Posts Tagged ‘Optometry’

« Older Entries
Larry Silver

The Lessons I’ve Learned by Lee Shuwarger, O.D.

Posted by Larry Silver

The Lessons I’ve Learned

“The Lessons I’ve Learned in My Journey to Become a Professional Practice Owner”

Part One: “What I Did Wrong”

by Lee Shuwarger, O.D.


Right off the bat, I can guess what you are thinking – why would anybody write about everything they did wrong? Well, one only learns from mistakes and in the interest and hope that possibly some recent graduates and colleagues may read this and get some help and/or insight in some of the lessons I learned, I wrote this.

Being originally from Los Angeles, I wanted to see why people live on the East Coast. So I decided to go to an Optometry school back east and ended up at NEWENCO in Boston.

Just before I graduated, I wondered why job offers didn’t just arrive on my doorstep. I quickly learned that everything takes effort and I had better get pro-active real fast if I wanted to start working in the profession I had just spent years being trained in.

My first issue was where to practice. L.A. would be fine, but with all my student loans I felt I’d better find a cheaper place to settle down. Unfortunately, that only eliminated Honolulu, New York City, and San Francisco. So, I went to the library to look for places that need optometrists. At the time, Texas kept on appearing in the results. My brother was an OB-GYN in Houston so I thought, “Houston is like L.A., with the climate of Bangladesh- so why not go there?”

After moving to Houston, I was hired by a large chain in Texas. I remember having lunch with one of the co-owners of the practice while negotiating my contract. I wasn’t very happy with the salary but, being naïve, I knew that with the combination of my friendly personality and my abilities as an optometrist, I would be able to impress him in just a few months. I therefore worked out to get the following clause into my employment contract: “Employer will evaluate employee’s performance in 4 months and, based on that performance, will increase the employee’s compensation.” Fair enough I thought.

Satisfied, I went to work for him in a brand new building- even the carpet smelled new! After 4 months of working there, I went out to lunch with him. He told me that the practice had grown in 4 months what he expected to see only after 12 months, that they had received compliments about me from patients and ophthalmologists. “Well, now I get the raise”, I thought. “Sorry”, he said, “we’re not going to give you a raise.” Needless to say, I was a bit stunned. When I questioned him further on this he said, “Look, The University of Houston is graduating 100 optometrists every year that I could hire to replace you at a lower salary.” I couldn’t believe he’d turn his back on his agreement with me.
This brings me to the first three things I learned in this life of becoming a practicing professional:

  1. Be very wary of practicing in an area that has a school of your profession.
  2. Get EVERYTHING in writing.
  3. Never underestimate the potential unethical qualities of your colleagues/employers when it comes to the “mighty buck”.

Within 10 minutes of this lovely lunch I went searching to find a place where I would be “appreciated”. During my time in Houston, I learned that Texas was saturated with optometrists that are practicing at or east of I-35 – one of the main transportation routes in the area. I discovered that if I went to the west I should be able to make a much better living. So I went as far west as I could go in Texas and ended up working for an optometrist in El Paso. He had promised me that he would give me a large bonus if I stayed for three years. I asked him what would happen if I was let go, for instance if business decreased. He said that he would give me that bonus as a severance pay. As he had this practice for about 40 years and he still had people working for him that were with him from the beginning, I thought that this was potentially great. To me it meant that, if he had staff for that long he must truly appreciate them and take good care of them and honor his agreements with them. Otherwise people would not stay with him for so long. That seemed obvious, I thought, and did not need any further investigation.

Wow, was I wrong! I soon learned that the area was very economically depressed and having a job – even a low paying job with no room for advancement, and not necessarily being appreciated – was far preferable to being unemployed. That’s why his staff had been there so long.

One day, while still working for him, I received a job offer in the mail. I’m sure many of you may have seen one like this before: “A wonderful opportunity is waiting for an energetic optometrist in beautiful (insert name of small, barely recognizable town)!”
I called out of curiosity just to find out how much I might be worth on the job market. On the phone, I explained that, even though I was not interested in moving and leaving my present job, I just wanted to call and see how much they were paying. He asked me who I was working for and I told him. BIG mistake. As you might deduce, I ignored rule #3 of never underestimating the potential unethical qualities of your colleagues/employer when the almighty dollar is at hand.

That day, my employer got a call from the potential employer that had sent me the job offer letter. I don’t know exactly what was said in that telephone conversation, but my employer told me, “If you are looking, you are obviously not happy. And if you are not happy, I need to find someone who will be happy here and I can’t afford two of you.”

I asked him about the bonus and reminded him how he had promised it to me if I were let go. He refused. Guess what – I had forgotten rule #2: “Get EVERYTHING in writing.”

Soon thereafter, I was in Lubbock, TX, working for the optometrist that sent me that form letter. That job lasted for just over a year- just long enough to complete my contract.

Through my experiences, I was able to observe the benefits of an individual working for oneself. That led me to wanting to have my own practice. Unfortunately, there was no way I could afford all the equipment and expenses. I was soon contacted by a “recruiter” for a very, very large national chain of stores (I’ll just call that store “Not-Smart,”) which had an in-store optometry office who told me about an opportunity at a their Vision Center in Amarillo, TX. It seemed like a really good deal for a recent graduate. You get to call the practice your own, all the equipment, materials, utilities, and even the phone were all paid for by the rent and the rent was just 10% of the gross receipts. But I soon discovered the negative points:

  1. Since they collected 10% of your gross receipts you were strongly encouraged to take all the insurance plans you could, and pushed to work for over 60 hours per week. I was told to even charge my family for their eye care.
  2. Management did not care about personal health issues, family issues, or religious holidays. You were required to either be there, or have another optometrist there during hours that you were suppose to be open. You were not allowed to close for any reason. You were required to have a replacement optometrist there even on religious holidays. If you miss any days for any reason, you are required to make it up by working on a Sunday or another holiday (like Christmas, Thanksgiving, etc.)
  3. The renewal of your lease was constantly threatened if any of the above type violations took place.

As an example of my dealings with them, one day I asked them for another exam lane so I could see more patients. I ran all the numbers and presented it to them. It was projected that the cost for the construction and equipment would be made up in only 5 months since it was also projected to increase my business about 20%. The regional manager had a meeting with me. He told me, “You’re working about 50 hours a week now, right? Well, you could make that extra 25% if you were open 60 hours/week.” “Yeh”, I thought, “and I could increase by 75% if I was open 24 hours a day and slept there too.” With working relationships like this, it was obvious to me that my growth there was limited.

I will say though, that I made A LOT of money there although it really wasn’t easy or enjoyable. It has now been over 6 years since I worked there and I still have a bad feeling about it. I guess this is what it feels like to sell your soul.

Which brings me to an additional rule I learned, rule #4:

When you work for chains, the money you earn is inversely proportional to the degree to which you sell your ethics.

At this point, although I knew I couldn’t afford to build a practice from scratch, I still wanted to find a place to see patients, a place my patients could go where they would be treated the way I wanted them treated. I always had a good professional relationship with one particular optometrist in town and, after talking to him, we decided to “blend” our practices. We arranged that I would move in to his office and be able to use his staff to schedule appointments for my patients. I would then see my patients and the other optometrist would collect a portion of what I collect as “rent” on equipment and space. I even got this in writing (rule #2).

This seemed to work well for both of us in the beginning. But soon I noticed that my patient exam numbers were decreasing to the point that I was seeing only a patient or two a day. Way too slowly and too late I started wondering what was happening. One day, one of my partner’s employees confessed to me that her boss told her, “Make every appointment for me and NOT Dr Shuwarger- even if they are a previous patient of Dr. Shuwarger’s.” I couldn’t believe he told her that! But that was confirmed by the fact that the number of patients I was seeing was severely down and his was up by the same amount. Foolish me, I forgot rule #3.

During this same time period, I bought a new house and my wife got pregnant. So here I was, 6 months into this venture with my patients being stolen and major life changes occurring.

I decided that I needed to get out of there and save what patients I had. I started negotiations on leasing space in a shopping center to have my own office. When my “partner” heard about this (and I knew he eventually would), he threw me out of his practice.

So, there I was. No job, large house, no patients, and a baby on the way.

I made it work and, in my next article, will explain how I took these hard won lessons and ended up finally creating a very successful practice. I know that everyone will not go through all the trials and tribulations that I went through, but I though it could be helpful to new graduates who are figuring out how to proceed with their professional life to see what I went through and, hopefully, be able to avoid some of these mistakes.

Note from the publisher: The experiences and opinions of the author are completely his own and do not reflect the opinions of The Practice Solution Magazine or its publisher. We are however looking forward with enthusiasm to his next installment to see how the story ends.

CLICK HERE to read Part 2 of this article

Tags: , ,
Posted in Issue 12 | No Comments »

Larry Silver

Tears Reveal Secrets

Posted by Larry Silver

Tears Reveal Some of Their Deepest Secrets to Researchers

Newswise – It’s no secret why we shed tears. But exactly what our tears are made of has remained a mystery to scientists.

A new study sheds some light on the complex design of tears. What we think of as tears, scientists call tear film, which is made up of three distinct, microscopic layers. The middle, watery layer – what we normally think of as tears when we cry – is sandwiched between a layer of mucus and an outer layer of fatty, oily substances collectively called meibum.

It’s in this outer layer that researchers describe, for the first time, a new class of lipids – a type of fat – that make up part of the film. They also identified one of these lipids, oleamide, which had not been known to be a part of tears before.

With each blink, meibum spreads over the surface of the eye. It keeps the watery middle layer in place, ensuring that our eyes stay moist.
Finding these lipids may help scientists better understand the causes of eye-related disorders such as dry eye disease, which affects anywhere from 12 to 14 million Americans, said Kelly Nichols, the study’s lead author and an assistant professor of optometry at Ohio State University.
“The lack of certain compounds in the tear film may result in a number of different eye-related disorders, including dry eye,” she said. “The amount of oleamide and related lipids in tear film may be related to these disorders.”

Dry eye is really a collection of irritating symptoms that includes microscopic damage to the front of the eye. The eyes may ache, burn, feel extremely dry or excessively tear.

The researchers report their findings in the current issue of the journal Investigative Ophthalmology and Visual Science.

They collected oily meibum secretions from the meibomian glands of healthy volunteers. The meibomian glands are tiny, grape-like clusters of cells that line the rim of our upper and lower eyelids – the outlets to these glands are roughly adjacent to the eyelashes. Researchers gently pressed the volunteers’ lower eyelids and collected droplets of meibum in tiny glass tubes.

The researchers examined the meibum samples in the laboratory. They used a technique called electrospray mass spectrometry to differentiate between the different lipid components. This technique adds an electric charge to microscopic droplets of the oily substance, which allows the instrument to detect different components based on electrical charges and mass.

Nichols points out that researchers have used other techniques, such as chromatography, to characterize types of lipids in the tear film, but advances in mass spectrometry technology are improving research efforts.

“Other scientists used different techniques to try to determine the composition of meibum, but mass spectrometry is sensitive enough to detect individual lipid molecules, like oleamide,” Nichols said.

Oleamide was first identified as a lipid in the brain, where one of its roles is to induce sleep. It also has other key functions throughout the central nervous system. But the current study is the first to find and describe oleamide and related lipids in tear film.

“The finding could give us more insight into the role of lipid activity in humans and may also indicate a new function for oleamide and related lipids in cellular signaling in the eye and in the maintenance of tear film,” said Nichols, adding that researchers don’t fully understand the function of oleamide, or the other lipids in the meibum.

“Oleamide appears to be a predominate lipid in tear film,” she said. “It’s there for a reason, but we’re not sure yet what that reason is.”
Nichols and her team are currently studying the role of oleamide in cellular signaling and communication in the eye, along with the role that the lipid may play in dry eye.

“Dry eye is really a disorder of symptoms that irritate the eyes,” Nichols said. “Not everyone with dry eye responds to the same treatment. If we could find individuals with varying oleamide levels, then we may be able discern one cause of dry eye, and specifically treat that.

“Even though two people with dry eye may have the same symptoms, there may be very different causes underlying those symptoms.”

Nichols conducted the study with Ohio State colleagues Jason Nichols, assistant professor of optometry; Corrie Ziegler, a graduate student in optometry; Kari Green-Church, a research scientist with the Mass Spectrometry and Proteomics Facility; and Bryan Ham, a postdoctoral researcher at the Pacific Northwest National Laboratory in Richland, Wash.

Contact: Kelly Nichols, (614) 688-5381; KNichols@optometry.osu.edu
Written by Holly Wagner, (614) 292-8310; Wagner.235@osu.edu

© 2008 Newswise. All Rights Reserved.

Tags:
Posted in Issue 12 | No Comments »

Larry Silver

“Lazy Eye” Treatment Shows Promise in Adults

Posted by Larry Silver

Newswise – New evidence from a laboratory study and a pilot clinical trial confirms the promise of a simple treatment for amblyopia, or “lazy eye,” according to researchers from the U.S. and China.

The treatment was effective on 20-year-old subjects. Amblyopia was considered mostly irreversible after age eight.
Many amblyopes, especially in developing countries, are diagnosed too late for conventional treatment with an eye patch. The disorder affects about nine million people in the U.S. alone.

Results from the laboratory study will be published online the week of Mar. 3 in PNAS Early Edition.
Patients seeking treatment will need to wait for eye doctors to adopt the non-surgical procedure in their clinics, said Zhong-Lin Lu, the University of Southern California neuroscientist who led the research group.

“I would be very happy to have some clinicians use the procedure to treat patients. It will take some time for them to be convinced,” Lu said.

“We also have a lot of research to do to make the procedure better.”

In a pilot clinical trial at a Beijing hospital in 2007, 28 out of 30 patients showed dramatic gains after a 10-day course of treatment, Lu said.

“After training, they start to use both eyes. Some people got to 20/20. By clinical standards, they’re completely normal. They’re not amblyopes anymore.”

The gains averaged two to three lines on a standard eye chart. Previous studies by Lu’s group found that the improvement is long-lasting, with 90 percent of vision gain retained after at least a year.

“This is a brilliant study that addresses a very important issue,” said Dennis Levi, dean of optometry at the University of California, Berkeley. Levi was not involved in the study.

“The results have important implications for the treatment of amblyopia and possibly other clinical conditions.”

The PNAS study shows that the benefit of the training protocol – which involves a very simple visual task – goes far beyond the task itself. Amblyopes trained on just one task improved their overall vision, Lu said.

The improvement was much greater for amblyopes than for normal subjects, Lu added.

“For amblyopes, the neural wiring is messed up. Any improvement you can give to the system may have much larger impacts on the system than for normals,” he said.

The Lu group’s findings also have major theoretical implications. The assumption of incurability for amblyopia rested on the notion of “critical period”: that the visual system loses its plasticity and ability to change after a certain age.

The theory of critical period arose in part from experiments on the visual system of animals by David Hubel and Torsten Wiesel of Harvard Medical School, who shared the 1981 Nobel Prize in Medicine with Roger Sperry of Caltech.

“This is a challenge to the idea of critical period,” Lu said. “The system is much more plastic than the idea of critical period implies. The fact that we can drastically change people’s vision at age 20 says something.”

A critical period still exists for certain functions, Lu added, but it might be more limited than previously thought.

“Amblyopia is a great model to re-examine the notion of critical period,” Lu said.

The first study by Lu’s group on the plasticity of amblyopic brains was published in the journal Vision Research in 2006 and attracted wide media attention.

Since then, Lu has received hundreds of emails from adult amblyopes who had assumed they were beyond help.

Berkeley’s Levi cautioned that the clinical usefulness of perceptual learning, as Lu calls his treatment, remains a “sixty-four thousand dollar question.”

“It’s clear that perceptual learning in a lab setting is effective,” Levi said. “However, ultimately it needs to be adopted by clinicians and that will probably require multi-center clinical trials.”

Lu is collecting patients’ names for possible future clinical trials. He can be contacted at zhonglin@usc.edu.

The researchers are also working to develop a home-based treatment program.

For patients who can travel, the Chinese hospital that hosted the pilot trial may be able to provide treatment. Contact Dr. Lijuan Liu, Beijing Xiehe Hospital, at lijuan_l@yahoo.com.cn.

The other members of Lu’s group are Chang-Bing Huang and Yifeng Zhou of the Vision Research Lab at the University of Science and Technology of China, in Hefei, Anhui province (Huang is currently a postdoc in Lu’s lab at USC).

Funding for the research came from the Chinese National Natural Science Foundation and the U.S. National Eye Institute.

ABOUT AMBLYOPIA (from PNAS)

Amblyopia affects about 3 percent of the population and cannot be rectified with glasses. People with the disorder suffer a range of symptoms: poor vision in one eye, poor depth perception, difficulty seeing three-dimensional objects, and poor motion sensitivity.

Also known as lazy eye, the disorder is caused by poor transmission of images from the eye to the brain during early childhood, leading to abnormal brain development. Lazy eye is actually a misnomer because in many cases the structure of the eye is normal.

Source: University of Southern California Released: Wed 27-Feb-2008, 13:10 ET Embargo expired: Mon 03-Mar-2008, 17:00 ET

Contact Information

Contact: Carl Marziali, (213) 219-6347 marziali@usc.edu

© 2008 Newswise. All Rights Reserved.

Tags: ,
Posted in Issue 12 | No Comments »

Larry Silver

Discussing Finances with the Patient/Client

Posted by Larry Silver

Strategies for Obtaining Payment

When discussing financial matters with a patient/client, always assume that the patient/client can afford the service or product. Do not be shy, embarrassed or apologetic when discussing these matters. You MUST let the patient/client know how much your services are going to cost. You should feel comfortable and be able to speak with conviction. If it is at all uncomfortable for you, have another staff member practice with you until you do feel comfortable.

ASKING FOR PAYMENT

The goal when making financial arrangements should be to obtain the entire fee as soon as possible. It is important that the Accounts Manager avoid giving the patient/client the opportunity to say “No”. Never say, “Would you like to take care of that today?” Instead, give the patient/client options that are compatible with office policy. For example:

“Mrs. Smith, the fees for today are $50. Will you be paying cash or using your credit card?”

“No” is not one of the choices. Remember that if you make clear financial arrangements in the first place, you won’t have any trouble collecting the amount due.

Let us say that there is a misunderstanding and they can’t afford to pay the entire balance. You could say:

“Could you tell me how much you are able to pay?”

The idea here is to get the largest payment possible. Now you need to get the balance.

“Mrs. Smith, that will leave a balance of $560. When might I expect to receive payment on that balance?”

When they agree to a definite date for the payment of the balance, put the information on a financial agreement form and have the patient sign it.

EXTENDING PAYMENT PLANS

If it appears necessary to extend a monthly payment plan to the patient/client, adhere to the payment schedule as governed by office policy. Do not stray from established policies.

Although it may not occur commonly, you may experience a patient who cannot afford monthly payments but does want care. You might consider implementing a “lay-away” plan. This works by having the patient agree to set up an account where they will send a small amount to you each month (to be credited to their account), and when they have accumulated enough in the account to cover service, you would call them to schedule an appointment. This system would certainly require approval from the doctor prior to implementation.

DISCUSSING INSURANCE PAYMENTS

When a person has insurance, address payment such as:

“Mrs. Smith, your insurance will cover approximately 80% of this bill. Your portion will be approximately (20% of the total). Would you like to pay cash or write a check today?”

If they say, “I’ll just wait until the insurance pays, then I will pay you”, you might respond:

“Well, Mrs. Smith, I know from having worked with this insurance carrier in the past that they will cover about 80% of this service. Your portion will amount to $120. If your portion turns out to be less, we will certainly refund any overpayment due”.

If the patient/client ever becomes upset about insurance or appears unhappy, it would be advisable to explain to them how insurance companies operate, including how they can delay payments, challenge the service, etc. You can also remind them that their insurance is an agreement between them and their insurance company (or employer), and not with the doctor’s office.

Most likely, once you have clarified this with the patient/client, and they truly understand, you will not have to deal with it again. The best time to discuss this issue of insurance coverage is when the new patient/client first arrives.

Tags: , ,
Posted in Issue 10 | 1 Comment »

Larry Silver

Extending Credit

Posted by Larry Silver

Tips to Control Your Accounts Receivable

Following are some guidelines to assist you in determining to whom you wish to extend credit and how to go about collecting on those accounts.

* Assess the patient/client’s credit worthiness before extending any sort of credit. Have them fill out a “credit application” (see sample in the Form section,) and verify the information supplied.

* Always charge for any credit extended, using a monthly percentage or a flat service fee.

* When extending credit of any kind, have the patient/client sign an agreement covering the terms of the credit. Ensure that they fully understand and agree to the terms of payment.

* Monitor all accounts monthly so that you know who may be delinquent. Take immediate action on any account over 30 days past due. The older an account gets, the more difficult it will be to collect. Call the patient/client right away and make arrangements to bring the account current.

* Flag past due accounts by putting a red self-adhesive dot on the upper right corner of the patient/client’s chart folder. In this way it is easier for any staff person to see that the patient/client has a past due account and it will be more likely to get addressed.

* Each day review the schedule for the next day so that you will be prepared to see any patients/clients whose accounts need addressing. Confer with the receptionist on anyone who will need to be seen after their appointment, or from whom the receptionist would collect over-the counter.

* If a patient/client you had planned to collect from has forgotten his/her checkbook or does not have the agreed upon amount, the receptionist should contact the accounts manager or the office manager so that the matter can be addressed.

* Patients/clients with delinquent accounts, who are not making an attempt to handle it, should be sent to a collection agency. Again, this should be done as soon as possible before the account gets too old to realistically expect payment.

* Ensure that statements are accurate and are being mailed out every month on time and without fail. Utilize appropriate labels on the statements such as: Thank you for your payment.”

Tags: , , ,
Posted in Issue 10 | No Comments »

Larry Silver

THE GOVERNMENT HELPS OUT ON NEW EQUIPMENT PURCHASES

Posted by Larry Silver

Taking Advantage of the IRS Section 179 Write-Off

Written by Brad Beck, Vice President Bank of America Practice Solutions

What did you think the chances were that a banker would not start anything that is printed on paper without a disclaimer? Well if you took the safe bet you were right and here it is: I am not a CPA and therefore not certified to give tax advice. What you will read in this article are my thoughts based upon my experience in the equipment and practice finance industry. Any decisions you make about equipment purchase, and the tax benefits associated with those purchases, should be made only after careful consideration with your tax advisors. With that disclaimer out of the way, let me proceed with some information that may be helpful for you.

State-of-the-art technology and equipment has become more important than ever in a modern, competitive Health Care Office, whether you are a Dentist, Veterinarian, Optometrist, M.D., etc. The cost of technology has increased, and continues to increase, in the economic environment in which we live. Purchasing equipment is a difficult decision for many reasons but, somewhat fortunately, the government has decided to make the decision making process a little easier by giving large incentives to encourage purchases over the next few years. These incentives also help on many levels to stimulate the economy. Unlike most complicated tax legislation we see, in this case the government has gone out of their way to make the tax benefits to purchasing equipment very easy to understand.

Let’s clarify the language first. What is IRS Section 179? This refers to a small business tax incentive bill that Congress passed this year that allows small business owners a significant tax break on purchases of equipment. A taxpayer can elect to expense up to $125,000 in equipment purchases in 2007. This legislation, passed on May 24, 2007 is retroactive to purchases made since January 1st of this year. This is up from $112,000 that was previously set for this year and up from the $25,000 that it was previous to that! So this is a significant change in a tax advantage. The equipment must be used in the active conduct of a trade or business, which is just a fancy way of saying you must use the purchase in your practice. (A boat may be a valid tax deductible purchase for a fisherman but not for a Dentist!).

The dollar amount allowable to expense from Section 179 changes yearly according to inflation. The equipment purchase becomes a direct savings on your taxes due based upon your marginal tax rate. Any purchase amount that exceeds the 179 deduction amount of $125,000 for 2007 will go to normal depreciation schedules. That may sound complicated, but it is actually very simple. Below are two real world examples of the math which should explain it better.

I hope the above real world examples give you a grasp of the concept of the Section 179 tax benefits. If equipment purchases are in your near future, and you have not already used your “179″ benefit this year, you should give thought to purchasing and installing the equipment before the end of the year.

Before you all run to your sales reps and place equipment orders, there are a few points and limitations you should be aware of:

* This tax benefit is available from January 1, 2007 through December 31, 2010.

* As noted above, the “179″ write off is limited to $125,000 yearly (adjusted to inflation yearly).

* There is a phase out provision for 2007: If you purchase over $500,000 worth of equipment there is a dollar for dollar reduction of the $125,000 write off. As an example, if a Doctor purchases $550,000 worth of equipment, $50,000 of the $125,000 potential write-off would be lost and only $75,000 would be able to be directly written off and the rest would be depreciated as normal. Or, as another example, if a doctor purchases $625,000 in business assets this year, the Section 179 is completely phased out and there is no benefit.

* The practice must have taxable income to qualify and be used, but any write off not able to be used can be carried over and used in the following year.

* Business asset purchases (equipment) must be “Placed into Service”

In order for an equipment purchase to qualify as “Placed in Service”, the equipment must be delivered and installed and ready to perform its function. It must be available and capable to perform its function. It does NOT have to be paid for in full. The purchaser must be obligated to pay, which means they must have executed a contract to pay, or created a liability (loan) to pay, or actually paid for it.

This tax deduction will be in effect through 2010, so you should be planning accordingly. What happens January 1st, 2011? Section 179 reverts back to $25,000 and the phase out starts after $200,000. So at $225,000 in equipment purchases there will no benefit to the Section 179 write off. Using one of the examples above, a $300,000 equipment purchase in 2007 will give a savings of $56,000 (with a 35% tax rate), but that same $300,000 purchased in 2011 gives a savings of only $28,000. That’s a difference of $28,000. I’m sure you all can think of something to do with $28,000 other than give it to Uncle Sam (maybe that boat that the fisherman was able to write off under Section 179!).

Now as I say to my two sons, you have to make your own decisions in life and in business. In the end, if you have no need for new equipment this year, then this information may be irrelevant right now. But, if you do have a need for new equipment and don’t take advantage of this, you could be wasting money. The world will not stop turning but, like I said, we all have things we can do with some extra tax savings.

I hope this information is helpful and gives you some food for thought that you should discuss with your CPA.

Brad Beck Vice President Bank of America Practice Solutions

brad.beck@bankofamerica.com

800-214-6087

Tags: , , , ,
Posted in Issue 10 | No Comments »

Larry Silver

Motivating Employees at Your Practice

Posted by Larry Silver

By Dr. Amy Shroff, VMDDr. Amy Shroff, VMD

The success of any business depends on its employees. Figuring out what motivates them is the tricky part. Motivation, like employees, is highly individualized – what drives one person may not mean nearly as much to someone else. While some people excel with a pat on the back, others look for financial rewards and others still seek power or equity in a company.

In our fifty-person practice, I have learned there are seven key elements which motivate employees. Recognizing which employees fall into which categories is what makes for a happy and productive staff.

Fulfillment: Employees who fall into this category are motivated by the successful completion of a project. They are often self-motivated, if the job is challenging enough;

Power: These employees receive satisfaction when they can lead and direct;

Affiliation: People who enjoy interacting with coworkers like social aspects of the workplace and do well on teams;

Autonomy: This group wants independence and freedom. Setting their own schedules is the key to harmony;

Recognition: This is universal. Positive feedback on specific tasks is essential for everyone. No matter how busy the day seems, taking a few minutes to praise someone for a job well done makes an enormous difference in overall staff morale;

Safety and Security: A predictable work schedule, job stability and benefits drive this cluster;

Equity: Across the board, an environment that encourages interaction and feedback will help employees communicate their needs. For instance, an organized office system with a written policies and procedures manual, compensation guidelines and access to information ensures compliance and equity for all.

Whether the practice is large or small, strong leadership is critical. The ideal person is someone with patience and insight that can shape and guide the practice. In the high- stress world of veterinary medicine, this is a tough role. The leader must be in charge but approachable, respect each employee, and know their names and their position.

The majority of the employees in the veterinary practice setting usually fall into the Generation X (30s) or Generation Y (20s) age groups. When surveyed, I found these employees seek a work environment that’s fun, offers opportunities for growth, and provides competitive salaries, interesting new projects and excellent benefits as well as the chance to learn and develop new skills. They also wish to travel and attend conferences. And yes, they really want flexible work schedules.

Both these groups have grown up with computers and are more receptive to information found online. That can have its drawbacks. Because our hospital is open round the clock, we all work different shifts. I can go for weeks without seeing some of our staff. Often those questions that would be asked and answered in person need to be addressed via email. As valuable a tool as this may be, it is essential not to lose sight of the impact of face-to-face conversations. Important information is conveyed through voice and body language. Learn to read your employees so you can react and motivate them appropriately.

The P Word

Recognition was addressed above, but is worth taking a closer look at effective ways to use praise.

Be specific when praising an employee. For instance, take some time with the person to cite a certain task. It could be one that made the practice more efficient or helped a client or patient. Make it a point to do this in front of the employee’s peers whenever possible. Sometimes, we buy lunch for the office and make an announcement about a job well done.

Supervisors can easily keep track of good deeds if they always have a list of employees. They can check off the names of those recognized each day. Leaving a voicemail message for a job well done is another effective way to send someone a high five. Or, deliver hand-written notes on special occasions to make everyone stand out.

A supervisor or team leader can also use praise to improve poor performance. If an employee is handling the majority of their tasks well but lacking in one or two areas, sit down with the person and have a conversation. Praise them for what works and discuss changes to smooth out the rough spots.

Moving On Up

A raise isn’t necessarily always the answer. Providing opportunities for advancement stimulates many of us. Employees wear many hats in veterinary practices and quickly find out what they like best and can move in that direction. By offering staff training, opportunities to sharpen skills and career guidance, employees will work harder and smarter.

Show You Care

Make sure your employees have the tools they need to do their job. A functional and emotionally supportive work environment including appropriate lighting, ergonomic workstations, and Internet access with use of VIN or VSPN makes everyone’s job easier. Insure all diagnostic equipment is serviced regularly and fixed immediately if something malfunctions. Have enough supplies on hand to conduct training sessions. The small things do make a difference: quiet meeting rooms, interoffice e-mail, voicemail and even business cards say you value everyone’s role.

It is important for all employees to be part of the decision-making processes whenever possible. Our practice has grown and evolved since it began. To better define our hospital, employees were asked to review our collective and write individual mission statements for each department. Then, a new one was developed based on everyone’s input. This exercise was an excellent team builder.

We reward employees who generate ideas that can be implemented. Audio CDs, gift certificates, contributions to a person’s favorite charity are typical. We have even sponsored baby and wedding showers.

Along with the usual Christmas bonus, we also provide bonuses and appreciation for Veterinary Technician week as well as birthday bonuses.

Each department receives a monthly cash incentive if they gross above their target number. Bonuses are given to full as well as part-time employees and allocated based on number of hours worked.

It is important to reward hourly workers for taking a shift on a non-scheduled day, coming in early or staying late. If someone is called in for an additional shift in my hospital, they receive a monetary bonus. All employees working holiday shifts are provided lunch or dinner as well as double time pay. The goodwill and increased productivity this policy fosters more than makes up for the expense incurred.

Share Information

Employees need to understand where company dollars are spent if they are going to help a practice grow. By distributing cost information at regular meetings, our staff is always aware of what is going on and often makes suggestions to cut expenses.

Employees are the single most important investment any veterinary hospital can make to ensure profitability and success. Before you ask them what they want, understand what motivates you. If you know the answer, setting an example for your staff to follow will be easy.

Dr. Amy Shroff is owner and chief of staff at the Veterinary Emergency & Specialty Center of New England (VESCONE) in Waltham, MA. www.vescone.com.

Tags: , , , , , ,
Posted in Issue 10 | No Comments »

Larry Silver

Search Engine Marketing for Doctors

Posted by Larry Silver

Article 1 of 4 part series

By Lisa Thayer,

GoldfishNetwork.com

Surveys show that over 80% of internet users find new web sites by using search engines.

The question that seems to be on everyone’s minds today is “How do I get my website top placement on the search engines?” If you have a website, you may have found other websites above yours when you have looked for your site in Google. In order to answer the previous question, I need to give you a little background on the way search engines work.

There are two primary ways (out of many) that your website gets to the top of search engines: one is to pay for placement, the other is to market and design your website so that it rises up through the page ranks “organically” in search engine results.

Before I begin to discuss pay-for-placement online marketing, I have to get on my soap box and make a special announcement: If you glean nothing else from this article, remember this – having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. A baseline is the point at which you begin a marketing campaign so you can compare the effectiveness of the campaign.

Programs such as Google’s AdWords and AdSense or Yahoo’s Sponsored Search are good examples of paying for placement. Each search engine has their own individual fee structure. The price you pay to advertise in this manner depends on the “keywords” you choose and the competition for those placements. Keywords can be thought of as the words a person would type into the search box on search engines. They can consist of words, phrases, or alphanumerical terms. If you are spending your marketing budget on keyword ads, you need to choose your keywords carefully.

Using keywords that are overly broad such as “best dentist USA” can result in bringing more traffic to your website, but if you only have dental offices in California, that search probably won’t result in a new patient. Conversely, choosing keywords that are overly specific might bring in too little traffic, like “veterinarians who graduated from Purdue in 1983″. Keywords are so important in fact, that selecting keywords has become an industry all its own.

The two top search engines used by the general public are Google and Yahoo. Google and Yahoo also supply some of the smaller search engines such as AOL, My Space Search, Netscape, Alta Vista, etc. with their search results. In fact, if you added up the huge market share of Google it would account for almost 70% of all searches!

As previously mentioned, having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. You obtain a baseline by having your web designer add a tracking program/ code to your website. We set up Google Analytics on all of our client’s websites.

Google Analytics (GA) is a free service offered by Google that generates detailed statistics about the visitors to a website. Its main highlight is that a webmaster can optimize his/her marketing campaigns through the use of GA’s analysis of where the visitors came from, how long they stayed on the website and their geographical position. Users can define and track conversions, or goals. Goals might include sales, lead generation, viewing a specific page, or downloading a particular file. By using this tool, marketers can determine which ads are performing, and which are not, as well as find unexpected sources of quality visitors.

Many of my clients have asked, “Wait a minute…why is Google Analytics free?” The simple answer is that Google knows that if you have the information to make informed online advertising decisions, you will be more likely to advertise. And, since Google is the giant of the search engine world, chances are they will be able to earn your business.

Next time, I’ll discuss spiders and crawlers and bots…oh my!

Lisa Thayer is owner of GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients across the U.S. Lisa can be reached at 503-783-0440 or by e-mail: Lisa@GoldfishNetwork.com

Tags: , , ,
Posted in Issue 10 | No Comments »

Larry Silver

‘Twinkle after effect’ can help retinal patients

Posted by Larry Silver

detect vision loss quickly and cheaply

Scientists hope to make it available online

Scientists at Schepens Eye Research Institute have discovered a simple and inexpensive way for patients with retinal and other eye disease to keep track of changes in their vision loss. In a study published recently in PLoS One, they demonstrate that a compelling visual illusion known as the induced twinkle after-effect (TAE) can accurately identify the location and breadth of actual blind spots in people with retinal disease. The twinkle after-effect is a “twinkling” that people can see in a blind spot when they stare at a blank screen after staring at a noisy visual target such as a detuned television screen.

“Our hope is that we can make this simple technique available online or on a DVD,” says Dr. Peter Bex, associate scientist at Schepens Eye Research Institute and the principal investigator of the study. “This will be particularly helpful with patients who have glaucoma, diabetic retinopathy or macular degeneration where early detection of changes in vision can impact the effectiveness of treatments.”

According to Bex, many people fail to seek help when they develop blind spots in their vision, because their brains automatically compensate or “fill in” the missing information in their visual field. Since everyone has a blind spot where the optic nerve meets the retina, this perceptual “fill in” process is useful for normally sighted people, allowing them a complete visual image. “But this innate process can mask the effects of serious disorders such as diabetic retinopathy and glaucoma and keep sufferers from seeking help until the vision loss is very serious or they bump into objects they can no longer see.”

The traditional gold standard method for detecting blind spots (scotomas) is very expensive and time consuming and must be done in an ophthalmologist’s office. The technique known as retinal specific microperimetry is a diagnostic tool that costs nearly 50 thousand dollars and requires specialized training to apply.

In 1992, scientists became aware of what they eventually named the “twinkle after effect.” They discovered that when someone looks at a television screen filled with static noise while covering part of their visual field with a small patch, the formerly patched area is left with a twinkling sensation after the noise is turned off and the person looks at a blank screen. The rest of the visual field does not experience the twinkling effect, which was described by one patient as resembling a moving cumulous cloud. “While this discovery was intriguing, it wasn’t clear how it could be used for patients,” says Bex.

In the past several years, Bex and his team began to understand its potential. “We theorized that if people with blind spots stared at a noisy screen, the blind areas would “twinkle” when the screen was turned off and their eyes focused on a blank screen. These ‘twinkling’ blind spot areas could then easily be mapped,” he says.

To test their theory, Bex and his team asked eight patients with macular degeneration to undergo the retinal specific microperimetry test and his “twinkling after-effect” test. The team provided a blank touch screen–after the noisy screen–so patients could outline the twinkling areas with their finger.

The team found that the results of the two tests matched in 75 percent of cases, and visual defects could be detected in areas that are not accessible to conventional microperimetry, confirming his belief that TAE could be used diagnostically. “This tool cannot replace the more sophisticated technique but we believe it is a powerful, simple tool that patients can use daily in the privacy of their home to detect any changes in their vision,” he says. “If a patient detects a change, his or her physician can then study it more closely and offer therapy.”

While the results of this small study are very encouraging, Bex says the next step is to do a larger clinical study.

Ultimately Bex sees this type of test being free to the public on the Internet or distributed through a public health entity. “We really believe this could have a great impact on the visual health of the community,” says Bex.

SOURCE: Schepens Eye Research Institute, an affiliate of Harvard Medical School

Tags: , , , ,
Posted in Issue 10 | No Comments »

Larry Silver

Congress Moves Children’s Vision Bill Forward

Posted by Larry Silver

Legislation an Important Step Toward Addressing the Uninsured

For the first time, the U.S. House of Representatives has approved legislation supported by the American Academy of Ophthalmology to combat undiagnosed and untreated vision problems in children.

In a move that brings the measure one step closer to law, the Vision Care for Kids Act of 2007 (H.R. 507) was passed recently out of the House Energy and Commerce Committee. The Act is part of the Academy’s long-term commitment to see that all children, including those with no insurance, receive an eye screening. The House is expected to vote on the measure before the end of the year.

“The Academy is pleased that this legislation passed unanimously and with bipartisan support. Clearly, Democrats and Republicans agree on the importance of children’s vision issues,” said Michael X. Repka, M.D., the Academy’s secretary for federal affairs and professor of ophthalmology and pediatrics at John Hopkins University School of Medicine. “We look forward to seeing the bill continue to advance and become law.”

Introduced by Reps. Gene Green, D-Texas, Vito Fossella, R-N.Y., Eliot Engel, D-N.Y., and John Sullivan, R-Okla., the bill would bridge a significant gap in vision care. While many states have vision screening programs in place, financial resources are often lacking for uninsured children to have follow-up diagnosis and treatment. This bill would complement existing state efforts by providing funding in the form of state grants for comprehensive eye examinations and treatment for uninsured children who fail a vision screening, authorizing $65 million dollars over five years. The Academy was instrumental in developing language used for the legislation.

“Because there is not a vision mandate under the State Children’s Health Insurance Program (SCHIP), this legislation is important to support and encourage current state efforts to address the needs of our nation’s uninsured children,” said Catherine G. Cohen, the Academy vice president for governmental affairs.

The Academy has joined the American Association for Pediatric Ophthalmology and Strabismus, the Vision Council of America, Prevent Blindness America and the American Optometric Association in making treating children’s vision a top priority for Congress this year.

SOURCE: American Academy of Ophthalmology

Tags: ,
Posted in Issue 10 | No Comments »

Larry Silver

42% of Eyeglass, Contact Lens Buyers Research Using Online, Traditional Media Before Purchase

Posted by Larry Silver

WESTERVILLE, Ohio- (Business Wire)-April 7, 2009 – Forty-two percent of recent eyeglass and contact lens buyers report influence from online media, the same percentage as traditional media, revealing the increasing power of the Internet on purchase decisions, according to the Spring 2009 Ad-ology Media Influence on Consumer Choice survey.

Among 45-54 year olds, 23.5% were influenced by manufacturer Web sites and 13.2% by search results. In addition to price and quality, the most important factors to this age group were knowledgeable staff (77.7%), product availability (71.9%), and store/optometrists’ variety/selection (71.7%).

Fashion/style-related Web sites influenced 35% of 18-to-24-year old purchasers and 30.5% of 25 to 34 year olds. These two groups were also more influenced by search results or sponsored links than older purchasers, and were more likely to buy online.

Consumers surveyed were almost equally split in regards to where they prefer to purchase eyeglasses and contact lenses. Approximately 49% prefer purchasing from their eye doctor/optometrist’s office, and 46% prefer to buy from an optical store.

“Although just over five percent of U.S. adults said they prefer to buy online, that translates to a market of more than 11 million potential customers,” said C. Lee Smith, president and CEO of Ad-ology Research. “Even those buying from optical stores and opticians are influenced by online information, making store Web sites and online marketing critical,” Smith said.

Other key findings from the survey:

* Approximately 40.8 million Americans adults researched eyeglass styles and contacts online recently

* 18 to 24 year olds were most influenced by social media, with positive reviews “significantly” influencing 14%

* Fashion/style-related Web sites influenced 35% of 18-to-24-year old purchasers

* Of traditional media, television, direct mail, newspapers, and yellow pages had the most influence on U.S. buyers

The Media Influence on Consumer Choice survey is conducted throughout the year by Ad-ology Research to study online, traditional, and social media influence on buying decisions.

The 64-page downloadable report, Media Influence on Consumer Choice: Eye Care and Vision Correction, is available for purchase through Ad-ology.net, and includes 27 data charts, consumer-spending estimates by market, and additional marketing insights.

About Ad-ology Research

Ad-ology Research analyzes key marketing and advertising trends in over 400 industries and what motivates end-customers. The company’s research is used by over 2,000 advertising agencies, media properties and product marketing departments across the United States. Ad-ology Research is a division of Sales Development Services (SDS), Inc. – a Westerville, Ohio firm founded in 1989.

Methodology

Ad-ology Research surveyed an online consumer panel of 1,213 adults in a manner that is 98% representative of the adult population of the United States from January 5-8, 2009. The margin of error for this survey is +/- 2.2 percentage points.

Tags: , ,
Posted in Latest Issue | No Comments »

Larry Silver

Streamlining Your Collections

Posted by Larry Silver

Tips to Improve Your Performance

Patient/Client Billing

Those patients/clients who do not pay cash at the end of their appointment must be billed through the mail. Most offices receive a large portion of their monthly earnings in response to these billing statements. A person who receives a billing statement in the mail may or may not pay it fully or promptly, though. The Accounts Manager can increase the percentage of patients/clients who promptly pay their bills through the following:

* Send all bills out promptly. Most people tend to pay bills that come in closest to the beginning of the month and postpone those bills received later in the month. Determine exactly when you are going to send your bills out, and get them prepared a couple of days prior to sending.

* Make sure that bills are neat and professional in appearance. A neatly written or typed bill carries more authority than a sloppy one. Computer billing offers the most efficient and neat method of billing.

* Accuracy of your bills is very important. Itemize the services performed. Avoid repeating a charge on the bill that has already been paid. Ensure that the spelling of the name and address is correct.

* Indicate a due date on your billings. Any amounts that were previously billed, but not paid should be listed separately and the balance carried forward.

Collecting From Insurance Companies

While there is not really one best way to streamline claim processing, the following are some suggestions to avoid unnecessary delays:

* Use electronic filing wherever possible.

* Use approved insurance claim forms. Some other forms are easier to complete, but may not be processed as quickly.

* Pre-print your identification information on the forms.

* Pre-print your most frequently performed procedures on the forms. This helps to avoid typographical errors.

* Submit your findings for predetermination of benefits any time extensive service is needed.

* Have patients/clients bring their claim form with them to the first visit and have them fill out their section first.

* Mail all claims from your office if not filing electronically.

* Remind patients/clients that insurance plans are intended to help them pay for care, not to pay the entire cost for them.

* Explain clearly and concisely, prior to service, what the patients/client’s financial obligation is.

* Come to a mutual agreement about the assignment of benefits.

Working Patient/client Accounts

The Collections position involves more than just sending out bills. Often the accounts involve some work. Therefore an accurate records and a tracking system must be developed which will keep the Accounts Manager informed on when to expect payment and how much to expect.

Maintaining Accurate Patient/client Records

Your office should maintain a separate financial record for each family or individual patient/client. Financial records can take the form of a computerized account or a patient/client ledger card. In either case, the name on the account should be that of the person responsible for payment of bills.

Every financial transaction should be recorded in the correct account or ledger card. Every charge and every payment received should be recorded. This is done regardless of whether the payment is received at the time of service or not, in response to a bill sent by mail, or from an insurance company. The more details in an account, the better. This card or account becomes the source for the patient/client’s monthly statement showing charges and payments.

Using a Tickler

Since the Accounts Manager must “work” the accounts, it is advisable for her to develop a tickler system that she will use to track the accounts. There are a variety of software programs that can be used for a reminder/tickler system. What is explained below is a system that was originally designed for a non-computerized system. It is presented here to give you the basics of what you need, whether doing it with software or not.

This tickler system can be as simple as using a 5 x 7 file box. The file box should have 31 dividers, labeled 1-31, one for each day of the month. When you begin “working” an account (using the aging information that follows,) make up a tickler card with the patient/client’s name, account number, phone number, insurance information if applicable, and the date.

You will then note on the card every date and time that you have any correspondence with the patient/client and/or insurance company. You will also note exactly what was said and promised. If you have placed a call to an insurance company to find out exactly when you will receive payment on an account, note on the card whom you spoke with and when the money is to arrive. You would then place the card behind that date in your tickler file. When that date rolls around, you simply pull the card, see that money was to arrive that day, and if it doesn’t you place another call.

Each day when the Accounts Manager comes into the office, she should pull the cards behind the current day and “work” those accounts. As the day comes to an end, she would take the current tabbed date card and move it to the back of the box (the days then are constantly moving forward in the box). Any card that she was not able to get to that day must be placed behind the slot for the following day so that any necessary calls or follow-up can be made.

Monitoring Your Accounts Receivable

All accounts should be monitored using an accounts receivable aging sheet, whether this is done with a software program designed for such or not This acts as a valuable collection tool because the status of an account can be assessed along with an immediate determination of which patients/clients are not complying with the terms of payments. The accounts receivable sheet should be analyzed ten days after each billing period. Patients/clients who have not made their payments should be sent a second billing (31-60 days) with a reminder that their payment is past due. (A handwritten one, such as “your payment is beyond the time established by you to pay your account,” is most effective).

Patients/clients receiving a third billing (61-90 days) should receive a statement with a stronger memo. If payment is not made within ten days, this patient/client should receive a call and a firm arrangement must be established.

If still no payment occurs, it is advisable to create a “third party credibility” in the collection of this account. You could send a letter such as “We have been informed by our accounting firm that because your account is considerably overdue, it will be turned over to an attorney for immediate legal action if complete payment of your balance is not made immediately”. This correspondence creates the image of the account now being controlled by an outside, stronger source. The account then appears to no longer be in the hands of just the Doctor and staff, and may create greater credibility and enhance the collection process.

The most important factor in keeping your collection percentage high is maintaining continual communication between the office and the patient/client (and insurance companies). By really staying in communication, you will remain in control of your accounts, and you will enjoy greater success in receiving prompt payment for services rendered.

Tags: , , ,
Posted in Latest Alt | No Comments »

Larry Silver

Employers Pay High Price for Vision Disorders

Posted by Larry Silver

Uncorrected Vision Problems Contribute to Decreased Employee Performance

Vision disorders carry a hefty price tag for employers and result in a marked decrease in productivity costing businesses an estimated $8 billion annually, according to a new report released by the Vision Council of America (VCA). The Vision in Business report shows the staggering financial impact of vision problems on the economy, individual states and the workplace.

“Uncorrected vision problems are costing employers billions of dollars,” said Ed Greene, CEO of VCA. “Direct medical costs associated with vision disorders exceed similar medical expenditures for breast cancer, lung cancer and HIV, yet few Americans get regular eye exams or have vision coverage in their health plans.”

Both the private and public sectors of the economy are affected. VCA’s state-by-state analysis of the economic burden associated with vision disorders finds:

1. In 17 states the annual financial burden of vision disorders exceeds $1 billion, and in 15 additional states, that burden exceeds $500 million;

2. States representing the largest cost burden are: California ($5.5 billion), Florida ($3.9 billion), New York ($3.6 billion), Texas ($3.1 billion), Pennsylvania ($2.7 billion), Illinois ($2.2 billion), Ohio ($2.1 billion), Michigan ($1.8 billion), New Jersey ($1.6 billion) and North Carolina ($1.4 billion).

Vision in Business examines the prevalence and cost of vision problems as well as the role of preventive vision care in improving the productivity and efficiency of the American workplace. It also shows that job-related eye injuries, computer eyestrain and other vision problems are costly for employers and employees in a wide range of industries and occupations. Employees in professions ranging from engineers, construction workers, stockbrokers, software developers, to accountants and administrative assistants are among those most at risk for developing vision problems that affect their work performance.

Specific findings from the report include:

1. Vision problems are the second most prevalent health problem in the country, affecting more than 120 million people.

2. An estimated 11 million Americans have uncorrected vision problems, ranging from refractive errors (near- or far-sightedness) to sight-threatening diseases such as glaucoma or age-related macular degeneration.

3. There are nearly 800,000 work-related eye injuries each year, 90 percent of which are preventable.

4. Nearly 90 percent of those who use a computer at least three hours a day suffer vision problems associated with computer related eye strain.

5. Employers gain as much as $7 for every $1 spent on vision coverage.

“I see patients everyday with vision problems that could impact their work performance if not corrected,” said ophthalmologist Elaine G. Hathaway, M.D. “In addition to refractive errors, eye injuries and computer eye strain, eye diseases such as glaucoma and diabetic retinopathy can impair vision if not detected and treated early.”

VCA’s report also highlights recent research that finds the annual financial burden of major adult vision disorders exceeds $50 billion. Specifically, there is a $35.4 billion drain on the U.S. economy with an additional $15.9 billion borne by individuals with vision problems and their caregivers.

“The good news is that because of these high costs, healthy vision is increasingly being recognized as an important health issue in the workplace,” said Greene. In fact, the federal government has set a precedent by adding vision coverage to its new health plan that launched in November 2006.

“Regular eye exams are the best way to maintain employee vision health,” continued Greene. “Increased productivity and accuracy as well as higher job satisfaction are just a few of the payoffs one receives from healthy vision. Therefore, it is crucial that both employers and employees make healthy vision a priority through preventive vision care and offering effective vision benefits in the workplace.”

Tips for Employers:

1. Offer vision coverage as part of a health care package.

2. Ensure a safe working environment with mandatory eye protection as needed.

3. Encourage regular eye exams for employees.

Tips for Employees:

1. When working on a computer take a 20 second break every 20 minutes and look at something at least 20 feet away.

2. Those who wear glasses should talk to their eyecare professional about anti-reflective lenses to reduce glare, eye strain and fatigue.

3. Wear protective eyewear that meets the approval of the American National Standards Institute (ANSI), which will be clearly marked “ANSI Z87.”

VCA urges employees to take an active part in maintaining healthy vision by scheduling regular eye exams. Permanent vision loss is not a normal part of aging, and many vision threatening conditions have no early warning signs. Eye exams can also detect other serious health problems including diabetes and glaucoma.

SOURCE: Vision Council of America

Tags: , , ,
Posted in Issue 10, Latest Alt | No Comments »

Larry Silver

Search Engine Marketing for Practices

Posted by Larry Silver

(Article 2 of 4 Part Series)

By Lisa Thayer, GoldfishNetwork.com

“Spiders and crawlers and bots…oh my!” – Two views of the same website

One of the most challenging aspects of optimizing a website is that there are two audiences to appeal to: 1) standard website users (like you and me) and 2) search engines. There are many similarities in attraction but also some very important differences.

First, let’s take a look at the top four usability issues from a human/standard user’s viewpoint:

* Ease of navigation – This is no time to be overly “creative” and make visitors guess where to find pertinent information. Sounds like a deceptively simple piece of advice but you only have an average of 8 seconds to capture your audience’s attention. After you have spent time and effort driving traffic to your website, don’t lose them by frustrating them! One navigational tool users appreciate is the addition of a “site map” or hierarchal list of the pages of your website.

* Visually attractive – If it looks like a high school student created your website, it will adversely affect your business’ public profile. If you don’t care about your professional image, the customer might also think you don’t care about the quality of your work. Keep in mind that the internet allows individuals the chance to anonymously pre-screen your business. You may truly have a solid, reputable business but if your website doesn’t have a good design with the proper aesthetics and technical capabilities, you’ll present a poor image of yourself. Unless you know how to design a website with these attributes, you should retain the services of a web designer and developer.

* Content-rich – Studies show that website visitors read websites like billboards not novels. Make sure that whoever writes the copy for your website is familiar with this very important difference in writing for the web. Place your most important content “above the fold” so that the user doesn’t have to scroll down unless they need more details. Make your website more relevant to the user by providing a set of Frequently Asked Questions (FAQ). Don’t be afraid of having a page of categorized links to other website resources but, of course, ask that they in turn link back to your website. Also, be sure to update your content as information in your industry changes as this will garner more frequent, repeat traffic.

Speed – In our increasingly fast paced society we have little tolerance for time wasters such as watching someone’s fancy animated intro or waiting for a picture to download. Use animation sparingly for maximum impact and to respect visitor’s time.

Not every website on the Internet gets the majority of its traffic from the major search engines, but you can’t afford to ignore them. Search engines processes and methodologies are quite complex and are updated all the time. The simple explanation of how search engines work is: the user types a query into a search engine which quickly sorts through literally millions (sometimes billions) of pages in its database and produces matches /results ranked in order of relevancy.

A search engine’s database is culled from a variety of sources.* Many of the larger search engines use things called web “spiders”,” crawlers” or “bot” programs that search the Internet in a methodical way to index and find new or updated data.

The most important thing for a website owner to know is that due to the use of these automated spiders some content and links displayed on a web page may not actually be visible to the search engines.

Now, let’s take another look at the top four usability issues – this time from a spider’s viewpoint:

* Ease of navigation – A spider isn’t concerned about getting lost – either you provide an easy roadmap to and through your website or it simply doesn’t exist in the spider’s mind; metaphorically speaking of course. The best way to do this is by adding a site map.

* Visually attractive – Web spiders don’t have eyes therefore even an actual picture of Bigfoot would have no effect on relevance. Search engines don’t index images; they won’t index any text your web site presents in image format. To fix this problem, you can use what are called “ALT tags” or image descriptions in your website coding.

* Content-rich – Content is also king when it comes to web spiders but beware… search engine methodologies have evolved to identify redundant text and the overuse of keywords. This means some of the tactics ethically challenged web designers used a few years back no longer fool the search engines and can actually harm your standings if overused. Search engine methodologies these days even go so far as to calculate the ratio of actual text (content) to the amount of coding. Web spiders also consider the information within three clicks of the home page to be most relevant to a search. Spiders, as well as human users, appreciate fresh content. (I will address the important issue of updating content in the next article.)

* Speed – Although search engines generally won’t penalize for the use of frames, dynamic content and multimedia files, they will have difficulty indexing them. They also don’t index pages that require registration, “cookies” or passwords.

I have seen many business owners make the mistake of designing an elaborate website and then seek out a professional SEO (Search Engine Optimization) expert. This can lead to disastrous results such as poor performance, missing your target market, and a potentially costly redesign. Before you begin your website project, make sure you clearly express your business vision, current and future marketing plan, and expectations with your web designer. (BTW- If the web designer isn’t asking you about these vital areas perhaps you should keep looking.)

*Other search engine sources include search engine advertisements, human based search engines or web directories and topical search engines.

Lisa Thayer is owner of GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients in 9 states across the U.S. Lisa can be reached at (503) 783-0440 or by e-mail: Lisa@GoldfishNetwork.com

Tags: , , ,
Posted in Issue 11 | No Comments »

Larry Silver

Do You Know What Constitutes Great Service?

Posted by Larry Silver

The Four Components of Great Service

Great service to your patients/clients is one of the most important factors required for building a successful practice. Under the heading of great service, you will find the following key components: convenience, communication, cost and quality, importance of your service as perceived by the patient/client.

CONVENIENCE: Consider the location of your practice. People generally select a service based on how convenient it will be for them to get to the location. Surveys and studies show that well over half of the public selects their healthcare services because of a conveniently located facility.

Are your hours structured to meet the needs of your patients/clients? Most people operate on a very hectic schedule and will actively seek out those practices that offer convenient or flexible hours. Practices that really work at ways to make it more convenient for their patients/clients to use their services will surely reap the rewards for their efforts.

COMMUNICATION: Words are not the only way in which communication occurs. Appearances and actions weigh equally as important in conveying an idea or concept to your patients/clients. Look at your staff, building, reception area, signs, business cards, letters, etc. What do these communicate to the public?

Decide exactly what it is that you wish to communicate to your patients/clients and prospective patients/clients. Then convey that in not only verbal communication, but in all of the above categories as well. Teach your staff to do the same.

COST AND QUALITY: The cost of your services is directly related to the quality of service that you deliver to your patients/clients. Your patients/clients will never feel that your fees are too high (or even really think about it for that matter), if they perceive the quality of service to be valuable. If you provide inferior or slow service, it will almost automatically make your fees appear to be too high. Again, patients/clients will take into account the amount of time they had to wait, the appearance of staff and facility and the demeanor of those servicing them.

Communication ties in with this area. Ensure that your patients/clients know what you are doing. Talk to them during the examination and explain what you are doing and why. This impacts the patient/client’s impression of the fairness of your fees. Clear and professional communication with your patients/clients helps to ensure that they go away feeling satisfied that they have received excellent value for what they paid.

IMPORTANCE: Although you may perform valuable services, it is most important that the patient/client perceives how important the service is. This presents you with a “marketing” challenge. A large percentage of the population does not visit their doctors often enough.

This only indicates that the importance of regular exams has not been conveyed effectively to the public at large (or even to some of your patients/clients).

National health educational campaigns are designed to increase the public’s perception about health and the importance of regularly visiting all of their family doctors. You cannot, however, rely solely on that type of campaign alone. It is vital that you take every opportunity to provide education to your patients/clients and to raise their “IQ” in the area of good health. The more they know, the more likely they are to use and appreciate your services and to tell others about you.

Provide a variety of brochures, put out a monthly newsletter, create your own handouts. Train your staff to educate the patients/clients. Maintain awareness in the practice that an educated patient/client is a more compliant patient/client and one who is much more likely to refer new people to your practice.

Tags: , , ,
Posted in Issue 11 | 1 Comment »

Larry Silver

Purpose, Product and Statistics

Posted by Larry Silver

for the Owner of a Health Care Practice

The Basics

Most doctors, when starting their practices, miss some of the basic actions that should be established prior to opening.

An owner of a healthcare practice should always, as a first step, work out the following basics: their purpose as a practice owner, the actual product of the practice, and the statistics that will measure the success of the practice.

Below are examples that you can modify and use for your own practice

Purpose of the Practice Owner

* To establish an efficient health care practice that delivers quality service to its patients and/or clients.

* To have a very solvent and viable practice that provides a high quality of life for the doctor/owner and an enjoyable place for the staff to work.

Once the purpose has been established, it is the owner’s responsibility to set the direction and the pace for the business and to demand that the valuable final products of the organization be achieved. To do that, she/he must work out what the product of the practice is. Below is an example.

Product

* A solvent, viable, expanding practice delivering high quality care and service.

* Satisfied patients and clients who have received high quality care and service.

Statistics

* Number of active patients/clients.

* Production

* Collections

* Net Income

* Solvency: amount of cash versus bills owiing

Putting the purpose, product and statistics in place will help create a strong foundation for the expansion of your practice.

Tags: , , , , ,
Posted in Issue 11 | No Comments »

Larry Silver

Steps to Safeguard Your Practice against Embezzlement

Posted by Larry Silver

Note from the editor:

In our first issue , we published an article entitled “Steps to Safeguard Your Practice against Embezzlement.”

As our research staff continues to discover that this issue is still prevalent with doctors nation-wide, we are re-visiting this same article with additional advises.

Minimize the Risk

More than likely, you’ve heard some horror story about a colleague who had a trusted employee embezzle money from him/her. There are steps you can take to minimize the risk of embezzlement.

The following procedures are recommended by an accountant and should be part of your normal routine as safeguards against embezzlement:

Cash Handling:

1. Firm policy that every patient/client gets a receipt whether they pay or not.

2. Cash handling and cash record-keeping duties need to be segregated. Have one person collect patient/client portions over the counter and another person post balances. Have a third person do bank deposits. As owner, play an active role in monitoring sales and cash if you have too few employees to fully separate the duties for handling cash and collections.

3. Each month, compare the amount of your collections that was cash. There will be some fluctuation, of course, but if it goes low one period, it is suspicious.

4. Start a patient/client sign-in sheet where patients/clients simply sign-in. Compare this on a daily basis to an over-the-counter-collections report (and day-sheet or equivalent), looking for inconsistencies such as patients/clients who are on the sign-in sheet but not listed on the day-sheet report. Spot check by phone call to patients/clients who are reported to not have paid a portion due that day. This can be done as a “quality control” call to the patient/clients. Of the questions asked one might be something like, “It’s our policy that all patients/clients who pay any cash on the day of service receive a receipt. Did you receive a receipt today for any cash paid?” Implement this policy in writing and DO IT. This will make it far more dangerous to attempt embezzlement.

5. Have a written policy to conduct unannounced checks of petty cash and other cash accounts on a regular (bi-weekly or monthly) basis. Conduct these checks without fail.

Accounts Receivables and Statements:

6. Review your accounts receivable aging report monthly. Look for changes from the last month’s report that don’t make sense. Scrutinize any balance over sixty days old as its existence normally does not make sense and minimally means a dropped ball by someone if not hanky-panky on collections.

7. Have a written policy that no balance write-offs or account adjustments are permitted without written Doctor approval. If possible, consider a ‘lock-out’ (in your computer software) to allow ONLY the owner the ability to write-off balances.

8. Spot check day-sheets against patient/client charts, ledger cards (or patient/client account records) and the schedule book at least once a quarter, looking for any discrepancies. That you do this – sporadically – should be overtly promoted to the staff.

9. Routinely check with visiting patients/clients who have balances over thirty days old – and with past-due patients/clients you are calling – to ensure they’ve received a statement from you. The idea here is to look for incidents of the collections person throwing statements out versus mailing them in order to cover a payment embezzlement.

10. Become suspicious if you find you are all of a sudden paying a lot of refund checks to patients/clients.

Accounts Payables and Purchasing:

11. Ensure all expenditures are authorized (via written request) and documented.

Safeguarding Records and Miscellaneous:

12. If using paper day-sheets, then remove these day-sheets from the office each quarter, and store them at home or in a safe deposit box.

13. Always change the locks immediately when a key-holding employee leaves employment.

14. The last thing to remember is to assume that if someone can rip you off, they will – and take steps to prevent it; and if your antenna goes up on some circumstance, you carefully check into it.

Tags: , , ,
Posted in Issue 11 | No Comments »

Larry Silver

“Fluorescent” Cells Give Early Warning for Eye Disease

Posted by Larry Silver

Scientists at the University of Michigan have shown that their new metabolic imaging instrument can accurately detect eye disease at a very early stage. Such a device would be vision-saving because many severe eye diseases do not exhibit early warning signals before they begin to diminish vision. The testing is noninvasive and takes less than six minutes to administer to a patient.

In a recent study, two researchers from the U-M Kellogg Eye Center used the instrument to measure the degree to which a subtle visual condition affected six women. Victor M. Elner, M.D., Ph.D., and Howard R. Petty, Ph.D., report their findings in the February issue of Archives of Ophthalmology. The women had been recently diagnosed with pseudotumor cerebri (PTC), a condition that mimics a brain tumor and often causes increased pressure on the optic nerve that can lead to vision loss.

Because each woman’s disease was in a very early stage, the researchers could evaluate how accurately the instrument would detect vision loss as compared to several standard tests used to evaluate vision: visual fields, visual acuity, and pupillary light response. In each case the imaging instrument provided results that were equal to and often superior to the standard tests.

The study grew out of Petty and Elner’s observation that metabolic stress at the onset of disease causes certain proteins to become fluorescent. To measure the intensity of this flavoprotein autofluorescence (FA), they designed a unique imaging system equipped with state-of-the art cameras, filters, and electronic switching, together with customized imaging software and a computer interface.

Petty, a biophysicist and expert in imaging, explains why FA data is a good predictor of disease. “Autofluorescence occurs when retinal cells begin to die, often the first event in diseases like glaucoma and diabetic retinopathy,” he says. “Cell death can be observed microscopically, but not as yet though any current imaging methods. We believe this study is a big step forward toward creating a diagnostic tool that can characterize disease long before symptoms or visible signs appear.”

The women in the study were newly diagnosed with PTC and had not yet received treatment. According to standard tests they had good visual acuity, and their visual field tests indicated either subtle abnormalities or none at all. Visual field testing, used to measure the area seen by the eye, is a standard tool for evaluating eye diseases such as glaucoma.

After the standard vision tests were administered, the researchers measured FA values for the six women and the age-matched control group. All of the patients with PTC had higher FA values in the eye that was more severely affected. In fact, FA values averaged 60% greater in the more affected eye of these women. By contrast, the control group had no significant difference in FA values between their healthy eyes.

The researchers also found that FA data more accurately described the different degree of disease in each eye for a given patient, as compared to the standard vision tests.

Elner, who is an ophthalmologist and a pathologist, says that the ability to detect subtle distinctions is important. “Early treatment for eye disease is so important, and this study suggests that FA activity is a very good indicator of eye disease,” he says. “Cardiologists have long used blood pressure testing to head off heart disease. We believe that FA testing will likewise be a helpful diagnostic tool for eye doctors looking to prevent blindness.”

Elner and Petty have patented the device through the University of Michigan Office of Technology Transfer. They are investigating its use as a screening device in diabetes and other major eye diseases.

This study was supported by grants from the National Eye Institute. Dr. Elner is a Research to Prevent Blindness Senior Scientific Investigator.

Source: Newswise

Tags: ,
Posted in Issue 11 | 1 Comment »

Larry Silver

Are Cataract Rates Declining?

Posted by Larry Silver

The population-based Beaver Dam Eye Study was designed by Barbara E. K. Klein, MD, MPH, and colleagues to determine through long-term observation whether there were differences among age cohorts regarding rates of cataract prevalence and surgery, as well as type of cataract. Five thousand residents of Beaver Dam, Wisconsin were examined for the three most common forms of cataract-nuclear, cortical and posterior sub-capsular—at baseline in 1990 and five, 10 and 15 years later. Results were analyzed by age group and gender for this population, which was 99 percent white. The rates of all three cataracts increased with age for all cohorts and are described in the study in detail by age cohort and gender.

An interesting decline in prevalence of nuclear cataract—the type characterized by hardening of the center of the eye’s lens—was found when participants were considered in five-year age and birth cohorts (excluding the 75+ group, which had too few participants). Even after adjusting for expected higher prevalence at older ages, the study found that prevalence declined in each successive birth cohort. The authors suggested that this decline may be related to negative health habits shared by people in the older cohorts and to more positive health habits in the younger cohorts. The researchers write: “Possible protective exposures include a decrease in smoking and increase in exposure to healthy lifestyle habits.” Rates of cataract surgery also increased in the 15-year time period, as surgical techniques and outcomes improved significantly and more people elected cataract surgery at earlier points in the disease process.

Source: Newswise

Tags: ,
Posted in Issue 11 | No Comments »

« Older Entries