This column spends a great deal of time on certain basic medical coding and compliance concepts—like medical necessity and properly recording the chief complaint—so that your office encounters can be legitimately submitted to a medical carrier for appropriate reimbursement of your professional services and expertise. 

I try to provide advice to help you prevent and avoid any potential reimbursement problems. And it got me to thinking: Are we, as optometrists, providing adequate preventive advice to our patients?

I realize that most ODs provide preventive advice every single day:

• “Don’t sleep in your contacts.”
• “Use your glaucoma medication every night.”
• “Take these nutriceuticals to help prevent AMD.”
• “Wear your plus lenses when you read.”

…And so on. It is inherent in what we do for patients.

Yet, our health care system is heading quickly toward outcomes-based care, which aims to prevent sequelae by providing the best treatment and advice before something goes wrong.

So, what do we as optometrists do in the area of both preventive care and ocular wellness?

What Do Dentists Do?
I recently was invited to a meeting that focused on the subject of “ocular surface wellness.” It was a very interesting meeting with some of the top experts in our field, discussing not only what we’re doing for ocular surface issues like meibomian gland disease or contact lens dropout, but whether we can do anything to prevent these conditions from even happening.
A dentist and a dermatologist also presented to the group and discussed how their professions became proactive on wellness. The dermatologist indicated that much of her work is increasingly related to wellness and prevention. The dentist made a point that prevention and wellness has been a widely accepted mandate within his profession since the 1940s.
The problem lies, of course, in a single simple question: How do we get paid for prevention? (More on that important question in an upcoming column.)

Prevent, Don’t Lament
Realize that we impact our patients’ quality of life by maintaining a healthy ocular surface. Everything from quality of vision to contact lens intolerance, to cataract and refractive surgery, depends on having a healthy ocular surface.

But even though we know that dry eye and meibomian gland disease occur in the majority of Americans, optometrists still tend to be remedial in our approach to ocular surface disease rather than preventive.

A parallel to consider: Does the dermatologist wait for someone to get skin cancer before recommending a daily application of sunscreen containing an appropriate SPF? Of course not. Each and every patient gets a proactive, preventive statement about skin wellness and a recommendation for it.

Can’t we do that in our practices? Couldn’t we remind our patients to use artificial tears in each eye every time they brush their teeth? “Two drops a day keeps your contacts in play.”

You get the idea.

Wellness and prevention are both new and old concepts for us. We practice them daily—but not in the most modern sense or in a consistent manner.

If your goal is to create and maintain the very best vision and quality of life for your patients, perhaps the answer is very simple: Be your patients’ advocate for the problems that they encounter today and for those that you can prevent from happening tomorrow.

Please send your questions and comments to