Economics 101: Too Many O.D.s
In the article, From Y2K to Today (November 2005), Dr. Mort Soroka stated, I dont think we have an oversupply (of optometrists) by any stretch of the imagination. Dr. Larry Davis felt there were peripheral needs unmet in the eye care community and stated, From that point of view, you could argue that there are too few optometrists.

Although I respect these doctors opinions, they are employed by institutions that recruit and train new O.D.s. If there were a movement to decrease the number of O.D.s graduating each year, their jobs could be adversely affected. However, those of us in the real world of Economics 101: Supply and Demand see new O.D.s enter practice every year, forcing us to compete for the same number of patients with few dollars from insurance plans, all while trying to run a business.

Although my group practice has grown, it is nowhere near its potential. If we were suddenly hit with a 25% increase in patient flow next month, we could make a few adjustments and still accommodate these patients, all while providing them with fine eye care. I would be far more swayed by Drs. Soroka and Davis conclusions if they earned their living in a private or group practice.

Ive also noted the petition by the group (now regarding the need for another school of optometry. Although the increasing number of O.D.s indicates that no more schools are needed, the University of North Carolina Pembroke president, another academic, is trying to open another funnel in the oversupply chain.

Dana A. Grist, O.D.
Johnson City, Tenn.

Editors note: As of mid-April, the president of the University of North Carolina decided to set aside plans for the proposed optometry school at its Pembroke campus. School officials do not plan to consider it again in the near future.

The Issue of Refraction
Dr. D.C. Dean makes some excellent points in Bill Your Patients Medical Insurance (the Right Way) (February 2006). Of particular note is the medical billing mistake of Submitting a 92000 eye exam code that includes a refraction to a medical carrier.

However, there may be some confusion of two issues in the statement, Some state boards, optometric societies and the American Optometric Association have published clinical care guidelines that list refraction as an integral part of a comprehensive eye examination.

While the AOA Optometric Clinical Practice Guidelines list refraction as a component of a comprehensive eye and vision examination, there is no mention of how this should be coded or billed. In fact, a bulletin from the AOA Office of Counsel from March 26, 2004, states that inclusion of refractions in examinations or the assumption of that inclusion is not in compliance with the HIPAA regulation. Refractions must be reported separately, if performed.

Certainly, refraction cannot be bundled into a medical procedure code. But just as certainly, refraction is a very important component of a comprehensive eye and vision examination.

Jeffrey L. Weaver, O.D.
American Optometric Association

Dr. Dean Responds:
First, a big hello to Dr. Weaver who was one of my clinical instructors in my fourth-year rotations at Ft. Leonard Wood. Dr. Weaver has always paid great attention to detail, and hes exactly right here. If more of us used the resources available at the AOA, we might not be so confused about the rules for medical billing. The AOA is leading the charge in the battle to establish optometry as an accepted part of the medical care delivery system.

One big issue facing optometry is how medical billing information is disseminated. I believe that every state and local association should establish a medical billing and coding committee that would bear the responsibility of educating their membership about this fast-growing body of knowledge. The AOA has many useful resources and much brainpower dedicated to seeing this initiative succeed.

D.C. Dean, O.D.
Albuquerque, N.M.

Vol. No: 143:05Issue: 5/15/2006