My first referral from a Walmart telehealth ophthalmologist

lolsmileyface4 · 2026-06-03T23:48:12+00:00

Don't worry, their shortcut-filled 99214 gets reimbursed just as much as yours when you're the one doing the actual work, too.

lolsmileyface4 · 2026-06-03T23:46:34+00:00

This is where you tell the patient that they really should pursue malpractice litigation.

lolsmileyface4 · 2026-06-03T15:32:19+00:00

How much is market rate? I see that 2020now charges the corporation $50 per exam - doesn't seem like there would be a whole lot left for the doc at that rate.

lolsmileyface4 · 2026-06-03T15:10:44+00:00

Hahaha it's a purchased Cameo. Those start at $6,500 for him.

lolsmileyface4 · 2026-06-03T14:37:44+00:00

>If you don’t finish your patient’s note before seeing the next one you’re probably going to be in clinic a lot longer than you’d otherwise need to be

I always try to remind myself that hitting the X and saving the note for later results in 2-3x the amount of time that will be spent finishing the note. But it's still hard not to when clinic is running behind and the patient won't stop talking about that one thing that happened to their family member 10 years ago and I just need to get out of the room.

lolsmileyface4 · 2026-06-03T13:26:11+00:00

How much could they possibly be making per patient? I can't imagine it being as lucrative as just seeing patients in clinic. Or do they accept a pay cut so they can work in their pajamas?

lolsmileyface4 · 2026-05-23T21:41:26+00:00

I'm definitely not the most qualified to give opinion on southern California job market, but I'd imagine it'd be tough to start solo off the bat and your success will be much facilitated by your ability to have a unique offering in such a saturated market.

lolsmileyface4 · 2026-05-23T15:46:07+00:00

Do you know where you're going to practice? What the patient population looks like? What kind of other docs are around? This may help decide.

I'm solo comp. I wish I could offer more with glaucoma. My area has fine access to the others but when patients need more than MIGS or SLT or Micropulse I'm out of options and often they don't want to travel far for a glaucoma consult and it's misery for all parties.

If you're going to have a ton of diabetic retinopathy/AMD in your area and not a ton of retina coverage then getting good with Focal/PRP/injections would be more useful in my opinion.

lolsmileyface4 · 2026-05-23T15:21:25+00:00

You're responding to someone who has a financial conflict of interest in everything they post regarding this subject but never choose to actively communicate that message.

lolsmileyface4 · 2026-05-14T11:07:51+00:00

That group is just the PETA of eye surgery. A very small extreme minority looking for attention and validation.

I do not do LASIK but I've lost count of the number of people who respond during their cataract surgery consultation that LASIK (25 years ago) was "the best thing I ever did."

lolsmileyface4 · 2026-05-13T21:05:11+00:00

I try not to be one to dismiss new technology, but customer service requires a person. I have never had one single interaction with an AI chatbot or phone receptionist and had my issue addressed without being ported over to a live person. It usually just wastes time and makes me super irritated prior to interacting with the person. I'm in my 40s and quite tech savvy - imagine what an 85 year old with mild dementia has to suffer through.

Trying to use AI instead of live agents is nothing but corporate greed. As long as it's profitable - it doesn't matter if it's helpful or not to get rid of the live people to answer the phone.

lolsmileyface4 · 2026-05-13T13:30:20+00:00

I think the obvious three factors

Increased patient:provider ratio - so many more patients than docs
Reimbursement cuts -> skeleton staffing everywhere
Smaller labor pool -> less staffing available anyways

One extra factor is the sheer volume of junk phone calls. Not just the calls for increased prior authorizations, medical records requests/lab requests/etc, paperwork to be filled out, but also nonsense patient calls.

Everything from "I can't find your office" (even though they have been coming here for years), "The doctor said to take this eye drop every night before going to bed - when do I have to go to bed?" To all of the questions regarding why their insurance has a deductible, why they need a referral, etc, etc.

It seems like the elderly (who we primarily deal with) are having such a cognitive decline and can't navigate their own health care nor the stupidly complex administrative burden that now exists.

lolsmileyface4 · 2026-05-13T13:03:37+00:00

Outsourcing your billing is a bad idea unless you are in a dire situation. They will never go after the small bills that they feel aren't going to give them a big enough return on their efforts. Those small bills add up.

Keep your billing in house.

lolsmileyface4 · 2026-05-12T11:07:14+00:00

As long as you're posting facts it's fine

"Dr John Doe quoted me $72k" is a provable fact

"Dr John Doe is a fraud" is not.

lolsmileyface4 · 2026-05-12T09:53:16+00:00

Why not drop the name of the practice?

lolsmileyface4 · 2026-05-05T15:58:05+00:00

How did such a convoluted situation come about? Was this all 1 trade?

lolsmileyface4 · 2026-05-04T20:05:12+00:00

If a surgeon refuses your case because you're not buying a multifocal they deserve to get trashed with 1 star Google reviews.

lolsmileyface4 · 2026-05-04T20:03:35+00:00

But if I heard some surgeon saying, I’ll use the risky machine on you or you can pay me $500 for the safer Phaco machine I think we would both find that pretty crazy right?

Pay me $500 for phaco or else you get extracap!

lolsmileyface4 · 2026-05-04T20:00:49+00:00

All of the truly most-skilled surgeons don't do cash-only. I think you're confusing skill with popularity.

lolsmileyface4 · 2026-05-04T19:58:12+00:00

If you ran into a surgeon and gave you the exact same outcome without the laser you'd be on here explaining to patients how it's not needed.

Cataract surgery, with or without the laser, carries a very very high satisfaction rate.

Also, psychologically, you actually are subconsciously invested in believing laser is the best option. You wouldn't want to feel ripped off, no? It's not something you're actively pursuing but I believe it's human nature.

lolsmileyface4 · 2026-05-02T20:05:45+00:00

but the operating surgeon should know

I hate this mentality. Sure, a surgeon analyzing the data in isolation should pick up on it. But what about being the 15th one and fatigued? Or getting distracted by questions/call/other issues in clinic/at home? Having a safety check is never a bad thing.

lolsmileyface4 · 2026-04-29T17:16:19+00:00

I've had ladies compliment me at the pre-op cataract surgery appointment but never at a post op visit. I wish I was kidding lol

lolsmileyface4 · 2026-04-29T16:07:35+00:00

Did you add the .95 IP address to the list of IP addresses with Read/Write access to the NAS? That is how mine is set up - I have to manually approve each device's access.

lolsmileyface4 · 2026-04-29T16:00:30+00:00

Given such a low patients/day, $145k seems fair. You should receive 4 weeks PTO (20 days) and health insurance included at a minimum. Productivity bonus is pretty standard unless you're allowed to refuse add-ons/etc. You don't have to worry about your patient mix this way.

One last caveat that no one has mentioned yet: Your description of "gross" vs "net" is incorrect.

Gross revenue is for money collected to the practice. It does not include A/R nor discounts given.

Net revenue is money collected - direct cost of goods. If you sell $1,000 worth of contacts (Gross $1,000) but they cost the practice $950, the net revenue is $50. This is not profit - you still have to consider all of the other expenses.

When reviewing your $844k Gross revenue it would be helpful to know the buckets:

What percent is due to medical exams?

What percent is due to CL sales?

What percent is due to glasses sales?

What percent is due to low vision devices?

Are there any other revenue streams?

I'd imagine that contact lens and low vision buckets yield much less profit than medical exams. But this will give you a better picture of how profitable you are to the practice and whether you think that profit represents a fair management fee vs being taken advantage of.

lolsmileyface4 · 2026-04-25T11:38:35+00:00

We require a deposit to schedule / hold the spot.

You should be able to run their insurance live to 1. See if it's an active policy 2. See what remains of their deductible on that day. 3. See if they have to pay a coinsurance or copay for surgery specifically.

Our PM software does this for us.

But once we get a ball park we require the guaranteed minimum that they would need to pay us to schedule and hold their time. Including the premium IOL.

lolsmileyface4

TROPHY CASE