for their service and expect the insurance companies to pay the increase. They will have to make up the difference with their private pay patients, or eliminate other overhead or services which may reduce the quality of care you receive.

ICD-10 coding for diagnoses is just one of the oncoming challenges we have to prepare for. The procedure codes we have to use that describe the time and testing we do in order to get paid is also getting more complicated by orders of magnitude (which is its own subject for another time.) We now have level 2 procedure codes and PQRI codes (quality assurance coding) to include when we bill, just so we can get paid without penalty.

Sometimes I wonder if the increased complexities in coding and billing are just a calculated effort on the part of payers to trim costs by virtue of our reduced compliance as we struggle to figure out and pay for the new programme. Understanding the current system is already so complex that keeping payments coming properly is a non-stop battle. We feel like we have evolved our processes to the point that it works fairly well, and we follow the rules to the "T."

Patients already get frustrated as they try to understand why we code and bill as we do. I fear the new regulations will add more layers of confusion between doctors and consumers of medical care, further separating the two from the normal market forces that control buyer/seller relationships in other market settings.

NEWS: Water-Powered optics

Click here for the full Chicago Tribune article.

A tinkerer/physicist in the U.K. has developed user-adjustable optics using water filled lenses that may make vision correction possible for the worlds poor who have no access to eye care. Here is a big thumbs-up for human ingenuity. One of humanity's critical unmet needs appears to have an inexpensive solution...no expensive government program needed.

NEWS: Potassium and Blood Pressure

High blood pressure is a disease that causes vascular damage, which, left untreated can destroy the gift of sight. Hypertensive Retinopathy destroys vision by causing poor perfusion, fluid leakage, and macular swelling. It can also cause strokes inside the eye. We urge our patients with high blood pressure to keep it well controlled for their eyes' sake, and have regular visits with the doctor to ensure treatable problems don't go unnoticed.

Here is an interesting piece of "news you can use." This report of a recent study on Potassium finds that it may help lower blood pressure. Click here for the report.

http://www.upi.com/Health_News/2009/01/28/Potassium_may_help_lower_blood_pressure/UPI-12251233197984/

News: SCHIP expansion

The State Children's Health Insurance Program (SCHIP) was originally set up as a stop gap to cover children in families that made too much to be covered under medicaid programs, but presumably, not enough to afford health insurance. Currently, the U.S. Senate is getting ready to consider a bill passed by the House that would expand SCHIP after provisions to protect private insurance companies were removed.

At issue is the concern that public insurance "crowds" out private insurance. Several studies conclude that the effect of this crowding leads to more expensive insurance for those in the private market. Here is the reference to one such study for which I couldn't find an online source: David M. Cutler and Jonathan Gruber, "Does Public Insurance Crowd-out Private Insurance?" Quarterly Journal of Economics, Vol. 111, No. 2 (May 1996), pp. 391-430.

In my opinion, this represents a dangerous trend that will be nearly impossible to undo. Generally, this sudden rush to move private business into the public sector saps vital market energy from the productive segments of our economy--all at a time when our economy needs all the energy it can get. Click here for some solid analysis of the SCHIP expansion by the Heritage Foundation.

Dr. Gooch

NEWS: Got Eyelashes?

Lattise. We have long wondered, when are they going to start selling this stuff for the cosmetic side effect of eye-lash growth? Lumigan, Travatan, and Xalatan are three similar drugs that we use to control eye pressure in patients with Glaucoma. All three drugs have an interesting side effect--they stimulate eyelash growth. So much in fact, some of our patients on these drugs look like they are wearing big, fake eyelashes. I even have a few who come in regulary for a trim--the lashes get too long.

Often our patients will ask, "My friends wonder if they can come here and get this medicine for their eyelashes?" Well...the thought certainly makes me a little uneasy.

CLICK HERE FOR ARTICLE

Today's New York Times article raises many interesting questions. First, the Mascara market is 5 billion dollars a year. The drug company knows opportunity when it sees it. Second, who is going to prescribe this stuff? Will our glaucoma patients be tempted to bypass us and assume that their treatment is going OK without monitoring progress after their dermatologist Rx's the cosmetic version? (The cosmetic version is the same strength as the glaucoma med).

It will be interesting to see where this goes...

NEWS: Blind Google Engineer develops Technology that may help those with vision and Improve Access for the Blind

Enjoy this link to the New York Times article about a Google Engineer who is blind with Glaucoma from the age of 14. I marvel how people without vision adapt to our very visual world. This is a great example of this adaptation, with practical application.

Regards,

Dr Gooch

Click here for Article

NEWS: Cancer of the Eye--Uveal Melanoma

Interesting news you can use:

Canada's Globe and Mail (12/12) reports that researcher Catherine van Raamsdonk, B.Sc., M.A., Ph.D., of the University of British Columbia, "has identified a gene mutation that can cause almost half the incidents of" an eye cancer "called uveal melanoma." According to Prof. van Raamsdonk, "the next step" is "to develop a treatment that targets the effects of the mutated gene." As reported by AOA's First Look