With Dr. Mike Wallace
Today on the show, I got to talk to Dr. Mike Wallace. Dr. Wallace is a 1986 graduate of Michigan College of Optometry at Ferris State University. Prior to joining Flushing Vision Clinic in Michigan, he was Clinic Director at TLC Laser Eye Centers . Dr. Wallace currently is serving as the Director of Managed Care Initiatives-Midwest State for Vision Source, North America’s premier network of private practice optometrists. We had a great conversation about strategic healthcare initiatives and alliances.
You can check out their full conversation here, or by searching “EyeCode Media” in your favorite podcast app.
Podcast
I got time. Yeah. Yeah. I get it. Well, thanks for doing this. I, I think it is interesting to think about strategic healthcare initiatives and, and actually when I was introduced to this idea, it was years ago with Paul Williams and he was doing a lot with genius, uh, cliff. Yeah, he is, uh, I think he had some relationships with, uh, cliff Robertson.
Who was I? Uh, so he was the, um, head of ch I, which kind of moved to moved into. I guess it was probably like five to eight years ago. So I guess, you know, the thing for me is it sort of fell off a little bit, but there’s so much value in strategic healthcare initiatives. So I think the listeners probably would benefit by hearing sort of what, what you, uh, what you’re working on in the back end and how we can think about, uh, strategic, he strategic healthcare initiatives.
And then we’ll, we’ll, I’ll kind of pick your brain about that. Sure, sure, sure. Sure. So, so as we lead this off, I, I have jokingly say, cuz you know, you work your butt off, uh, for optometry and educating and, and private practice and all that. And so in a way we, you know, we kind of dedicate this in a way to the future optometrist, right?
And so I took the opportunity where my, my, uh, uh, Indiana university shirt for my daughter who’s in her last year. Uh, of course I call it, I OOU instead of IU, but, um, anyway, uh, she called me the other day. What is tuition now? . Yeah. Uh, well, it’s out state. I think she’s paying 55 a year cuz it’s out of state for her.
But the interesting thing she called me on Friday or something like that and said, dad, I gotta tell you what I did today. Said what she goes, I did my first YAG and two SLTs and man talk about a proud moment and this is the way, uh, future of optometry. And so you know, so I applaud you and others and, and, and years ago when I was fighting those scope battles, um, we’re doing this for.
And doing it for our communities and doing it for the, um, for the profession to, to continue strong, especially independent optometry. That’s my focus. Um, but nonetheless, um, I thought, I thought it was a good opportunity to do a shadow to, to my daughter, Noah at, uh, at, um, IU. So anyway, well, I think that’s great, but I wanna pause you cuz you made a, made a point of, you know, there’s something special about independent optometry and you and I have discussed this before, but you.
Um, I think a lot of times people a, uh, say, well, it doesn’t matter how you practice. It matters. It doesn’t matter where you practice. It matters how you practice. Um, and I think that’s probably true to some degree, but why do you think in your opinion, independent optometry is the, the best way to practice the way you want to.
Self control. You, you have control over how you practice and nobody else is telling you how to practice or limiting your practice. Other than the legislative battles, we’ve all fought for, uh, and earned. But, uh, self-determination is the key to our, um, our livelihood, our profession, the best way to provide patient care, in my opinion, uh, the best way to provide patient care cost efficiently, in my opinion.
And. in our own self respect. There’s just so many reasons why I like that. Now I’ve practiced in every environment. Okay. A multidisciplinary commercial, uh, center director for TLC way back when, you know, 25 years ago and then in private practice. So I’ve done it all. And, uh, I respect and enjoy every one of those environments for different reasons, but for the whole gestalt of it, private practice gives us the best opportunity to propagate our profession and provide great patient.
Yeah. So, so then that, uh, if that is the best way, then we have to be involved in additional healthcare, um, alliances and or strategic healthcare alliances. And in doing that, it makes it really challenging because we are completely well in theory. Much more independent. We can do things that we believe is best for our patients, and then subsequently can run our businesses the same way.
So how do you tell me about strategic prac healthcare alliances and why I should care it as independent practice? Um, yeah. And we’ll go from there. So, yeah. Yeah. So let’s call it almost pseudo independence in a way. Um, because listen, um, even primary, uh, care physicians. For many years were totally 100% independent.
And, uh, that was very possible for them, but with the, uh, inroads of, um, government rules and regulations, and we all know this compliance issues, it became almost impossible for primary care physicians to be fully independent. And so the idea of primary care physicians. Uh, being independent is by the wayside.
So, um, that means that in the local communities, as an independent practice, we are up against, uh, kind of a, a yinging yang. We have personal relationships with a providers in the area that we would like to continue relationship, uh, referral relationships with. But we also understand and know that they now have people directing them.
They have. Chief medical officers or medical directors or executive level decision makers that are telling them what their referral patterns have to be. So we have a, a, a kind of a problem, uh, or an opportunity on our hands, um, as independent providers ourselves. And, you know, we, we want to make sure we have access to those pathways of, uh, coordinating patient care with physic.
um, but at the same time, you know, unless we’re in the game or, um, on the, on the right team, we may lose some of those, those, uh, pathways. So it’s important to us as independence to, to, uh, continue those local relationships. Cause they’re, they are gold, but at the same time, um, we need to network, uh, with let’s call it local alliances, if not national alliances, but local groups of like-minded.
Um, professionals, uh, that provide care at the highest level of their scope of practice so that we can align together and go to, uh, large healthcare, uh, provider groups or, uh, or health payer groups or hospital groups that own, uh, PCPs. We have to make sure that we can go to. In some way and have the conversation about what we can do, why we do it well, and why we do it efficiently for them to save money, uh, and provide excellent patient care.
If you can make that argument and you have a, a cohesive group that, again, they’re all independent, but if you have a leadership around that group that you can say, this is what we need to do together. Uh, and you can make that argument to your. And then you can sell that to, uh, a, a provider group. That’s a medical provider group.
You have the opportunity to keep those, those pathways or channels of, of referrals open. Um, but if you’re completely independent, that’s a, that’s a tough sell to make, because again, they want these, uh, executive teams. Want some control over how their patients are cared for. Uh, what are the, what are the criteria in which somebody’s in your group?
Uh, and what are you gonna do if you find something, uh, that you need to do extra testing for and how are you gonna, uh, provide that care, you know, completely open with every test in the world or some degree of. Um, limitations, you know, what are you gonna do that they, they want some control. They wanna be able to audit.
They want them to be able to measure, uh, Hetus measures. And that’s a whole nother conversation, of course, which, um, I I’m very familiar with, but nonetheless, some degree of relationship is necessary and it’s almost impossible to do it exclusively independent. So let’s call it pseudo, independent and.
national Alliance groups, uh, that do it well, do it for real, not say they do it, but do it for real, uh, is the first step of that. And then as that trickles down to state or multi-state regions, um, that’s the second step like in Michigan? Um, one group specifically that, uh, I’ve been working closely with to establish a relationship, uh, McLaren is what’s called, you know, they have a huge, uh, footprint in Michigan.
which matches the demographic footprint that, uh, my Alliance vision source, uh, is, uh, aligned with, but they’re also in Indiana. They’re also in Northern Ohio. They’re also, uh, you know, in probably Northern Wisconsin. So it’s great to be part of Alliance that I can, I can go to, to McLaren and say, Hey, look at, this is our footprint in Michigan, but we also have, uh, you know, another 300 practices in Indiana, uh, Ohio.
Wisconsin and blah, blah, blah. And all of a sudden it gets their attention. If you can make the argument that you’re great providers and you know, the whole spiel. Well, I, I mean, I do, but I think what’s interesting is to try to break down that, that, so. obviously the reason for, um, the need for a group of, of ODS to come in and provide that care is because, uh, is because those, those primary care physicians don’t have the ability to offload that care to somebody else.
So what, um, like why not? So the normal patterns would be that they would try to send them to their ophthalmologist buddy from medical school. And, uh, and, and presumably those ophthalmologists would be on the insurance panels because they would do surgery in those hospital systems. That’s exactly. And so they have easy access to those insurance panels or those, uh, those HMOs or whatever kind of the locked in group is.
And most of the time optometrists don’t have access to those panels because we don’t do surgery in those hospitals or probably the, the more accurate. Description is we don’t typically have hospital privileges in those hospitals, uh, in the bigger cities because they don’t, they don’t need optometrists to have hospital privileges and, or perceived need for it.
And so with a health, with a strategic healthcare Alliance, you’re saying, look, we’ve got 130, whatever. Maybe it’s a hundred, maybe it’s 50. I don’t know. But, um, guys that can provide or end gals that can provide services in your, in your community. Uh, and then, and that is that correct? Yes. Um, except that, um, the ophthalmologists have extreme leverage, um, to execute whatever they want, because when they’re doing surgery there they’re, they are driving revenue into a hospital.
So it’s not just that they have hospital privileges, they have leverage and that’s. What we, uh, that we somewhat battle or overcome. So, yeah, so, so yeah. So then the conversation goes to, um, I’m in the conversation with a, a provider group or healthcare provider, um, payer group. The conversation is, is this, uh, is.
I’ve got great ophthalmological surgeon, colleagues that I refer to, uh, when the patient needs cataract surgery. And when you have a diabetic patient, I make sure that DIA diabetic patient is in my chair within two days or three days of that referral. Cuz I know how important that, um, that result is for you, both for your HES measurements and for everything else.
But the real key is that diabetic patient to me is gold. Cuz I expect to have that patient as an annuity and their family forever. However. Um, my surgical colleagues, uh, that, that exam slot is worth $2,000, not $300 to them. Mm-hmm . And so it’s not a priority typically for them, and they’re gonna do it because you’re good friends with the PCP and all that.
And it’s very important. They provide great care, uh, or maybe the optometry set. Uh, they hired us providing that care. But the point is, when you send me that diabetic patient, I’m gonna see ’em in two days, you’re gonna have your com your communication in on day three, you’re gonna have everything checked off on the Hetus measure immediately, and then I’m gonna make sure that patient is healthy, but I’m gonna refer them for appropriate surgical care.
When that time is right. My priority is not taking out a 2025 cataract. my priority is making sure they don’t have diabetes. Won’t get diabetic retinopathy. Um, and they’re back in your chair with a proper education. That’s a different priority. I think from our colleagues in, in surgery. I make that argument.
Yeah, I think that’s a, yeah, I think that’s a really good point. Cause I wanna make this, I wanna make this point is that, um, When, you know, a lot of times I talk about, and you’ve heard me talk about this idea of a comprehensive care model or a total patient care model where whereby we have this comprehensive exam that allows us to detect all the things that this patient could potentially have.
And, uh, and then when those patients have those things, they become. Um, we, we have to serve that patient. And by serving that patient, that’s a pillar of our practice. Well, ophthalmology’s no different, but our co common two pillars in our profession generally are comprehensive exam. And then, I mean, I’m just telling you historically, uh, from the perception is.
Then comprehensive exam. Then if, if you need glasses or contact lenses, I can sell you. Those that becomes a, a pillar in my practice is something you needed, but it’s a pillar in my practice. Well, what you’re saying is ophthalmology does the exact same thing. They say, well, look, I’ll do the comprehensive exam.
I’ll do the diabetes exam, whatever. It’s, it’s fine. But I don’t really want that. I want the pillar, which is cataract surgery or glaucoma surgery or retinal surgery. So they do the same thing. Um, but we have so many more opportunities to offer that patient, I believe better care and also more comprehensive care for all the things they have.
And that becomes a bigger value to the healthcare Alliance and the healthcare system. And so tell me how, when, when you talk about the value of that proposition, Uh, how do you sell the value of optometry? Not just the, the quick turnaround, but what’s the value? Well, the value is, is the extra five minutes I’m gonna spend talking about, um, blood sugar control and the extra five minutes I’m spending, talking about not smoking or lifestyle choices or the things that they need to do to continue to maintain good healthcare and good eye care and all the things that diabetes.
Uh, uh, broadly in their body, which they, how many times have you had a patient come in and said, well, I didn’t know, diabetes affects the eyes. Well, I didn’t know. Diabetes affected the, yeah. You know, the kidneys was all the time. How could they not know that is because somebody’s not spending the time or maybe they are, but it’s so much information to digest.
Even when I go to the doctor and I spend 10 minutes with them, I’m still like five minutes later. What did he say about this? So I get it. I totally get it. It’s, it’s a message that needs to be repeat. Often. And so that time, the 15 minute or 20 minute time I’m spending with a patient, maybe it’s, uh, 10 minutes of data gathering and maybe it’s five minutes of evaluation, but the five minutes time I’m spending with that patient discussing the priorities of their healthcare, uh, are.
Much more valuable comprehensively. And the other argument I make to, uh, payer groups is I’m not doing a diabetic retina exam. I’m doing a comprehensive, uh, vision exam health ophthalmologic exam. That’s also talking about dry eye or glaucoma or macro generation, or, and that’s another whole story with high risk complications and things like that.
But there’s a, there’s an interesting caveat that you touched on. Needs a little bit of a maybe conversation, maybe not now, but in the future. And that is, yeah, let’s have it. This term comp this term comprehensive eye exam. I wrote a paper 10, 15, 20 years ago. Uh, that was, uh, just published in the local mission comprehen association.
And I said to myself, we are shooting ourselves in the foot with this term comprehensive eye exam as part of a managed vision care. We are as a profession, we’ve shot ourselves in the foot because now all of a sudden we’re getting 45 $50, uh, reimbursements for what we’re calling a comprehensive eye exam compared to our medical colleagues getting 200, $250 for the same service that they’re calling it, comprehensive eye examination, but they’re doing it under medical.
And I don’t see there’s an answer to that at this point, but this whole concept of, of, uh, where our professionals going, cuz we wanted to be in the big boys. may have shot us in the foot. We may have needed to, to distinctly say these are these managed vision care exams. Maybe we should have been changing that narrative to screenings, you know, vision screenings, uh, healthcare screenings.
So the immediate moment an anomaly was detected. That exam is over from that perspective. And now it’s, now it’s either come on back for your medical comprehensive. Examination. Now I know that that’s water under the bridge, but we better start thinking about language . Was he saying language matters? I’ll tell you.
I, I am, I am totally on board with you about this and, and I don’t know that you can describe, you know, I I’ve gone back and forth a lot. There’s one of my buddies, um, Kyle clue, who I run with, he wasn’t, he didn’t work out with us in DC. Uh, but. Um, but I run with him every week and he and I have have gone back and forth about how to, how do, how do you describe, um, a, what I was describing too?
Like, how do you describe comprehensive eyecare in a different way? How do you describe a total patient care model in a different way? What, what that is intuitively. understandable to the lay person to distinguish that from what you’re talking about, which is a, what was probably more appropriate to say a routine eye exam, right?
When everything is routine, but even then, you can’t know if that’s routine until you’ve actually seen the patient. And so, you know, I really push people and, and I’ve made people mad. In fact, I’ve got a new associate and I think I kind of made her mad one of the first days she, she was here because, um, because I I’ll ask a question and I’m gonna do this time and time again, but I’ll ask a question.
I’ll. when I’m speaking to a, a large audience, I’ll say, okay, let’s say you have a patient that comes in on XXX. Um, uh, Routine with a routine exam coverage, and they just have complaints that they want new glasses and they’re 42 years old and you see a pressure of 27 and 21 on eyecare. So first I’ll ask them how many people, uh, use eyecare, telemetry, or N CT, or, you know, some other screening device, Tono pen.
And, you know, everybody’s hand goes up and then I’ll say, okay, if you get a pressure of 22 and 27, uh, on your pretest and that patient, uh, is 42 years old, what do you do next? And everybody says, everybody says, recheck with Goldman. I said, well, why do you recheck with Goldman? You’ve already done the test.
You’ve already been paid to do the test. Now that now you are the physician and you can make the determination on whether or not this is erroneous, uh, um, finding, um, or you can say, you know, we found an erroneous finding. We need to dig into this deeper. I under need to understand better why this is why there’s asymmetry here and why there’s this and why there’s that.
But, but people get upset because they’re like, but I don’t wanna have people back unnecessarily. Do you think your, do you think the, uh, primary care doctor checks an A1C and then the A1C comes back at at 8.5 and they say, well, let’s just recheck that again today. Cuz that was, that was high. I don’t really know if I trust that.
No, they don’t do that. And so like right. We, we just have to get out of our head of like this, this idea of a comprehensive eye. It is to detect all these other things, but it’s not to attend to them. Right. Let’s detect them. Then we have them back to attend to them. Otherwise we’re gonna be, we’re gonna be kind of lost in this, um, in this rat race of not really understanding how to run our practice and, and really, I think it harms patient care because we, we just say, well, no big deal.
Let’s just, let’s just recheck it here. And would you recheck and recheck and recheck it until we get a normal finding? or we don’t know what, what we’re getting. And so we don’t understand how to get reimbursed and how to communicate these things. So we’ll just send it to the ophthalmologist down the street, because I don’t know.
I can’t really right. And, and that’s so frustrating if you don’t have that figured out, um, in your practice and you don’t have that a way to address those co those things in your practice, you will, um, be very frustrated when you’re trying to provide a, uh, a total suite of care for patients who have diabetes and macular degeneration and dry.
Et cetera. So I don’t know how I’m like you, I don’t know how we better communicate that to the public, but probably we just need to, you better have your script to our profession. Well, uh, you know, uh, you better have your script and I’ve taught my associates over the years and, uh, and I said this, you have to have a script that you’re ready to say every time every patient, when they fail.
Listen, Mrs. Jones. I’m so sorry, but. You’re here for your regular, uh, what we call your, um, eyeglasses exam today. However, some of the tests show that that possibly more significant issues exist in the area of glaucoma or microgeneration or, ah, so why don’t we today since your primary concern, was these glasses.
I’m happy to take care of that for you today, but understand we’ve detected something that is a visual, uh, site threatening disease that must be evaluated. And let’s have you back to do that under your medical care, understand this was just your vision screening. And now because of this other condition that may be significant to the, the future of your vision.
We need to have you back and do your comprehensive. Comprehensive evaluation that takes in not only your ophthalmological health, but all the other systems of your body that relate to the, to your eyes. Oh, you mean something wrong with my kidney could also affect my eyes. Well, yes, your eyes are part of your body and not exclusive.
They’re not a silo. And so something shorter than all that, but some script. that anticipates what they’re gonna say, what they’re gonna be perturbed about, because, well, I want my vision cam, you have to have a script ready to go. That’s brief that anticipates that brief and easy, but distinct and firm.
Yeah. You have to believe it. You have to believe it. And I think so. So when you’re talking about, we could go on and on about that, but, but, um, but when, if we wanna take, stay on strategic healthcare initiatives, how do you parlay that idea? Into making sure that you’re communicating that effectively. Uh, so that the primary care doctor understands that maybe they don’t even care when that when they come in, that patient has a, a managed vision care plan.
And then they have their medical plan that the primary care doctor sent them to have their diabetes evaluation. Uh, what does that sound like in your practice? How do you articulate that? Well, that, yeah, so that conversation starts with the PCP. okay. And, and that’s part of it and, and they won’t remember it, but I want them to understand what’s going on in our practice.
So when the patient comes back to them and complains, well, you sent me to that doctor over there and he billed my medical insurance and that cost me more than my $10 copay. So I start the conversation there and say, you know, just understand that when you refer your patient over to me, of course, I’m gonna do it under their medical plan.
And they may have a vision plan and, and there may be some confusion when the patient arrives. So please make sure your. Co contributes to the conversation about, we are sending you to Dr. Wallace for a medical eye examination related to your X, Y or Z patient presents in the staff at the front desk. When, when the patient says here’s my VSP card, or here’s my, you know, whatever card the staff says, thank you very much.
This will be useful if you need to get any routine glasses, but today your examination is under your medical insurance. Your copay is X, your deductibles X, and we will take that up front today, upfront on that copay. Bef so that, so that later on, they don’t say something about, well, that was upfront. So it’s clear to begin with, and then if there’s additional tests later or, or you return ’em back, it’s fine.
It’s already, it’s already clear. That’s what happens in ophthalmological offices. You collect the copay or there partial deductible at the front desk where, where it’s clear and understood before you and I have to get into that conversation cuz. Our physician. Yep. Colleagues don’t have that conversation.
The staff has to be comfortable having that conversation and they collect it up front and you see the doctor, you know, Mrs. Smith. I’m so glad that you’re here today. We understand how, how dangerous diabetes is with your eyes and how you can lose your vision. Let’s take care of your copay today, so that when you’re seeing your doc, the doctor, you can have your attention fully on what he has to do to help you save your vision.
Yeah. And yeah, it’s great. I, I. . Yeah. I, I mean, I think that it has to be a, it has to be a deep down. I mean, if, if where I see it working well, where it always hiccups is the doctor ha doesn’t have a clear guidance to the team. Uh, so there’s this kind of wishy washy. Um, and, uh, if somebody pushes back on something, they don’t want to be, uh, they don’t want to have.
Perceived confrontation. And so when you’re not forceful in, in what you’re doing as the right thing, then, um, then patients can kind of move things around and you don’t have a, if you don’t have a good, solid answer as to, well, why don’t have to come back for that doc? Why can’t I, why can’t you do it all today?
Well, your insurance companies, don’t, you know, you have great insurance. One allows for when you just need glasses and kind of lens. Prescription changes. One allows for all the other diseases like diabetes, glaucoma, macular degeneration, dry. But the problem is I can’t do both of them on the same day. So you can pick, you know, we can pick which one we we’re gonna do today.
You’re in for this one. Right. That’s what you told us. So we’ll do that and we’ll have this other one on a separate visit. And I think having, like, if, if you had that conversation, just like I had just like you had. Um, whether it’s you or your team. Right. And it probably you’re right. It’s it is your team.
But, but the point is, is if the doctor can’t have that conversation comfortably with authority, then the patient patient doesn’t feel confident that, that you knew what you were talking about. And so if you don’t have that in place in your practice, You will, you will get frustrated. Patients will get upset.
They will be confused. Right. Um, and they’ll think you’re trying to milk the system, which you’re just, you, you could just have to apologize, like this is the way the system works. Can’t do ’em both. You said it, you said it, it cannot be delivered with an arrogant and careless. Um, uh, disposition, it must be either yourself or your staff member says I’m, I’m really sorry.
I understand how you feel. Um, and how frustrating this is as a healthcare. And I know you’re here and you took a day off from work. I just want you to understand that relative to your, to the, the, the problem you’re here today. This is the way we are, um, um, forced, um, or audited or whatever word we want to use.
It is necessary for us to move forward, to take care of your eyes, that, and your staff cannot take on. you know, that attitude that we all know when we go into the physician’s office and, and some front desk, person’s got their smoky little look on our face. Now, typically our offices are amazing with our front office staff.
We gotta make sure our staffs disposition is very, very firm, but sweet understanding, understanding. Uh, uh, you know, considerate all that’s incredibly important because when that patient walks through the door, their anxiety already went up. They’re already anxious and they’re already ready for a fight, cuz they’ve never been into any physician’s office without a fight.
So we have to be, we have to be understanding of that. It, that doesn’t mean we change the way we do things, but we have to be understanding of that. And. uh, when we have even on like some of the Facebook platforms or even our own staff says, oh, I had this patient and how dare they say that? Well, how dare they say that?
That’s what they’re thinking to begin with. They already have, right. They’re already, you know, uh, swinging at the, at the ball. So you’ve gotta understand where they’re coming from so you can present and anticipate in a considerate. Understanding manner, but yet firm, you know? Yeah. Anyway, that’s another hotel.
Yeah. So to me there’s no, I, I I’m, I’m right with you. I think, um, you know, to, so you’ve, you’ve, if you were going to start building some of these, uh, relationships, where do you go, how do you connect people? How do you connect ODS together? And then where do you start? I mean, you, you and I have talked about some kind of low hanging fruit, but where do you.
okay. There. There’s no doubt that, uh, let’s say we’ve moved on. Uh, and we’re talking about our local, uh, relationship with PCPs and specialists and others, and I, I think that’s what you’re, you’re getting at. Yeah. So exactly. I think obviously, uh, obviously the PCPs, uh, you need to be in those offices.
Regularly not one and done. You need to go in every, every six months say, Hey, I’m here. Any questions? Any issues with communication between our offices? I really wanna make sure you’re getting your diabetic reports and, and your reports on, on those patients with hypertensive retinopathy or those reports.
And you gotta kind of say all those things. So they, so they, even, they go, oh yeah, you guys take care of that too. Oh, yeah. You’re, you’re worried about thyroid eye disease. Oh yeah. Or Macrogen you, you have those conversations often. So you’re in those offices every six months for five minutes, maybe with the receptionist, they almost always pull the doctor out just to say, hi, great.
You must do that. But that’s, that’s the tip of the iceberg, the, the, the rheumatologist, or even the neurologist that doesn’t have a visual field in his office or, or all these other specialists, they don’t know that we take care of patients with, um, you know, um, high risk. Long term medications. They don’t know.
We take care of all their patients that have, you know, uveitis. They don’t know. We take care of all, all those patients. We need to be in there saying, Hey, you know what, if you can’t get your patient into your normal referral channels, or even if you can, I’m happy to take care of those patients. I’ll take care of ’em immediately and they’ll be back in your office and they’ll be, they will be treated very well, but every let’s face it.
Every subspecialist is interested in some form of the ophthalmological complications of the things they. They are, uh, managing. So we need to make sure those subspecialists know that we are in the game. And if we don’t do that, we’re in trouble. But again, that’s, that’s only the next tier of the pyramid.
Okay. Or the iceberg. There’s, there’s a number of other opportunities. The obvious one is urgent care, urgent care, PAs, mostly. Hate managing eye stuff. They hate it. And so if we’re not letting urgent care managers, urgent care providers or the urgent care medical directors know that, Hey, if you got a patient with, uh, with foreign bodies, we’re happy to see those patients.
We do that all day long and I know how, how hard they are to get outta their eyes and how, you know, kind of dramatize a little bit, I suppose, but either way I want those patients and they’re happy to get rid of ’em if they’ve got a resource, even the managers or their let’s say it’s a multi-location.
Your urgent care that has a medical director, even they want, want those out of their offices. So we have to make sure they know that we are happy to take care of, of, uh, foreign bodies and red eyes. And again, you, red eyes can be pretty complicated. Now we know oftentimes or easily managed, but they don’t wanna manage those.
So, so urgent cares are an critical component of that. Another really important one. And I mentioned this the other day, and I’m doing a lot of research on this. in the past dialysis centers. Who, who would’ve thought dialysis centers want anything to do with eye doctors? Right? Well, yeah, in the past. And I’m doing some research on this now.
Dialysis centers had their own small local, uh, uh, accountable care organizations because dialysis patients were so expensive that the large accountable care organizations wanted nothing to do with them because they, they couldn’t afford them. So, uh, for a while there, and I’m not sure this is still in existence, but Medicare had a special program that allowed, um, these dialysis centers and their nephrologists to do the value based healthcare or comprehensive health of.
Of these patients enrolled with dialysis. That means they were accountable to Hetus measures with diabetic retinopathy and all the other things that are important. It also meant that they benefit from those patients being diagnosed from us with macular generation or dry eye or glaucoma, all long term diseases.
So yeah, low and behold, you go to dialysis center, they need an eye doctor to take care of the patients for their HES measures. So the research I’m doing now, and part of my role is how do I get up to the, to the big decision makers? comprehensively rather than just my local, um, dialysis center, but that doesn’t stop you and I in our local community from establishing relationships with ne nephrologists, absolutely critical.
Nobody understands that or knows that. Yeah. And then I also mentioned at some point, you know, go ahead. Go ahead. Okay. So the other conversation, a lot of people don’t understand this. We get a lot of foreign bodies from the local, you know, uh, car shop, you know, the guy’s grinding out the yeah. Aluminum wheels.
So the, so the guy’s not losing air in his tires and, and they get a foreign body and they’re all going into urgent care. We should be going into those car shops and advancing, Hey, here’s my card. I’m right down the street. Next time you get a foreign body just come on in. I’ll have you done in. 10 minutes, get you back to the, get you back on, you know, talk to the manager.
And in fact, uh, we don’t have to do this through your worker’s comp. If you don’t want to, we just do this out of pocket. It’s a lot less expensive. It’s a lot quicker. It’s a lot cleaner. We’ll just get, get, get you taken care of and make sure you’re fine. You know, you could have these little relationships.
I don’t know. I’m not talking legality. I’m not a lawyer. Okay. And that’s my, that’s my, uh, that’s my defense for everything. You know, I’m not a lawyer. I just try to take care of patients. You. Ask, uh, ask forgiveness, not permission, but you have these local relationships. You take care of these, these patients, you’re doing the best thing for them.
You’re doing the best thing for your local community, and you’re getting them back in the job. And, uh, and you’re saving the urgent care of the worry of taking Cal, uh, foreign bodies. They don’t know anything about, so you get into all these. Yeah. You know, uh, 10 minute oil change, places that they’re constantly looking up and getting, you know, crap in their eyes.
You’re going to the body shops. You’re going to the mechanics. You’re going to the local tool and get dye shop. And you’re saying, Hey, you know, um, or if you’re in the rotary club or if you’re in your local lion club, these guys are oftentimes part of that, you make sure you, you tell them those patients need to come to me.
Definitively. Those patients need to come to me. Yeah. Not the emergency. It is amazing at two or $2,000. It is amazing. Yeah. It’s amazing that, that, that we haven’t just owned. You know, even in large cities, we haven’t owned those, those foreign bodies from urgent cares and, and emergency rooms, but you’re right.
You know, that’s another great place. We’ve got a, there’s a big auto body shop in, um, in Omaha that has about five or six locations. And, um, you know, as you know, like removing a foreign body, it’s pretty straightforward. And, um, and you know, you can wiggle those into your schedule all day long. And, uh, and not, and not get behind.
And so the, um, but, but anyway, we see, we see the owners of that shop and they just start, they just started sending us all of their, their guys that were getting stuff in their eyes and, and the guys love it because they’re kind of. You know, unfortunately they’re they’re, they don’t want to be outta work.
You know, they don’t want be outta work. They don’t wanna be down. They, they, most of them don’t want to like, be looked at as, at a burden. They’re like, oh, stupid. I didn’t put my glasses on. They sure. They know they did something wrong. Right. Uh, and then the, like you said, the auto body shop just wants to taken care of so they can get these guys back.
And if you can get ’em in and out, um, yeah. And we see that all the time. So you’re, you’re absolutely right. It’s something that I think a lot of us don’t think about. So I’m gonna summarize here, Mike, cause I’m gonna be respectful of your. It really starts with building this network of starting kind of toward the bottom auto body shops, uh, urgent cares, primary care physician.
And then you get, uh, you know, kind of elevated a high, a little higher level where you have primary care physicians. Uh, and then you have your kind of your, um, well, you could probably say your. Nephrologists and your, uh, your, your, um, dialysis centers would maybe be a little bit above that kind of a smaller piece, but a unique piece.
And then, um, neurologists, uh, rheumatologists, and then your, and then through those relationships, if you’ve establi, if, if you’ve established those relationships among healthcare providers, then you’ll be able to develop relationships to the, the pinnacle of the people who are making larger decision. And if you’re working in your zone within your community with other optometrists, to be able to say, look, you send to any one of these 10 locations and we are gonna get you in.
We guarantee you we’re gonna get you in within two days exactly. Or three days, and we’re gonna get you back. And, and everybody’s committed. Now you have a fourth force that could be reckoned with. . Yeah. Yeah. And then, and then the piece that relates to alliances real or imagined it is, is the group you are aligned with truly making these inroads or making these attempts on multistate or national.
A lot of people are saying they’re doing it. I don’t only know of one, that’s doing it. And so that’s part of the equation. There will be a day when large regional alliances rule in the healthcare arena. Michael Wallace. Thank you so much for doing this. I really appreciate it. You’re welcome. My pleasure.
Anytime we’re gonna have to do this. Take care. We’re gonna have to do this again soon. Strategic healthcare. strategic healthcare strategic healthcare.