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Is it just my paranoid delusions or is it true that mindless drones are slowly infiltrating ophthalmology? The slow and insidious changes remind me of the science fiction classic Invasion of the Body Snatchers. The movie’s plot centers around a town’s population slowly being replaced by clones devoid of emotions, with the hero realizing almost too late. Is the ophthalmology field suffering the same fate?

First it was the medical payment system in this country. The original fee-for-service has changed as medical insurance took a foothold. Now, we are no longer considered kind, caring doctors but cold, sterile healthcare providers. Our services are now being dictated by medical review boards and “standards of care” written by committees with no higher medical training.

The movie, released in 1956 at the height of the cold war, is widely interpreted as an allegory about the evils of communism. Bureaucrats are less nefarious than communists, but cut from the same central-planning cloth.

Dispensary Assault

Next, the snatchers went after our optical dispensaries, which were once considered a bastion of free-market enterprise. Many practices have been forced to relinquish control of optical dispensaries to the insurance provider’s “kit” of allowable frames since, contractually, one can no longer purchase and supply a patient with high quality, fashionable frames. Many insurance plans will only pay a miniscule “fitting fee” and require you to use their lenses and optical lab. Insurers use outsourced vendors who do not deal directly with your patients, so customer service deteriorates and patients receive inferior products. Then the brunt of the patients’ frustration falls on your practice.

The latest end-around is coming from spectacle lens manufacturers who have purchased significant interest in online eyewear vendors. Under this arrangement, patients are encouraged to buy their frames and lenses at a discounted price through the Internet, thus bypassing the optical dispensary entirely. Trouble comes when patients are unhappy with their Internet glasses and are told to have their prescription checked by their doctor. In reality there may be nothing wrong with the prescription itself, but the patient has most likely measured their papillary distance in the mirror incorrectly, or has selected the wrong lens for the frame type with incorrect seg heights. Apparently faceless clones have replaced doctors and opticians who went to school to get licensed to measure this properly.

If you think that you are immune because you don’t own or run an optical, not so fast. In order to renew one of our major insurance contracts last year, we were forced to use insurance-sourced supplies and implants. Luckily, we were able to negotiate an exemption on intraocular lens implants and shunts. However, I worry this will only be temporary since insurance carriers are looking for more and more ways to increase their revenue. What insurers don’t understand is that we have become very efficient providers of care in ways they cannot hope to replicate in a large corporate environment.

Taking a Stand

It is time to fight back—not only in the interest of self-preservation, but the interest of our patients. The first step is assessing the value of participating in some of these insurance contracts. They only exist as long as we participate as providers and, unfortunately, there always seems to be a provider willing to lose money or, at best, break even with a contract. The intangible savings of not participating in bargain basement plans outweigh the loss of patient volume. By providing better service and products to our core patients, word of mouth continues to drive new patients to the practice.

The second step is educating patients about the value of quality care. When purchasing glasses, patients must understand that they can’t just select a pair of frames and lenses. It is crucial to have a professional measurement and fitting for appropriate products, complete with individual follow-up service.

Finally, it is incumbent on our professional societies to fight for our collective rights since, in many cases, we are individually unable or not legally allowed to. In the end, the invaders usually figure out that the juice is not worth the squeeze.

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