March 2024

Spring Into Action

Board members (l-r): Lisa Hamilton, OD; Richard Hults, OD; Milissa Stone; and Ken Kopolow, OD

By the SNAPP Board

Put this item on your spring to-do list right now: mark the date of the 2024 SNAPP Las Vegas Meeting, to be held Sept. 15-17 at The Palms Casino in Las Vegas, Nevada.

We will be updating our website under the Meetings tab as we begin to get information, but with the date and place set, you should begin planning now. SNAPP meetings offer education, advice, business insights and entertainment in fabulous Las Vegas.

Your SNAPP board is already at work trying to top last year’s program—which many of you told us was the best one yet. We feel as though we are up to the task of delivering another stellar program that provides the time to get to know each other and share ideas as well as to learn what’s new in the industry and how trends might impact us in the future.

Over the next few months, we’ll be sharing previews of the program as details become available. We’d also love to hear from you. Have you attended a SNAPP meeting that fired you up to do something different in your business? Send us a note here.

Glimpse Forward

The Virtual Doctor Is In

When Marjan Valenzuela learned she and her husband were moving to Winter Park, Florida, from Michigan, she asked her employer if there might be a career opportunity for her there. She had been working for West Point Optical Group (WPOG), founded by Bill Noble, a Pearle Licensed Operator (LO) with 87 locations across 14 states. Sure enough, the company had an opening for a manager.

Marjan Valenzuela manages a Pearle Vision location that for
now offers tele-optometry visits exclusively.

(l-r): Marjan Valenzuela received a visit from
SNAPP Member Services Representative Camila Martinez.

However, after the optometrist who had been working there left in May 2023, the reality of optometric recruiting reared. “The search for the right doctor is still on, but we needed a quicker fix,” Valenzuela says. So the company contracted with the tele-optometry company 20/20NOW, which provides live consultations with patients in the location.

An important note is that there are several “hard stops” to a tele-optometry exam. “If the patient has a current infection in their eyes or has had head trauma, injections into their eyes or ocular surgery, we cannot schedule them for a tele-optometry visit,” she says. She has a list of optometrists and ophthalmologists to whom she can refer them. That list includes a Pearle Vision location about 15 miles away; while that practice generally is fully booked, the staff there knows that this is a patient who needs to be seen by a doctor in the exam room.

But for eyeglasses and contact lens exams, “it is very similar to having an in-person doctor,” says Valenzuela. “We take Optos images on every patient. We take seven images of each eye with a digital camera on the slip lamp, with different magnifications and from different angles. If patients wear contact lenses, we take videos of the contact lens movement on the eye.” The pretesting process includes color and depth-of-field testing and intraocular pressure readings.

Once those tests are done, a certified refraction specialist takes over the control of the digital phoropter. The technician in the office can help out as needed for near vision testing.

The next step is the visit with the optometrist directly. Optometrists who work for 20/20NOW receive a notice that a patient is in their queue. On their computer screen, they see all the data collected on the patient as well as any data the practice might have from previous visits. “It feels like a personal visit because the doctor is speaking directly to the patient and has full access to the data. Many patients tell us that they feel like they have received a more thorough and attentive experience here,” she says.

Valenzuela has worked in locations where there is a live doctor, so she can compare the situations. The scheduling for tele-optometry visits takes a little longer. Most tele-optometry visits take between 30 minutes and an hour. She could schedule more patients into the practice with a live doctor present, she says, but the practice has one exam lane outfitted for virtual visits—and she and a technician are the only two who work there. “I can do as much pretesting as possible to help speed it up, which does provide us with a little more availability than other practices in the area to see walk-ins or same-day appointments,” she says.

She also says that in this first year of offering tele-optometry visits, patient education takes a little more time. As this location formerly had a doctor on-site, she does let patients coming in know that it’s a tele-visit. “I get about five people a week who call and ask if that means they can do it from home or what it means. So I explain the process. If they’re uncomfortable with it, I have a list of providers I can refer them to,” she says.

If and when the location does hire a doctor, tele-optometry might not go away entirely. Valenzuela sees opportunities for that option to extend hours or cover for a doctor who is on vacation or ill. “I feel like it’s a very thorough and comprehensive way to get an eye exam.”

Cultivate Calm

Tips for Dealing With Difficult Patients

On the SNAPP Facebook page, a SNAPP member asked if anyone had strategies for dealing with difficult patients. Lisa Hamilton, OD, a SNAPP board member, responded. Here’s what she wrote.

Dr. Hamilton

Remain calm. Try to stay composed and avoid reacting emotionally to their behavior. Taking a deep breath and maintaining a calm demeanor can help diffuse the situation.

Set boundaries. In cases of true disrespect or belittling or humiliating behavior, politely but firmly assert boundaries. Let the person know that their behavior is not acceptable and that you and your team deserve and expect to be treated with respect.

Empathize. Sometimes, rude behavior stems from underlying issues or stress. Try to understand where the person is coming from and empathize with their situation, even if you don’t condone their behavior.

Avoid escalation. Refrain from engaging in a back-and-forth argument or escalating the situation further. It’s often best to disengage if the person continues to be rude despite your attempts to address the issue.

Build a team-support culture. Dealing with difficult people can be draining. At our office we foster a culture on our team of communication and support; if one team member needs a break, we support that. Brené Brown gave a wonderful example of this in her book Atlas of the Heart, where she referenced “code words” like “I’m in the weeds” or “I’m blown.” Our team members know how to respond and provide support when they hear another team member say this, and they are starting to be very aware of when their team member needs support even if no code words are mentioned.

Fire patients, if necessary. Life is too short, and fighting to keep their business or trying to negotiate with them to be reasonable often isn’t worth the cost or drain of your energy. Joe DeLoach, OD, FAAO, CEO at Practice Compliance Solutions, has a letter template you can use to “release” these folks from your care and release yourself and your team from their drama.

Dr. DeLoach

Remember that we cannot control other people’s behavior, but we can control how we respond to it. By staying calm, setting boundaries and prioritizing everyone’s well-being, we can navigate interactions with difficult people more effectively.


SNAPP Recognition in Newsletter

The EssilorLuxottica Optometrist Newsletter sent a shout out to Lisa Hamilton, OD, and the SNAPP group in March, Women's History Month.

Billing Tip of the Month From Helix

The Basics of Medical and Vision Eligibility

Understanding how to pull and read benefits is one of the first interactions you have with a patient that can considerably impact your reimbursements. That said, it is imperative that the staff is trained correctly to do so. Below are some key items to be aware of when pulling medical and vision benefits.

Vision Benefits

•  Confirm who the subscriber is, so if you don’t find the coverage through the patient’s name, you can reference the subscriber’s name.

•  When reviewing the authorization form, confirm that you have the correct patient by name and date of birth, and make sure the date of service falls within the authorization range.

•  Ensure that the patient is eligible for the services/materials they are being seen for in the patient coverage section of the authorization form. “NA” may mean you didn’t request an authorization for that service/material.

•  Even if you’re familiar with the patient’s plan, don’t assume you know what is covered and what has an additional co-pay. Check the relevant sections on the authorization form to confirm.

•  Confirm any second-pair benefits to promote sales in office.

Medical Benefits

•  Double-check whether the medical payer is processing the claim directly or through a vision payer. This will help you determine where to check for benefits and where to send the claim.

•  Check if the patient’s insurance requires an authorization for the service/procedure being performed or a referral (common with HMO coverage or if a primary care physician is listed on the ID card).

•  Familiarize yourself with key terms:

>>  Deductible—The dollar value a patient has to pay before their insurance provider starts to pay its co-insurance percentage

>>  Co-insurance—The percentage the patient/insurance pays toward the allowed amount after the patient’s deductible has been met

>>  Co-payment—The amount a patient pays as a fixed fee for a service/material

•  Ensure you know your allowed amounts by CPT and payer, as outlined in payer contracts. To calculate patient responsibility accurately, the office needs to know what each payer allows for each CPT code. This allowed amount can be used to calculate how much of the deductible or co-insurance a patient needs to pay for the service. It can also help in confirming the amount the payer should pay.

Whether confirming medical or vision benefits, remember to obtain a copy of the insurance card (front and back) and scan it into the practice management system. Doing so can result in significant time savings if needed for reference in the event of a rejection or denial.

It is important to perform due diligence upfront to avoid headaches on the back end. It’s no different when checking benefits. Having a solid understanding of the points mentioned can put you on the right track to building a robust eligibility process.

Reach out to the HELIX team with any other billing questions you have at this link; we might have the solution for you.

HR Advice From AmCheck

The Value of Mentoring

What is mentoring in the workplace?

Mentoring is a professional relationship between a senior or more experienced employee (the mentor) and a newer or less experienced one (the mentee).

The mentor shares their knowledge and experience, offering guidance, advice, feedback and encouragement. The mentee, for their part, can go to their mentor with personal and professional goals, questions and frustrations.

Mentorship is not a replacement for management—these conversations can and should also take place between managers and their direct reports. Mentoring relationships are meant to supplement supervisory ones. They’re designed to create a more psychologically safe environment since the mentor typically has no authority to discipline the mentee or advance or deter their professional development. Mentors also have expertise and insights to share that the mentee’s manager may not possess.

If you’re considering setting up a mentorship program, ask yourself what you want to accomplish. If your aim is to integrate new employees into the organization more easily, the tenure and experience of your mentors may not be critical. If your aim is to ensure that the skills and expertise of your senior employees get passed on to their possible successors, you’ll need to design a system that matches mentors with mentees who are in similar jobs. If your goal is to provide employees with someone to go to for advice on advancing their career, it will be more important to recruit your senior leaders to serve as mentors.

This Q&A does not constitute legal advice and does not address state or local law.

News of Interest

Eye Exams Can Help With Fall Prevention in Older Adults, APHA Says

Falls among older adults are recognized as a deadly public health crisis, according to a new policy statement from the American Public Health Association (APHA). Many of the injuries and deaths are avoidable, says Andrea Thau, OD, policy chair and governing councilor of the vision care section of the APHA.

APHA has released 17 action steps to prevent falls, including for the American Optometric Association and the American Academy of Ophthalmology to advocate for annual, in-person, comprehensive eye exams for all adults 65 and older. Read more here.

Myopia Becoming More Prevalent in Patients Undergoing Retinal Detachment Repair

A recent study in England and Scotland, published in the journal Eye, examines the link between increasing prevalence of myopia and retinal detachment (RD). Researchers note that myopia cases in children and young adults have doubled over the past 50 years, now affecting up to 30% of young adults across Europe.

The proportion of myopes undergoing RD repair has increased sharply in the past 10 years, from fewer than 10% in 2012 to more than 40% in 2023. In people 60 or younger, myopia constitutes more than 50% of those RD patients. Read more here.

Researchers Develop Method to Study Liver Using the Eye

Researchers at a Swedish university have found a way to study liver function and disease by transplanting liver cells into the eyes of mice. The cornea is then used to study the liver cells over the mouse’s lifetime.

The study found that liver cells attached to the iris of the eye and were supplied with blood vessels and nerves necessary for survival. They also retain their typical liver characteristics and appear to reflect the health of the animal’s liver. Read more here.

Older Adults With Vision Problems More Likely to Experience Anxiety, Depression

A study published in JAMA Ophthalmology found that vision impairments in adults 65 and older were associated with several mental health disorders, including symptoms of depression, anxiety and social isolation. Binocular distance visual acuity, near visual acuity and contrast sensitivity were tested. Read more here.

Getty Images photo credits—anxiety: shapecharge; benefits: Daniel_Tadevosyan; calm: RomoloTavani; fall: Jacob_Wackerhausen; glimpse: greenbutterfly; liver: SEBASTIAN_KAULITZKI-SCIENCE_PHOTO_LIBRARY; mentoring: Ezra_Bailey; myopia: Gorodenkoff; and spring: fotomay

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