Compliance Horror Stories with Dr. Joe DeLoach

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[00:00:00] Dr. Christopher Wolfe: 

Hello and welcome to the Crystal Podcast on I Code Media. Today I had a great conversation with Dr. Joe Deloche from Practice Compliance Solutions, and we talked about, uh, hipaa, we talked about osha, we talked about billing and coding compliance. And I think my take home is that really as doctors we’re.

Kind of motivated primarily by ethics, and then secondarily by revenue, and then probably by fear. And so when I think about OSHA and hipaa, my motivation in my practice is to, you know, be able to ethically take care of my patients primarily. And then, um, and then make sure that I don’t have to worry about whether or not if the, if, if the HIPPA police or the OSHA police come in and, and audit my business, um, that we’re gonna survive that, that audit.

And so, um, that’s a lot of what we talked about. It was a fun conversation and it gave me some things to think about and I hope it does for you as well. As always, be sure to subscribe to the [00:01:00] podcast, write a review, share it with your friends, and support those who support us. We’re in the best time to practice optometry.

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This provides our presbyopic amatic patients with an excellent option for minimizing their dependence on glasses. Check out [00:02:00] the show notes and link to supervision’s website for contact lens parameters and more release information. Yeah. Yeah. It’s amazing how, how often I’ll talk about that. And I always, I always mention that where I learned it from and, um, and I, I, I think how many docs are really doing this, and it, it brings up the point of.

Ted, Ted McElroy and, and, uh, Paula, Jamie had a conversation, uh, on, on their pod, on Ted’s podcast, um, and just recently, and Paul made the comment, which I thought was really astute, and I actually, Griffin, when you look at the data, is the number of patients or the number of doctors that actually fully utilize their scope of practice as it is really small is unfortunately.

Yeah. Yeah. Why do you think that is?

No, I think it exists. I think it exists across any profession. Like if you look at ophthalmology, you can say the same thing. Them right? They, they use, you know, they have all this surgical training, most of ’em are doing cataract surgery. [00:03:00] So, you know, I I, I’ve made the statement before that the older you get, you know, Uh, more your mouth moves that maybe it shouldn’t because it’s like after 40 years in the profession, if someone doesn’t like me, it’s, I want everybody to like me.

[00:03:17] Dr. Joe DeLoach: But you do get more outspoken, you know, uh, at that point. And I’ve always said, you know, honestly, to me, my opinion, one of the biggest reasons we have this problem is because traditional routine eyecare is just too dramatically easy and Luc. And so there’s not, you know, we’ve, we’ve preached that, you know, we’re going to start losing the product market and blah, blah, blah, blah, blah.

But it hasn’t happened to the point that it’s really dramatically impacting too many people, so they don’t believe w you know, we need to replace it. Um, I think that’s one of the major reasons right there. [00:04:00] And the second one, and I, I don’t mind if this goes out to, to anybody. I just don’t think the schools push medical optometry at the level they should.

Uh, I think it’s still too focused on routine, which is important. Obviously, that’s the backbone of our profession. But if we are gonna implement change in the profession and grow it into a true medical profession, it’s gotta start with education. And it’s got to start with the schools saying this is what you need to be able to do in a very competent manner and actually allow them to do that in the clinical rotations.

Um, so I think that’s probably my answer to the two reasons. I just don’t think people latch on, uh, to. I could add a third and say that I think there’s a lingering, this may be hard, and as you know, once you do it, you realize it’s, you know, it’s kinda like the keratectomy for the recurrent corona erosion seems like a really [00:05:00] hard thing to do, and it’s a little techy, but anybody can do it.

It’s just a matter of practice, and that’s, you know, no surgeon or MD or any initials after anybody’s name. They didn’t just, you know, this just wasn’t gifted. Then from above it’s all about practice. Um, so I think, you know, those things are all changing slowly, but probably not at the rate. A lot of the more progressive thinkers would like for it to change.

But I do think it’s changing. I think the, the, to your point, if I were gonna add my perspective on it, cuz I, I don’t where I would disagree with you in terms of the, the schools and, and their teaching and you, you get to see a lot. I mean, you, you’re, you, you spend a lot of time training students and residents, but.

My, um, my perspective is more related to the training and teaching about the value of those services to a system overall. And when students get outta school, they have the, they have the clinical acumen to manage those [00:06:00] conditions really well, but they, they don’t know how to get paid for ’em. Yeah. And so they, I would totally agree with you on that.

Absolutely. Um, The curriculum is there and with good rotations, the opportunity for practice is there. But again, you know, it’s, if you don’t put that into the core of the being of an optometrist, they do graduate without the appreciation of this is what we really can’t do. So I think we’re really saying the same thing.

Yeah, I agree with you. I think the, um, So, so how do we over, I guess, how do you overcome that? I mean, you’ve, you’ve pretty much spent, what, 30, 40 years in clinical practice? 40 plus. You’ve 40 plus. You’ve kind of, uh, you have these other hats where you’re, you’re sort of, uh, cutting edge, you know, disease based.

Clinic plus you have this, this realm of being able to help doctors understand their [00:07:00] value and also watch for potential pitfalls within where they might, they might fall in terms of compliance issues. So how does that all pl come into play in terms of helping the profession continue to integrate the, you know, our ability to manage patients?

Um, you know, I, I, I’m gonna not. Downgrade the schools at all, but it, it, it really has to start there. Um, and things like, um, uh, you know, I, I’ve always said that, you know, the one thing I think we don’t graduate optometrist with is the concept that I am a doctor. You know it. And a doctor is a doctor and a doctor does certain things, says certain things, you know, operates in a certain.

And I think a lot of just the historical nature of optometry was, we wanna be different than medicine. And that core is kind of hard to undo. Um, so I think it always has [00:08:00] to start there. It always, it’s kinda like it has to start at home. Well, home is our education, so it has to start there. And then I think there’s a lot of factors out there that are stopping the profession from growing.

And here I go, getting in trouble again. But, um, you know, the more you know, x, y, z best or this model or that model type thing out there, it, it degrades what we are as a profession, in my opinion. Um, and it stops, you know, a large group of people growing together and that’s not gonna stop. Um, unfortunately.

It’s, it’s an obstacle to growth. Um, but I think the biggest thing to me, from what I see, Both from a student level and from my colleagues’ level is just we, we need a different understanding that that optometry is no different than being a pediatrician. No different than being a cardiologist. I mean, we are doctors in a healthcare system and we have to operate and you know, do certain things a [00:09:00] certain way, and that includes a more complex type of practice than what we maybe the army we signed up.

It includes things like compliance with laws and you know, having to jump through the HIPAA hoops and having to do all this stuff that we have to do, uh, because that’s part of being a healthcare provider. Do you think that there is a component to it that when. When it comes down to it in a, in a lot of cases, that one of the differences between many optometrists and the, the places that they practice are being, when they’re seeing some of these things like, like HIPAAs and like the different OSHA compliances, all that sort of thing.

That is not what they, not the, what they signed up for in a sense that they don’t wanna really manage that, but it’s becoming more prevalent. And so where, whereas medical doctors and they’re sort of existing in this realm where they don’t have to worry about some of that stuff. It’s like that’s taken care of by the [00:10:00] nurses or by the OSHA managers or by the, the HIPAA compliance officers that are being managed in their large corporations.

Cause I don’t know about in Texas, but in, in Nebraska. There are very few independent ophthalmologists. I mean, what I mean by that is that are not in groups. Yeah. You know, ophthalmology, by and large isn’t owned by a large, uh, hospital system, but like, like, uh, family practice physician is, or by like, uh, pediatricians are typically in Nebraska, but, but they are, they’re rarely by themselves and so they, they sort of get to like offload all of that stuff where they don’t have to think about it.

Is there a deterrence to. Integrating all that stuff, all, all those kind of new treatment options and, um, managing all this other disease because of, of the perception that compliance is so challenging where they’re just like, I don’t wanna mess with that. I’m gonna let somebody else do it, and then they just kind of dump it on somebody else.

Or is that a, is that a, um, is that a reason that people are kind of [00:11:00] abandoning private practice to allow somebody else to manage it where they’re just either going in with somebody else or selling their practice altogether? Yeah, I, God, that was. Big question. There’s a lot of stuff. Sorry, I’m not, I’m not good at small questions.

Um, well see. I think part of it, and I always talk about, it’s crazy, it’s a crazy statement, but I think when we go into some kind of profession, some type of genetic makeup drives us in that direction. Optometrists, by their very nature are independent, little cusses, and it’s kind of part of what drives us into the profession of optometry, which historically, and still to this day, is predominantly a bunch of independent little.

And because of that, we don’t ha we have to manage everything. And so we, we don’t have that, that fallback that you, as you discussed, where we’re in a, you know, nine person or a 19 person ophthalmology practice and we have a compliance officer that does everything and we don’t even know how to spell HIPAA nor what it is because someone else is taking care of it for us.

But, [00:12:00] you know, the vast majority of practicing optometrists in private practice are in a small. Group practice or in an individual practice. And the bottom line is they have to handle it themselves. So the independent person always, their first nature is, I can do this. And you can’t. I mean, you just can’t.

It is too complicated. Uh, it, it’s not so much that it’s too complicated, it’s just too big and no one has time to do this. So they, they have to outsource to somebody to help ’em out, or they play the head in the sand game. Uh, By most all the compliance company’s estimates is still over 50% of the profession in in.

So explain that a little bit. When you talk about Head the Sand game and you say it’s 50% of the profession. Yeah. Does that mean all regulations? Is there specific regulations that people are missing commonly where they can just say, do this and do that and it’s easy not, no, I don’t think, oh, I’m, I was specifically referring to compliance cuz that got brought up.

So, [00:13:00] and, and I would have to say that’s specifically related to hipaa because that’s what. The gathering of the HIPAA companies have in all together felt like it’s probably greater than 50%. If you talk about osha, it’s greater than that. Um, yeah, so there is a large, I’m, I’m just gonna put my head in the sand and hope nothing happens.

And I’ve, I’ve said this from the podium many times. The reality is it’s, it’s nothing but a gamble. It’s like insurance. Uh, you’re buying insurance against something bad happening to you. And some people are riskier than others. And, um, it’s a, uh, tell me what you’ve seen. So tell me what you’ve seen then in terms of, um, like the bad, like I, I am, some people are motivated by horror stories, right?

Yeah. Tell me a horror story, uh, in somebody you’ve worked with, uh, horror story or So you try to dig him out of a horror story. [00:14:00] Yeah. Horror story. Um, And this is, this is unfortunately a common situation. Um, privacy for patients in a situation of, uh, stepparents are the new, the, the divorced daddy’s hot girlfriend, which is what happened in this case.

So we have the, the new girlfriend bring the kids in for their care. Number one, she has no healthcare privacy or she has no healthcare authority, number one. Uh, number two, she has no authority for privacy rights for the kids. Um, she signs all this stuff, you know, I’m gonna sign my HIPAA acknowledgement, and yes, I can do this.

And yes, you can file your insurance to the V S P, blah, blah, blah. The. Very upset. Ex-wife, uh, finds out about this because she’s actually the one that holds the vision plan. So she finds out, uh, files a suit against the [00:15:00] doctor for two things. Number one, HIPAA privacy violation for both children. Number two, child molestation because the doctor had no authority to touch these kids.

So how often does that happen? It happens enough that, that we literally had to change the acknowledgement in our company to protect against that because this is something that happens now. This is the only one where I know child molestation charges have been filed, but HIPAA violation charges are not uncommon.

So it’s just a little thing that you have to protect yourself. Uh, there’s you a good one. Uh, we can tell OSHA violation stories all day long of having your clinic locked down. Uh, you know, so when you, when you, it wouldn’t be a common OSHA violation. When you, when you tell one or two and there’s 40,000 of us, it’s very easy to just sweep it under the table and go, ah, probably won’t happen to me.

Which the reality is it probably won’t, but if it does, it’s just a really bad. Yeah. [00:16:00] Well, tell me about, tell me about it, like the common things you see with OSHA that, that people will get dinged for. Yeah. Uh, employee injuries, uh, in the workplace that will always, or almost always initiate some degree of investigation, uh, which will then reveal you have none of the required OSHA compliance, um, uh, dangerous chemicals.

Uh, those, those are often. Something that they will randomly, um, uh, audit just by investigation because they do random audits just like HIPAA does, just like everybody does. And, um, so chemicals and workplace injuries and, and of course OSHA just became a common whole household name in the past year with Covid.

Uh, and interestingly enough, in the Biden administration, they’re shifting all authority for regulation of the covid programs to. So you’re gonna be hearing more OSHA instead of C, D, C. And the reason for that is c D C is not an administrative function of the [00:17:00] government. So they have no authority over anything.

They’re just a recommendation body. OSHA has authority to prosecute. So they’ve already said, we’re gonna put OSHA in charge of all this now.

So then, um, well then tell me about the. The things that can be done. Okay. So obviously you help people with hipaa, you help them with, with, uh, OSHA regulations and compliance. What, what sort of programs would you help them with to say like, okay, well this is how you would detect against a, uh, young hot girlfriend that’s bringing the stepkids in.

Um, how do you protect against that? Like how do you know what questions to ask? How do you know? I mean, well, you know, If you’re gonna be in compliance with anything, whether it be HIPAA or whether, I’m sure we’ll talk about later, cer certain coding regulations. Mm-hmm. I say you have to educate yourself [00:18:00] and you know, no one’s gonna just implant this into your brain.

It, it takes effort and it’s, it’s back to that thing of this is what doctors have to do now in the new age of being a doctor and nobody like, But all this stuff can be protected against with the right education and the right policies in your office. Now, you can never protect from crazies. Uh, but if, if you, the interesting thing about most of these regulatory agencies is if you have made a good faith effort to do what they told you to do, bad things typically don’t happen.

As a matter of fact, we, we can see. Please go send no more if you actually have made the effort to be in compliance. Uh, but again, over 50% haven’t, so kinda hanging out. Yeah, we, I’ve got a buddy who, um, manages a, a concrete block, uh, business in town and, and they’ll just get random osha, [00:19:00] you know, it’s common in those types of businesses to just get, I mean, it’s not like it is.

So they sort of get these random osha and, and then they even go through this protocol, like they’ve got their legal counsel that are always there and, and, um, you know, they’ll go in and they’ll, uh, contest it. So then they’ll have other calls with OSHA and all those sorts of things. But, you know, one of these infractions, when we’re talking about OSHA or hipaa, you’re talking tens of thousands of dollars.

Yeah. And then the worst, the worst infractions. And there. The, the past four years at the administration have been a very non-focused administration on compliance almost across the board, uh, from a standpoint of c m s, you know, any type of fraud and abuse issues across the board. Um, and the new administration is 180 degrees opposite of that.

So they have line item budgetary items for enfor, investigation enforcement for almost all this stuff. Um, It’s a changing of the guard, obviously. Um mm-hmm. So [00:20:00] the, the solutions are out there and people just need to take advantage of those and there’s multiple of them. Just work with whoever you want to, but people shouldn’t try to do this on their own.

Yeah. When you think about, um, so that, that’s an interesting comment and I wanna kind of dig into that a little bit, is this idea of using different regulatory bodies to. You know, I’ll just say recoup dollars, uh, seems to be an interesting strategy. Yeah. Uh, it, you know, you could, you could assign it to a specific political bent, but I, but I think it’s, like you said, it’s just a changing of the guard and whether it’s politically driven or not it, you know, but, um, what, what other kind of regulations or, or things are you seeing is in this shift over the last, you know, two months?

Um, that, that doctors ought to be aware. Um, as I said, it’s gonna be across the board. Um, I think we all kind of [00:21:00] took a, a little bit of a, of a breath during Covid because we are getting used to all these emails saying, oh, we’re calling off this. We’re not gonna audit anybody. Uh, no one’s gonna be in trouble because all the bad things that are going on.

Not to make any light of how bad it was at all. But I think we’re kind of moving into that phase where people are used to, well, the government’s not gonna do anything for a while. And the problem is you hit the nail on the head earlier, why? I mean, these, these programs exist to protect. Um, now we can say that many of them go dramatically overboard, uh, in their intent, but that’s the law.

Um, But they are cash registers for the government. I mean, HIPAA alone has brought in 14 billion to the government. HIPAA finds, uh, OSHA finds probably, I, I can’t even get the information on it, but I’m sure it’s way bigger than that. Um, so in a government that is starving for money, it may, [00:22:00] I don’t even think it’s a political decision.

I don’t think it’s a party decision. I just think they’ve realized that we have to get the cash registers clicking. Uh, and so it’s kind of interesting, you know, the c m s statement when they came out and said, we’re, we’re gonna start the audits again, despite any pandemic that happens. Cause they realize that this, you know, it’s a source of income that just can’t go away.

They can’t survive without it. So, and it’s on our back. Yeah. Yeah. Well, that kind of drives us into a conversation about billing and, and so, yeah, well, ab I would say, On the one hand, you know, the information that you have, um, is super important. On the other hand, do people, you said, you know, you said at the beginning of our conversation that, you know, there are people, people that might li if you have been practiced for 40 years, people aren’t gonna, there’s gonna be some cohort of people that don’t like ya.

Anybody get mad at you when you, when you deliver this information to them? Um, not so much. Get mad at [00:23:00] me. Um, I have had comments that. Um, literally I had a guy call me the Freddie Krueger of optometry once. Um, which at first I was insulted and now I use it in a slide, in a promotional manner to say Good for me.

You know, if, and I, I’ve taught that, um, there’s another HIPAA company run by a guy. We won’t go into names, but his name’s Mark and we talk all the time. We’re very friendly, competi. And he says the same thing. He said, no doctor is going to do anything except out of a issue of revenue or fear. Uh, or the, the ethics of being a doctor, okay, which are first and foremost, but outside of that revenue or fear are the only thing that’s gonna drive change.

And so I haven’t really had people get mad at me, but they kind of get upset that. In some degree intentionally try to scare the pants off of them to try to get them to do the right thing. [00:24:00] Um, and that’s, that’s sometimes the only way you can really affect change. Yeah. I, I mean, I think, um, I think in the compliance realm, that’s really, that’s really motivating.

I think that’s probably the right way to, to do it. I, I see though, and, and I’ll throw this out there because in the, in the billion coding realm, I think. Often doesn’t affect change. I think it actually causes people to, to retract a little bit. I’m not saying you do this, I’m just saying that that like, if I were to go out there and say, oh, you’re gonna fail this audit on a nine, if you use 99 2 14, you’re gonna fail this audit.

You use a 99 215, you’re gonna fail. You should never do. Then what, what do you think doctors are gonna do? What do they do when you look at the data? They’re gonna use level twos and level threes and that’s it. I, you know, my, almost every coding lecture I’ve ever given starts with. Um, you know, number one, coding is not that complicated, which I don’t believe it is.

Um, now maybe that’s because people like me and [00:25:00] you live it, you know, all day long, but I don’t think it’s all that complicated, especially when you’re talking about a single specialty. Uh, you know, profession, it’s our world is pretty simple from a, from a coding standpoint, to be honest, in my opinion. Um, but I would totally agree with that.

Uh, and I, I, I always try to start with, if you just do it right, you will make more money than doing it wrong. And I, I’ve always felt that if you. Follow the rules, unless you wanna be a total crook. If you just follow the rules and take care of the patient, the money will follow. And I’ve always believed that.

Someone told me that very early in my career and I’ve believed it ever since. The more you try to manipulate the rules, the more problems that we get into. So I, I agree. I don’t try to really use sphere as much to get people to do the thing right. In coding. I think if, if they will do [00:26:00] things the right way.

They will absolutely thrive, uh, in their reimbursement, but you do have to do it the right way. I, that’s all there is too. Yeah. Well, and, and that’s why, you know, you get, it’s, it’s, it’s amazing to me, the kind of common questions I get will be, well, how can I, how can I bill a 99 code with a cornal corneal foreign body removal?

Yeah. Well, you can, you can’t, unless you were attending to something else on that same visit that wasn’t related to the foreign body removal. Yeah. So I mean, it’s like, it’s the same stuff. Well, how can I get paid for, uh, doing a photo on an optic nerve and an O C t on the optic nerve on the same day? It’s like, okay, well there’s, there’s, you, you, you can’t just use a modifier in that scenario, but you could.

You know, give an abn, right? And, and you can charge the patient, they can pay out of pocket if they decide to, or you can have ’em back another, I mean, it’s like, it’s just not that complicated. But what, it’s amazing what people start doing. You know, they’ll, they’ll find these modifiers and they’ll find that they get paid from a modifier, and then they think, oh, I got paid.

Right. I [00:27:00] did it. Right. Well, you know, that’s, as, as you well know, that’s some of the most damaging words in all of reinforcement was I got paid. Um, And that’s totally the wrong reason to do anything and leads to a whole lot of trouble. And, uh, it’s one of the, you know, it’s where. Most of the people, you know, listening are not old enough to remember the BR commercials, but I, I don’t, I used them.

There was a shampoo called Breck and their whole advertising thing, I remember that shampoo they used BR and told Mary, Mary told blah, blah, blah, blah. And I always used that as that’s the way coding misinformation happens too. Like somebody did it because they got paid. Because they told somebody because they told, and it always ends up with somebody that just made it up because they got paid.

Uh, and that’s the source of a lot of misinformation. Rules are rules. Honestly, coding is far less gray than compliance is. Uh, I just don’t think there’s, you know, people talk about, oh, well there’s all this interpretation, not so [00:28:00] much sometimes, sometimes. Mm-hmm. But not so much. Uh, it’s like you mentioned the, uh, you know, the edit against O C T and Fundus photo Look, it is what it is.

Uh, you, you try to get around that edit and you run a very high risk of paying the money back because it just is what it is. And I’ll say one more thing that a lot of people don’t want to hear, but as optometrists, we have to adopt the medical model of insurance pays for some things. Patients pay for some things and we have to get comfortable at checkout with your insurance covered this.

Your medical insurance covered this, and you’re responsible for this. And it’s always been baffling to me that we, that I see that we can’t grasp that sometimes because we sure grasp it from the vision plan model of your frame coverage was only $75, but your $700 frame is gonna cost you this. It’s no different in the medical arena either.

Insurance pays for [00:29:00] some things, patients pay for some things, and once you determine a patient needs a certain level of care, insurance pays for part of that patient. Pays for what the insurance. And that’s nothing new or unique. That’s the way medicine works and almost everybody has gone to the doctor and to an MD something and check out, and it’s like $200 cash check or credit card.

It’s just the way the reimbursement system works and always has. It was a stew of you to to mention that because I, I, that’s exactly where my mind was going is that, you know, we, we have. As a profession, it’s e you know, we, we don’t have problems telling a patient that, that their vision plan covered X, Y, and Z and then they didn’t cover A, B, C, but for some reason it’s like, well, I don’t, you know, we get this hand ringing of, you know, what if a patient has a high deductible?

How do I handle that? What if a patient, uh, doesn’t come back for a follow up that I tell them to come back for? It’s like, Well, what if they don’t [00:30:00] come back next year and, and they, um, and, and they didn’t come back for their routine exam next year. Well, well, you don’t care about that. I mean, you care about it, right?

You, you foundationally care. But that didn’t, that didn’t make you not recommend that patient to come back, not pre-app appoint them. Yeah. You know, if, if the patient says, look, I’ve got, I, I want only, what’s my, what? My vision plan cover. You don’t, you know, that might, that might not be what’s best for them, but you don’t take it personally.

But for some reason, we take it personally when we’re really worried that a patient’s, we’re gonna say, I wanna see you back next month to reevaluate your meibomian glands and your ocular surface. And, but, but man, they have a, a $3,000 deductible and, you know, a $75 medical copay. And it’s like, yeah, but, but that’s the decision they.

You, you probably know that there’s a friend of all, a lot of ours, you know, one of his, his big deals in his coding lectures is he makes everybody raise their hand and say, you must learn these words. It’s not my fault [00:31:00] you didn’t think their insurance, you know, it’s not our fault. And that’s not, that is in no way being coldhearted or not being a good doctor or anything.

It’s the way it works and it’s, it’s just the way it works. Yeah, and you can be empathetic with a patient. I think that’s the other thing is like, if you, if you get good at those conversations, you can say, look, you know, it, it stinks. I mean, you, I always do this. I’m like, I’m like, look, I’ve got a family of 10.

And, you know, I know how much insurance costs, and I, and I know that, that sometimes it’s hard to make decisions and I understand if, if it’s not worth it to you to, to see, you know, see me for this or do this procedure, whatever. Um, but I always then I’ll always say, but look, I’ll try to find, I’ll try to find other opportunities for us to be able to make you feel better or to solve this problem or find that.

And, and so I think, like, I just embrace that, you know, for example, it, it’s very common. I use this, I use this example often. It’s very common that you’ll, you’ll write a prescription for let’s say Restasis or Xiidra, and then the insurance company will deny both. [00:32:00] Or require prior authorization or require that you try other things, whatever.

Well, why do you think they do that? They do that Because most doctors are just gonna be like, oh, your insurance denied it. See you later. Right. But I think, okay, well you’re gonna deny Restasis fine. You’re gonna deny Xiidra fine. You’re gonna deny squa. Okay. Well I know that we’ve got a infamous in my back pocket that that has, uh, clarity C.

Right. So I can send that. It’s gonna be no more than 55 bucks a month. And you know, now you. An option available. Yeah. And, and if, even if they say, well, $55 a month is too expensive for me. Okay, well we have, you know, doxycycline, we could, you know, if we’re not in Texas then we need it for more than 10 days.

Right? We have doxycycline that could control inflammation. And if that, if that’s contraindicated or the patient doesn’t wanna take that, well, we could use a topical steroid, but guess what? Who’s gonna pay for us to monitor that patient as a glaucoma? Because we’re using a higher risk medication. Well, that insurance company, so the bottom line, the reason I say all of that is to say that, that like if you take the approach of like the patients, first, we need to solve this patient’s problem, [00:33:00] and I’m on their side.

To your point, then, um, then we will find a way to solve that problem. It may not be the first line treatment or the second line treatment, but we’ll find a way that’s gonna be cost effective, um, for them and, and manage their disease state. And that’s what other, to your point, that’s what other MDs do, right?

That’s what, what other professionals do. Well, they’re, they’re brought up from their infant stage that this is the way it works. And it’s back to my point of we need to be brought up from our infant stage that this is the way it. You know, not to get into legalese terms so much, but throughout the, is the concept of, of kind of this whole thing is, is very easy and it’s ingrained in the medical reimbursement.

A physician only has really one function and that is to perform, is to give, um, knowledge to the patient. We provide knowledge to the. Ultimately, the patient has the legal writeup, informed refusal, so we provide [00:34:00] informed consent. They provide informed refusal, so the patient always gets to decide, you know, what they want to do.

It’s just our job to give them those options that we feel is the best care for them. And. To get off on a tangent, but I have to say this cuz I opened my own door. Another thing I see that really grips me is I provide my advice, which is not very much like what you just described. It’s like you need X and the patient says, I don’t want to do X, therefore I divorce you as my patients.

Hmm. And you know, I’ve, that’s always ground on me a little bit because I, I, I, you know, maybe it’s ego totally, but I want ’em to come back to me even if they. Because I know I’m protected if my medical record says I, I said this, do this. And they said, no. Mm. Take me to court. Okay. There’s no way you win because my medical record says I did the right thing.

But if they come back again, I have another shot. Mm-hmm. To try to [00:35:00] tell them, this is what you really need to do. And if they don’t, I bring ’em back. I have another shot to tell ’em. So what are they gonna do, Chris? They gonna go to you and, and you’re gonna convince them? You know where I didn’t? You know, I believe we’re all very competent providers and we can communicate this to our patient.

The patient always has the authority to say no. Yeah. So you’re saying what you’re saying is that there are a lot of docs that just take the approach, like if the patient denies my recommendation. I don’t want you. Yeah, that I don’t. I, yeah, I do. Yeah. You go someplace else. Yeah, yeah, yeah. I think a lot of times they tag that to the fear of liability, which is why I made the comment that as long as we document in our medical record what we did, we have done our job right.

And you know, some lawyers gonna go, oh, well your medical record is a lie. Well then they can’t do that. Really? So if we document correct, it’s all back to that. Here we are back in code. But it’s all about the documentation. And if we [00:36:00] document correctly, we have done our job as a doctor. Um, and now the patient gets to do their job that I wanna hang onto ’em.

You know, I don’t want ’em to go somewhere else. I want to try to convince ’em to do the right thing. Yeah, I totally agree with you. I think, I think that’s, that’s where you think about the patient first model where you’re just like, you know, we’re, we know enough about most conditions that we manage, that we can know three or four or five different treatment options that are okay.

And there’s probably an order and there’s probably a recommendation that we would think we would make very strongly as the first recommendation, but like, We gotta get out of our minds of thinking that patients who don’t take those recommendations are really, it’s an affront to us or an assault on us.

And certainly not to your point about worrying about, you know, the lawsuits that might come from a patient that doesn’t take your first recommendation. It’s, I mean, you’ve put it in there and I, I take the same approach as you do. It’s like, even from an audit standpoint, you know, we’ve been audited as a practice multiple times and, and I’ve helped a lot of people with audits.

You know, it’s like, I, I always tell people it’s like you don’t [00:37:00] have to, if you know the rules, like you’re saying, if you know the rules of billing and coding and you follow those rules and you document appropriately and somebody audits you, God bless you. Yeah. I mean, what, what do you have to fear? Well, you know, and it, and it’s something you brought up a minute ago, and I, and I feel like I dropped it on my end because I know where you were going with, with this about, you know, if they hear horror stories and building and coding, or they think building and code is so complex, too many of our colleagues.

The response is, I just won’t do it. Mm-hmm. I just won’t do medical because I’m afraid or I, you know, I’m afraid something’s gonna happen because you know, they’re gonna come shut me down because I put the wrong day to service. So I’m not a claim one time. And that’s not the way it works either. You know, it, the whole code, as you see, you’ve been involved with many audits.

I, you know, I’m an auditor. That’s what you do. Yeah. Yeah. So, you know, I’ve been involved in a lot of them. Uh, You know, it’s, it’s audit doing [00:38:00] the right thing when, when people, when payers want to come look at you. And I’m gonna talk specifically about medical payers. Mm-hmm. Cause there could be a difference.

Medical payers are not on a witch hunt. I mean, they’re really not. They’re out to see if you’re doing things the correct way. And unless you are completely pushing the envelope or totally frauding the. You don’t go to jail, you don’t get one of these $800,000 fines levied against you. You may pay a little money back because you did something wrong.

But that’s not what, the system doesn’t work that way. Um, so if you do, if you get the knowledge, do the best you can and stay within as best you can. The rules and regulations of the system sleep at night. Yeah. Um, but don’t avoid doing all that at the. Uh, you know, at the consequence of number one, you’re not helping your patient, and number two, you’re not helping your practice.

And [00:39:00] that’s the only two things that matter at that point. So, uh, I, I just, I think we have a hu you, you said it a minute ago at the very beginning. We have a huge aversion to our profession embracing medical, you know, care at a very high level. And it, it’s a complex problem. You know, if you just do the right thing, I see no reason to not sleep like a baby at night.

You may get looked at. So what? Yep. Yeah, I agree. I mean, so Joe, let me, um, let me kind of wrap this up. So be respectful of your time. You know, tell, tell everybody kind of what, uh, where they can find you. I know that most people know you, but where can they find you if they want to use your services and, and help them help themselves sleep better at night?

Where can they find you? Yeah. Um, so, you know, practice Compliance Solutions is a company and it’s become an optometry well-known name at this [00:40:00] point. Um, our website is www practice compliance solutions.com, so they can go there and learn all about what we offer. Uh, anyone can email me personally. It’s very easy.

It’s Joe at PCs Comply, or if you can’t remember that, it’s Joe at Practice Compliance Solutions.[00:41:00] [00:42:00] [00:43:00] 

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