Our Own Greatest Enemy
My compliments to Drs. Sowka and Kabat on their comments regarding therapeutic practice (“ Build a Therapeutic Practice,” May 2012). I have often argued that O.D.s can be their own greatest enemy, creating their own mysterious brand of legal guidelines and clinical protocols based on who knows what! This one reminds me of an old favorite: “If I don’t dilate, I won’t be responsible for the periphery.” While I often do not know whether to laugh or cry about these matters, I do know that you guys need to stick with it. Great job!

—Elliot M. Kirstein, O.D.
Cincinnati, Ohio

Mazel Tov, Monty!
I had to comment on Monty Vickers’s exceptional tribute to Irv Borish (“ Borish Built a Better O.D.,” April 2012). It ranks as one of his finest “Chairside” columns ever, and captures the essence of this iconic personality in a way nobody else has even approached. Congratulations Monty (or as Irv would have exclaimed, “Mazel tov!”), and I also fondly recall meeting your grandmom Mimi many years ago. I can certainly imagine that comment on the Bible.

—Marc S. Hecker, O.D.
Latham, N.Y.

Be Careful What You Wish For
The debate over including or excluding stand-alone vision plans, as part of the upcoming establishing of state insurance exchanges, is a very important one. The success or failure of many of our practices may ultimately hinge on the outcome of that policy decision. It was with great interest that I read the letter  from VSP board director Dr. Tim Jankowski (“ Letters to the Editor,” February 2012).

Dr. Jankowski expresses several concerns over the possibility of VSP and other stand-alone plans being excluded from the exchanges. He laments the possibility of being discriminated against, compared to medical doctors, and not being allowed to be on the provider panels just because of the way they are set up, thus losing access to caring for his patients. He wants a guarantee of being included on the plan panels. He “can’t risk losing those patients.”

Well, Doctor, welcome to the club. We VSP-excluded doctors are used to it. How ironic that he and other VSP policy makers should be in this precarious position while all along they have been perpetrating the worst kind of discrimination—discrimination against their own based only on the doctor’s mode of practice. Now they can appreciate how we excluded doctors feel and are affected when an employer changes vision plans and we are then arbitrarily prohibited from caring for our patients due to VSP’s prejudicial anti-competitive policies enforced under the guise of “private” O.D.s providing better patient care. More likely they are concerned that the VSP member would prefer to be serviced weeknights or Saturday afternoon, or even Sunday when the private doc is closed. For Dr. Jankowski and his VSP colleagues to portray themselves in this light as being discriminated against and potentially losing business is the ultimate display of hypocrisy.

Furthermore, I disagree with his other main argument. Most of the medical plans will likely have associated well vision plans with such plans as Davis, OptumHealth, OptiCare, etc.—plans, by the way, that do not discriminate against providers. As long as these well vision plans are available, there is no reason to contend that usage will drop off.

I do agree with Dr. Jankowski that the possibilities of O.D.s being excluded from the medical panels are real and potentially extremely damaging. He makes reference to the Harkin Amendment. He again laments at the fact that, while apparently providing for parity amongst different categories of health care providers, it does not require a plan to contract with every provider, therefore potentially leaving him locked out of a plan. Does that sound familiar?

I would encourage Dr. Jankowski and any other VSP board member or provider to lobby for the Harkin Amendment to be changed to address his concern. If that could be done, I will be the first to offer my sincere appreciation for the effort that would then also result in myself and the thousands of other excluded VSP doctors to then be required to be allowed on the VSP panel. Beware what you wish for. You might get it.

—Name withheld by request