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Real Deal

How Would You Rate This Practice’s Handling of an Angry Early Bird?

A patient denied before-hours service takes matters into her own hands.

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SPARKLE CITY OPTOMETRY normally opened its doors at 8am. Receptionist Heather, a night owl, found she could only manage this by grabbing breakfast at the coffee shop next door and scarffing it down at the front desk. One morning, Heather looked up from her sandwich to see a woman peering in the window. Heather jumped a little, and the woman waved impatiently and pointed at the door. Heather suppressed an eye-roll and moseyed over, keeping her hand on the deadbolt as she leaned her face through the door crack. “Good morning, ma’am, we will be opening in 10 minutes!” said Heather cheerfully.

ABOUT REAL DEAL
  • Real Deal scenarios are inspired by true stories, but are changed to sharpen the dilemmas involved. The names of the characters and stores have been changed and should not be confused with real people or places.
  • ABOUT THE AUTHOR
  • NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com
  • “I know that, but I need to get my contact lens order and I really need to get to work as soon as possible!” she said.

    “Our staff are still arriving and getting the office ready. I will unlock the door at 8am and we can make that happen,” said Heather, stepping back.

    “Wait!” the woman exclaimed. “Can’t you just get them for me? I paid already; you just need to hand them to me!” 
    “It’ll just be 10 minutes,” continued Heather. “There is a coffee shop next door while you’re waiting?” she said, flashing her best smile at the scowling woman. She grabbed her food off the desk and marched back to an empty exam room, far from any windows.
    By 8am the lights and equipment were on and Heather’s coworker unlocked the front door. The woman made a beeline to reception and coolly gave her name to Heather, who had the boxes of lenses ready.
    “My eyes are actually bothering me, too,” said the woman. “I think it’s allergies. Can Dr. Wylam see me now?”
    Heather grabbed the schedule and studied it, while the woman scanned her name tag. “Yes, I think we can do that! I am going to need to pull your insurance, but I can do that while you’re in with him,” she said. “You have a $30 copay. I’ll take that and a technician will bring you back.”
    A few moments later, Dr. Wylam stepped into the exam room, already operating on autopilot. “Good to see you. My notes say you’re having some allergy issues. Let’s take a look at your eyes, chin up here, look at my ear, blink…”

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    The patient suddenly pulled her head out of the chin rest and shook her head. “Actually, I need to speak to you about your receptionist Heather,” she announced. “She was here at 7:50am and came to the front door but refused to give me my contact lenses. I’m making myself late for work but I couldn’t leave without talking to you. I’ve never been treated so rudely!”

    The doctor was shocked. “I’m so sorry that happened,” he said.

    “I’m sure you are, but I want to know what you’re going to do about it,” she said, clasping her hands.

    “Well I’m sure there will be a conversation, and…”

    “I think you should fire her,” the patient said bluntly.

    “I’m not going to do that,” said Dr. Wylam without hesitation. “We have an internal system for handling staff issues.”

    “Then you’re losing five patients: me, my husband, my son and my parents,” she said. “Now, I really need to go to work.”

    Dr. Wylam said goodbye to her and summoned Heather to hear her side of the story.

    There was no punishment or follow up, but a few weeks later Dr. Wylam received a voicemail from the patient, livid that the visit had been submitted to her insurance. She threatened to report fraud if he didn’t cancel the claim and reimburse her for the $30 copay.

     

    The Big Questions

    • Did Heather treat the patient badly, or is she blameless?
    • Should this exam have been submitted to insurance? Why or why not?
    • Is there anything Dr. Wylam can do or say to salvage the situation?
     

    Expanded Real Deal Responses

    Greg H. Minneapolis, MN

    Bill her insurance. Do not refund her a penny. Your open hours are your open hours…not 10 minutes prior. Let them walk; there are more fish in the sea. Chances are she’ll be back. Too bad for your staff. Sadly, the doctor’s hands become tied whenever a patient makes ridiculous demands, and reprimanding a staff member in front of a patient to assuage the patient’s overly ruffled feathers is a dangerous precedent to set. He was right to defend Heather at that point, but a follow-up apology letter with a gift card afterwards might have helped. PS: What office is still “getting ready” 10 minutes before opening?!!

    Lewis K. Milan, TN

    Heather should have gone and gotten the lady’s contact lenses. Insisting on firing her was unreasonable. We are there to serve our patients and anything reasonable that we can do to improve our services is indicated.

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    Danielle S. Fort Worth, TX

    The question you should ask yourself is, “If I were the patient, what would I want?” The staff member wasn’t in the wrong, but the manager/doctor was. Your staff doesn’t make the decision when to come in, so therefore you should mandate that enough staff members get there 10-15 minutes before 8am to unlock the door, get the office ready, and avoid problems like this. It’s a simple solution and far more convenient for the patient. In addition, the staff should be trained to go above and beyond for your patients. Don’t leave good behavior up to fate! The charges are a little tougher. If you schedule an appointment with a doctor, you should expect to be billed. The time you took on the schedule is time they lost on other patients with real issues and trouble. However, common courtesy shows the doctor could make the choice to waive the fee, due to the circumstances of the false visit. There isn’t one right answer!

    Tim O. Richmond, VA

    Not to be too hard on Heather, but she should come to work prepared for the day and ready to work once clocked in. Creating a customer experience will reinforce strong lasting relationships. Heather should have taken care of the customer immediately and not put her off. This would have eliminated the additional issues. Given the actual events, the customer charges should have been voided and no claim sent to the insurance company. It was bad enough that they lost the family’s business; you do not want to do more damage and risk an online review that could deter other customers from doing business at the office. The doctor’s response to the request for Heather to be fired was perfect. I would suggest the doctor go above and beyond once all the event details are known to keep the customer. Except for firing Heather!

    Sheri H. Creighton, NE

    If Heather did not wish to be bothered before 8 o’clock, she should not have been sitting and eating her breakfast in full view of the windows. Was she clocked in? If she was, she is at work and should have assisted the woman. If not, she should be eating in a break room. Should the appointment be billed? Yes, the patient stated that she was having eye issues. She should simply have asked to speak to the doctor about a personnel matter. The only way for the doctor to defuse the issue was to apologize to the woman in person and explain the insurance issue versus the personnel issue. He should speak to his staff about using the break room. If you are clocked in you are considered to be at work and should assist patients even if it isn’t the stroke of 8 o’clock.

    Staci V. Sun City, AZ

    While it sounds like the patient was a bit over the top and demanding, I think it could have been handled a bit differently. It sounds like Heather was pleasant and tried her best to delay the woman, but it would not have been the worst if she helped the woman a few minutes early, unless store policy prohibits it or she herself was not qualified to dispense the lenses. While it was underhanded of the woman to make an appointment under false pretenses and she should have been up front about why she wanted to speak with the doctor, the visit should not have been billed to insurance. As for as the woman’s demand that Heather be fired, she was out of line, and the doctor did well in his response.

    Stewart G. San Francisco, CA

    1. No, the patient was not treated badly. There are many offices where rules are to start business at official opening time, not before. In some cases, premises insurance will not cover accidents during non-business hours. The employee was very polite. However, I would tell staff that they cannot eat in full view of the public. And if the patient had to get to work, why did she waste time creating that ruse right then and there?
    2. I wouldn’t have, because the non-medical nature of the visit became apparent at the time the patient spoke to the doctor.
    3. He shouldn’t bother. If the patient is offering their business predicated on removing an employee who did nothing wrong, that’s a patient you do not want in your practice. The doctor’s appreciation of their staff in these instances will go a long way to maintaining the office environment and increasing business.

    Sondra M. Wichita, KS

    Our policy states that we MUST have two people in the office before the doors are opened just to avoid this possibility. This gives an eyewitness to any unhappy occurrence and helps in controlling flow of the office. The only fault I see is that Heather made herself vulnerable by being visible. Office hours are office hours and clearly stated, if we make an exception for one, we must make exception for all. That’s bad practice as patients will think they can come and go at their convenience and not stated open hours. Insurance is justifiably filed. She stated her complaint and took the doctor’s time. The doctor stood up for his staff, that makes for a great work environment when staff know they won’t be penalized for upholding stated business guidelines. However, there should be policy in place regarding eating outside of designated areas.

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    Kenneth P. Oklahoma City, OK

    The practice took a chance on losing a patient or patients for a 10-minute issue. This sounds like an internal problem that needs to be handled quickly. Poor handling will cost the practice patients, reputation, and money. The office manager or the doctor needs to impress on the staff that they are in a customer service profession, and this was a big fail. Heather shouldn’t be fired. Nothing should have been filed. A nice gift card should be sent for the patient’s trouble. With all the competition out there, why would you risk losing this patient and her family for 10 minutes?

    Katie A. Nashville, TN

    Heather did not have to give the patient her contacts, but it would have been beneficial to the practice if she had. And that should always be the consideration taken by employees — to go the extra mile — especially with the competition from online companies and the unfortunate expectation of instant gratification becoming more prevalent. Our office realizes customer service is our best defense against online sales, so we try to put forth extra effort any way we can, even if it means staying over a little later to give a patient their glasses or working through the occasional lunch break.

    Daniel M. New York, NY

    She should have handed her the contacts. Nothing can fix this. No exam should be submitted. Copay should be taken in advance.

    Scott L. Greenville, SC

    Heather was not rude but she did handle the situation incorrectly. She took the time to open the door so it would not have hurt to get the patients’ contacts. She had them ready when the patient came in, so she could have just given them to her. Not a firing offense but punishable for sure. The exam should not have been submitted because the doctor did not actually look at her eyes. I would give her the $30 back and ask her not to return.

    Dennis I. Monroe, CT

    Unfortunately, Heather triggered a chain of events making a bad situation worse. Customer service is always the first priority. Customer service is what sets eyecare practices apart. Heather should have allowed the patient in and dispensed her contact lenses to her. The patient was already expecting a hassle, being late for work, and Heather just fueled the fire. There is no justification for the doctor billing the insurance company unless he actually gave the patient a diagnosis and a treatment. Since that wasn’t done, the office staff should immediately contact the patient and rectify the situation. There is a whole lot of room for staff education in this scenario and the doctor needs to adhere to appropriate exam protocols.

    Angel M. Cynthiana, KY

    Heather’s breakfast was not more important than patient relations. It would only have taken a moment to pull up the patient’s records and dispense the contact lenses. No type of examination or medical consultation was given, so she should not have been charged, or the visit filed. That was just throwing fat into the fire and I agree that it seems fraudulent.

    Monica T. Charlottesville, VA

    It is very frustrating when you come in early to try and get something done prior to opening, however since the contacts where paid for — I would have left her outside and gotten her contact lenses. It should not have been billed to insurance but very tempted to charge for the doctor’s time since she lied. I would refund the money and make notes in case she decided to return. I would also contact the insurance company and let them know to avoid getting in trouble with them. She doesn’t respect other people’s time and could have reached out to the doctor in a different manner. My doctors always shared emails or letters that needed to be addressed. If you want your staff to have the time prior to opening to be undisputed then I would put up a screen on the door so patients cannot see in or have a back desk they can work at — if she was just eating — she should stay in back to avoid this in the future.

    Olga C. Yuma, AZ 

    Heather shouldn’t have let it get that far. If she had let her in and dispensed the contacts in the first place the other issues wouldn’t have arisen. Sometimes staff has to use their best judgement with patient satisfaction.

    Rick R. Girard, PA

    1. Heather is 100% to blame. If she would have eaten breakfast somewhere besides in full view of a potential situation like the one that happened, all of this could have been avoided. No, instead she adds fuel to the fire by not giving the customer the contacts, which would have taken minutes at the most and, again, avoided the situation all together.
    2. No, since the exam was never really performed. Granted she mentioned allergies and that in itself could constitute a reason to file, but losing five patients and then getting accused of insurance doesn’t seem worth the hassle.
    3. I doubt it. He waited too long. Seems like Heather takes the cue from her boss.

    Chani M. Highland Park, NJ

    Heather didn’t treat the patient badly per se, but she did make some serious mistakes. If the office is closed, don’t sit near the front window where patients can see you. This would have made the issue a non-event. Once she was spotted AND went over AND listened to her request she should have sucked it up and handed her the contacts, they were paid for anyway. Then she should have told herself never to sit up front again when the office is closed. The encounter with the doctor should not have been billed, I understand she took time with the doctor but how do you legally code this encounter? Not cool. Refund the copay as well. Tough call as to how to salvage the situation. I would hand write a letter of apology/explanation to the patient, telling her how much I value her patronage etc. etc. and that Heather was duly admonished. The patient was definitely not 100% right either, but that’s not the point here, the point is the interaction occurred.

    Robert M. Edina, MN

    Heather should have gotten the patient her lenses and thanked her for her business. This problem escalated when she decided taking two minutes to deliver the lenses could have made the patient happy. Heather could have made a much better decision. You could make the argument for billing insurance, however better judgement could have saved even more pain and distress. Dr. Wylam should retract the insurance bill and refund the patients co-pay since no service was performed or treatment plan developed. He should write the patient a sincere apology for the incident and outline what steps have been taken to prevent its reoccurence. He could include a gift card or an offer of free plano sunwear. He should then follow-up with a phone call inviting her back to the practice.

    Lisa T. Mountain View, CA

    She wasn’t rude, but wasn’t friendly about it. The exam didn’t seem to be an exam after all, so the patient should have been charged for doctor’s time, but not billed for any services. The doctor can assure the patient that her concerns are heard and that his staff was following opening procedures. Maybe he can evaluate this procedure in the future. Apologize for the inconvenience.

    David G. Beckley, WV

    Yes, I believe the insurance should be billed, the patient agreed to see the doctor. There is not much that can be done in my opinion. Pull the shades. I am sure the patient isn’t going to pay Heather for her 10 minutes off the clock. Also, for security reasons the door should be unlocked when the office is fully staffed.

    Barbara S. Ohio

    Heather should have let the patient in, this is usually an isolated incident and for the client to have seen the employee in the window and even addressed by her made matters worse. The time it took Heather to go to the door and let the woman know she could come back and the ensuing actions, she could have just got the woman her contact lenses which were already paid for. No, the exam should not have been submitted because clearly, the woman, right or wrong was using his time to make a complaint, however, had Heather let the woman in in the first place, this would not have happened. Dr. Wylam could calmly have let the woman know, he will train his staff to let patients know in the future, if they have extenuating needs to pick up product outside of store hours, that they need to call in advance the previous day.

    Amy P. Corona, CA

    Heather should not have been sitting at the front desk eating in view of the front doors. I understand that they were closed but she should have been somewhere that she was not able to be seen by patients. Personally, for myself I would have given the patient her contact lenses but then again, I also deliver contacts to patients that are unable to make it to my office before I close and they are on my way home. I do not feel the exam should have been submitted to the insurance because it sounds as if an exam was not performed. I would not fire Heather but I would definitely have a talk with her. I always try to treat my patients the way I would like to be treated. It does no harm to go out of your way once in a while. I don’t think there is much that can be done to salvage this situation.

    Judy C. Virginia Beach, VA

    Lesson 1: Don’t eat breakfast, or any other meal, in view of patients. 
    Lesson 2: Establish an office policy concerning allowing anyone in outside of operating hours and develop a “script” to use.
    Lesson 3: Refund the copay. Cancel the claim. This patient will never let it go if you don’t. Document everything.

    Ben R. Rockford, MI

    1. No Heather did not treat the patient badly but at the same time once you open the door for a patient you are kind of out of luck. If I had opened the door, I would have taken care of her. That said I would have made a “just a minute” gesture and disappeared out of sight if it was that important that I not open the door a few minutes early. 
    2. Depends. Did the doctor find something diagnosable if so then yes the patient used doctor’s time that he could have been using for a patient who had an actual concern.
    3. No this patient is someone who is just looking for a reason to make everyone as miserable as she is.

     

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    Real Deal

    If This Team of Expo Slackers Worked for You, What Action Would You Take?

    They spent most of the all-expenses-paid trip in the hotel bar.

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    DR. BENNIGAN’S STAFF of 12 was buzzing. Liz, the office manager, was spreading the word that for the first time ever the practice would be sending some team members to a big optometry conference. The lucky staff members would fly from their home in Lexington, KY to Atlanta, GA for three days of continuing education, special events and expo exhibits.

    ABOUT REAL DEAL

    Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

    ABOUT THE AUTHOR

    NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

    Liz asked everyone to email her a short “essay” describing why they wanted to attend and what they hoped to get out of the experience. Based on these essays Dr. Bennigan chose four staff—two opticians and two technicians—plus Liz to lead the trip. She immediately booked the flights so the group could sit together. Dr. Bennigan agreed to pay each staff person their regular wages for an 8-hour workday. Liz carefully scheduled each staff person with CE lectures as well as time to attend the expo. She printed the course handouts and made binders for each attendee.

    The morning of the flight Liz met her four co-workers in the office parking lot and everyone loaded into an airport shuttle van. It was early, just after dawn. As they pulled out onto the highway Liz shushed the group to go over some of the details, beginning with her binders.

    “I’d recommend reading through your handouts on the plane,” said Liz. “Dr. Bennigan has scheduled a 3-hour staff meeting for when we get back home, and each of us is going to need to present a 3- to 5-minute summary of what we learned at each lecture.”

    The group collectively rolled their eyes and shifted in their seats, but no one argued.

    “Tomorrow night at 7:30pm we are going to meet up in the hotel bar and walk across the street to a restaurant so we can talk about the first day, okay?” The girls tiredly sipped cups of coffee and stared out the windows.

    Liz was booked in a room by herself and spent the first night zoned out in front of the TV. The next morning, she saw one of the opticians on the shuttle bus.

    “Where’s your partner in crime?” Liz asked amiably.

    “Oh, we met up with a few of my old co-workers at a bar last night. She got pretty drunk,” the optician said, chuckling. “She’s still out cold; I left her in the room.”

    “Oh boy,” Liz tried to hide her frustration.

    That evening, Liz waited for her team as planned but by 7:40pm she sent a group text asking for an ETA.

    “I forgot!” wrote the technicians. “We’re at the big optometry party – come here!” “We have drink tickets!”

    “We’re too tired,” texted one optician. No reply from the other.

    Liz called the restaurant to cancel their reservation, and backed off the group for the remainder of the trip.

    At Dr. Bennigan’s staff meeting the presentations were of varying quality: one of the technicians did an adequate job, but the other had clearly not taken any notes during her classes. The two opticians confessed to missing several classes and largely worked off the handout binders.

    Dr. Bennigan held the four back for a recap. “Ladies,” he began, “Liz and I are not satisfied with your efforts—not today, and not while in Atlanta. I was OK paying you for the time you put in to your education, but you clearly have taken advantage of the situation.

    I think we need to revisit the terms of this trip.”

    The Big Questions

    • Would it be fair of Dr. Bennigan to subtract from an employee’s daily rate for each missed course?
    • Should the team be held accountable for missing team-building events? How?
    • If Dr. Bennigan decides to send staff next year, what should he do differently?
    Becky M.
    Osawatomie, KS

    We have to show proof that we attended our classes. If we don’t have our schedule stamped we don’t get paid for the time in that class. The staff should not be paid for the classes they did not attend. The staff was disrespectful for not attending the dinner they were aware of ahead of time. If the doctor sends staff next year he should spell out, in writing, what is expected of staff and none of the staff that attended this year aside from Liz should be allowed to attend again. We have never had to put the expectations in writing at our practice. We have a lot of fun at conferences but we also attend our classes and take notes because we’re being paid to be there and our doctor is paying for CE. Common courtesy and respect.

    Thomas W.
    Myrtle Beach, SC

    The doctor paid the staff to attend the classes. They did not attend, so it would be fair for him to subtract for each missed course. The team should be held accountable for missing the team-building events, but as these were clearly after hours and not during their paid work hours, there should be no financial consequences for missing these events. If the doctor decides to send staff next year — and I think he should—he should personally explain his expectations to the staff. Additionally, it would be wise for him to attend the conference along with his staff. It would also be a good idea for him to take them out to dinner as a team-building event and not as a business meeting. I would encourage keeping the team together as much as possible. The office manager zoning out in front of the TV by herself is not acceptable.

    Deanna A.
    Fort Collins, CO

    Express your concerns and document it in their employee file. I would consider sending less people the following year and certainly not the ones who didn’t follow through. There seemed to be a lot of hand holding and trying to make sure they follow through. There needs to be some point of responsibility of the employee. They go to learn and share. The partying and missing classes is abuse of the situation. Next year if they miss class, then they would be docked those hours and asked to reimburse for the cost of education.

    Brian C.
    Prescott Valley, AZ

    We had a similar situation when I took my entire staff of five to Vegas Expo West about 20 years ago. Most of my staff did not attend the education I paid for, and were off drunk/gambling the entire time. Time dedicated to purchasing new frame lines and evaluating equipment was spent trying to find errant employees who were passed out/vomiting in their rooms after the “Marchon party.” It was a terrible experience. I was furious that I closed my clinic for three days (thousands in lost revenue), paid for the entire thing (a couple more thousand dollars), the staff’s hourly wage for three days, and I netted no positives at all. It was a complete waste of time and money. The staff noted my resentment for years afterward, and never brought up going to Expo again. I have never paid for any employee to go to Expo since. I attend it alone, sober, and only for one day.

    Chris D.
    Tampa, FL

    I would not touch the employees’ pay for the trip. But not having filled the agreed requirements, I would suspend them for three days for gross negligence of their duties. This was not vacation; this was work and education. The expectations were set. They failed to deliver — three of them, at least. I would bar them for one year for any company paid events or education. I wouldn’t rub their noses in it, but set the tone to know it will never be tolerated again. And why.

    Cherlyn F.
    Decatur, IL

    Speaking as an office manager, I would write up the employees who did not participate according to the agenda. I would also forbid them from any future trips for a period of time, say one to five years. Our policy on continuing education: Continuing education and the expenses involved will be left to the discretion of management. There may be times when you will be required to attend a seminar scheduled after office hours, or on a Saturday or Sunday. The doctors will pay your registration fee, and you will be reimbursed hourly pay for time spent in classes and for two hours for exhibit hall time. No reimbursement for travel expenses will be considered.

    Pamela M.
    Highland, CA

    1. Would it be fair of Dr. Bennigan to subtract from an employee’s daily rate for each missed course? ABSOLUTELY.
    2. Should the team be held accountable? YES.
    3. No further out of area continuing education except for the staff person who adhered to the rules. No exceptions for staff members who took advantage of their employer and office manager. The staff, despite the rules, took this as a vacation at the employer’s expense. Shame on the employees. This breach of trust has now created an office problem and will remain as part of the employees’ records. Trust will have to be earned back, if that is possible, and it is up to the doctor and the office manager.

    Taylor K.
    Ellington, CT

    1. Yes, it would be appropriate to subtract the daily rate for missed courses. The staff was being paid for the hours they were attending the conference/expo, so why would they be paid for not going? Especially considering typically you pay per credit hour, so not only would the staff be paid to not be working, they were wasting money for attendance fees.
    2. While it is frustrating the team didn’t attend, if they weren’t being paid for that time, there isn’t much to do for this specific issue, unless staff was told it is mandatory.
    3. I would call a meeting with the doctor and the attending staff and express disappointment with what transpired. I would then explain that I will not be considering any staff members who missed courses for the next education trip. In the future, having very clear expectations of the staff will be essential.

    Judy C.
    Wilkes-Barre, PA

    Yes, the doctor should hold the staff members accountable. Rather than docking their pay, it should be considered during their annual review process and the costs reflected in any resultant pay increase. I also believe there should be a written agreement between the doctor and any staff members attending a conference stipulating what will be required during the event. I would hope that any staff members offered this opportunity would jump at the chance. I know I would have.

    Pam P.
    Downers Grove, IL

    It’s disappointing when a staff member does not value an opportunity like this! However, without expectations set prior to the trip, I don’t know that it would be fair to not pay for something promised. Spelling out expectations and letting staff select classes that might interest them, or covering CE requirements if they are certified, would give staff the ability to decide if they could meet the doctor’s expectations. Additionally, it should have been noted that any missed classes/days/activities that are required (and most likely already paid for) would result in a reduction of any reimbursement or pay. Working together as a team to cover any aspects of the meeting the doctor needed information about would have benefited all. But the girls all missing the meeting Liz had asked them to attend at the end of the first day could have derailed plans for the following days and was blatantly disrespectful to Liz. Action might be considered in that respect. The staff acted irresponsibly.

    Martha D.
    Wheatfield, IN

    I definitely think he should subtract some of the hours for the ones who didn’t attend their classes. They didn’t live up to their part of the bargain. If he does send anyone next time, I would draw up paperwork specifically letting them know what is expected of them and what is expected of the doctor and have everyone sign. That way, when they come back afterwards and the doctor goes over the conference with them, all parties will be held accountable. If I was the doctor, I would have been really upset with my staff; they were chosen to go and all they did was play around.

    Dennis I.
    Monroe, CT

    The doctor should have laid out all expectations and consequences prior to the meeting. This way, if someone didn’t fulfill their duty, there would be no questions regarding consequences. The staff manager should not only have made sure the staff met for an appropriate meeting, but also allowed for free time. Because the doctor and manager did not lay out their expectations, the only consequence should be that the individuals do not qualify for another trip.

    Rigo L.
    Indio, CA

    This is funny, and at the same time sad but true. The staff should be held accountable for this. There is no reason why the doctor has to pay/lose for their staff to party. The staff should be ashamed, but I understand how things got out of hand. I give props to the manager for not trying to babysit her staff. I would subtract their pay — they would understand why. They need to understand that this is not acceptable. If they get bonuses, I would consider skipping them or cutting them significantly. I would also consider a write-up as well. As for the following year, I would still send staff but not those same staff ever again. There is no room for immature staff.

    What’s the Brain Squad?

    If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

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    Real Deal

    Ever Feel Like Your Billing Policy Is Backfiring?

    This practice does. How can it get back on track?

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    IN FOCUS VISION CARE, a private practice in Olive Branch, MS, was adding a new billing manager to the office. Sean had four years of experience submitting optometry claims and 12 years billing for a physical therapist; this would be his first position as a supervisor. Erin was office manager and spent a lot of time training Sean during his first few weeks. After lunch on his third day, Erin brought Sean to the conference table and spread out several documents.

    ABOUT REAL DEAL

    Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

    ABOUT THE AUTHOR

    NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

    “I’ve delayed going over Medicare but I think it’s time,” Erin began. “We made a decision that doesn’t really seem to be panning out for us, so you and I need to work with the doctors to edit our protocol.”

    Sean was intrigued. “I’ve always known Medicare to be straight-forward. What’s happening?”

    Erin pulled one of the documents toward Sean: an EHR-generated pie chart. “As I mentioned earlier, 44% of our comprehensive exams in the last five years have been Medicare exams. Eighteen months ago we saw a major increase in Replacement plans.”

    Sean nodded. “Right, patients on Medicare can buy a hardware benefit. I’ve seen this advertised on television.”

    “Well, the plans these patients pay for also include a well-visit.”

    “The doctor I used to work for always sent the exam to Medicare. I understand these plans to be for optometrists to ‘identify – don’t treat.’ Elderly patients usually have a medical diagnosis and require actual care.”

    “I agree with you. Their comprehensive exams are, on average, too complex to bill to these kinds of plans — not to mention the significant difference in reimbursement!”

    “So what’s the issue?” Sean asked.

    “Several patients complained, first to our doctors and then to me, that they wanted to use the services they had purchased. Most of the patients I spoke to were in their early 60s and relatively new to Medicare. One patient even went to our local newspaper and got a reporter involved. ‘Potentially deceptive practices.’ We were pushed into the spotlight.” She sighed, pulling the newspaper clipping out of the pile towards Sean. “We did what we thought was best at the time: the doctors only do a refraction and the minimum level required for the Replacement plan, delay all patient counseling and education, then schedule a comprehensive visit using Medicare for a few weeks later.”

    Sean nodded. “That sounds reasonable. The patient uses both plans and I imagine at the second exam you skip the refraction and only collect the 20% co-insurance?”

    “Yes, but the problem is most patients are no-showing to those exams, or canceling last minute and never rescheduling. We’re now seeing these initial patients pass the 12-month mark and call to book again. One doctor believes as long as we document carefully and have a signed consent that each patient understands the difference between the well-visit and a comprehensive exam, it’s the patient’s right to select their level of care. The other doctor told me she plans to refuse well-visits for patients who skipped their Medicare-level exams last year, because she doesn’t think a piece of paper will protect us from the consequences of subpar health care.”

    Sean drummed his fingers on the table. “I think I need to do a little research before bringing my professional recommendation to the doctors,” he said.

    The Big Questions

    • How would you have solved this dilemma if it was your practice criticized in a newspaper?
    • If your parent/grandparent was a patient at this practice and wanted to use a Medicare Replacement plan, which doctor would you side with?
    • Would your own protocol be affected if your Medicare base was only 10%? How about 80%?

    Real Deal Responses

    John M.Victoria, TX

    I recommend the practice stop participating in the Medicare advantage plan and see patients that have regular Medicare.

    Nina C.North Chesterfield, VA

    This is hard. I would like to do the wellness on the vision plan, but Medicare patients have more complex ocular situations than most. We have a large Medicare group. Most will not return for the Medicare exam and liability is such that I cannot give a “lesser vision exam.” We tell patients when making the appointment and again on checking in that we are Medicare providers and will be filing Medicare. We will be collecting refraction fees unless the patient has a vision plan that coordinates benefits to cover refraction. We can use their material benefit towards glasses or CLs. Those who disagree never make an appointment or leave. If the optometrist was to forsake filing Medicare, we would soon be dropped as physician providers.

    Rigo L.Indio, CA

    Newspaper! Who reads a newspaper nowadays? Anyways, it could have been worse with social media or TV. Patients with Medicare usually require extra time and visits and they think Medicare works the same everywhere. I have seen offices take Replacement plans with Medicare only if they have a vision insurance plan and refer out for medical exam or not take Medicare at all if it’s a Replacement plan. Well visits don’t do much for a patient and most of the time they need comprehensive exams or medical during an office visit. That being said, I would change protocol for the Medicare patients to only see them for comprehensive or office visits. I make that clear when the appointment is made. Having a good relationship with MDs and co-managing patients works best.

    Maureen G.Oak Park, IL

    I see the problem as one of a lack of educating the patient. Our office sees maybe 10 percent Medicare patients, but the doctor takes time to explain so the patient understands the importance of the medical visit. We have few if any patients that do not schedule a medical visit. And it has to be the doctors doing the explaining, not a manager or technician. Patients will listen to a doctor more than anyone else.

    What’s the Brain Squad?

    If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

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    Real Deal

    A Sublease Eye Doc Didn’t Work Out

    Should the optician/owner pursue their non-compete?

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    ROXANNE WAS AT HER desk on a Sunday afternoon reviewing bills and rubbing at stress hives on her neck. The optician-owner of a gorgeous boutique near Sioux Falls, Roxanne was at her wits’ end with her sub-leaser, Dr. King. The women had a meeting scheduled to try to resolve their differences.

    ABOUT REAL DEAL

    Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

    ABOUT THE AUTHOR

    NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

    The pair met the previous year at a CE event and hit it off. Dr. King, a stay-at-home parent of several years, was inspired to return to work part time, and Roxanne was inspired to offer eye exams to her loyal client base. They created a two-year contract including a non-compete clause limiting Dr. King from practicing within 3 miles of her office within a year of contract termination, on penalty of several thousand dollars. Once the commitment was made, Roxanne retrofitted storage space into an exam lane and purchased second-hand equipment.

    Roxanne, waiting impatiently, now ran through the details in her mind to prepare for a contentious discussion. The terms of their agreement were 8-10 comprehensive exams in 4 hours for a flat rent. Patients scheduled with Dr. King directly so she could book around her family commitments. She billed and collected all exam fees, while Roxanne’s employees pretested, collected co-pays, and processed contact lens orders.

    For a few months everything went well. Then the financial disagreements began: Dr. King started scheduling just 2-3 patients a day and decided it would be fair to only pay rent every second or third week. Payments on the equipment leases were now greater than the rent. Roxanne was also seeing lots of shipping charges for contact lens trial orders, which Dr. King felt were the responsibility of the business as they profited from supply sales.

    The front door squeaked and a moment later Dr. King sat down at Roxanne’s desk. She looked worn but resolute. “I know you called this meeting,” she began, “but I’d like to speak first.”

    Roxanne nodded and pushed her paperwork to the side. “Okay, I’m ready.”

    “I’ve given it a lot of thought, and I just don’t think this is a good fit for me,” said Dr. King. “I’m tendering my resignation, effective 2 weeks out. I don’t have any patients booked past then anyway.”

    Roxanne’s eyes bugged. “You’re quitting?!” she managed to get out, throwing her head back and staring at the ceiling. “You’re quitting.”

    “This just isn’t fun for me,” she continued. “I don’t like your stress towards me, and I feel like I’m being nickel-and-dimed.”

    “Are you leaving to go work somewhere else?” asked Roxanne.

    “No, my wife and I don’t rely on my income,” she said.

    Roxanne sighed. “Well, it sounds like your mind is made up. It stinks we weren’t able to resolve things, but … I get it.” As soon as Dr. King left, Roxanne got to work posting the job vacancy online.

    A few weeks after Dr. King’s last day, Roxanne’s lab tech stopped her in the hallway. “I just heard through the grapevine, Dr. King is seeing patients over at Family Vision Center,” he whispered. Exasperated, Roxanne thanked him and went to call her lawyer about enforcing the non-compete clause. Family Vision Center was less than 2 miles away!

    The Big Questions

    • In what way could Roxanne and Dr. King have changed their agreement to mutually improve the situation?
    • If Dr. King bills for a contact lens fitting and the boutique bills for the supply, who pays the shipping and handling of trial lenses?
    • Is a non-compete clause justified for a sublease doctor? If the lawyer deems the contract enforceable, would you pursue?

    Expanded Real Deal Responses

    Andy H.
    Jacksboro, TN

    This scenario poses a significant problem for the optician/owner. I’m not sure how I’d resolve this situation, but it could’ve been avoided if a reputable business consultant had designed the contract. A professional consultant would have covered all the disputed variables. I think it’s interesting that a recent INVISION survey showed a mere one in four ECPs use consultants, and this Real Deal demonstrates the need to do just that. We’re all pretty smart about eyes, but not many of us can claim to be experts in business.

    Chris G.
    Inver Grove Heights, MN

    First, I didn’t see a copy of the non-compete document. Some of these documents are unenforceable depending on the laws in the state where this occurred. Second, all costs should be negotiated at the beginning of the employment. Third, even if a lawyer deems the contract enforceable, it can still be nullified by a myriad of other factors. Having said this, if all the contingencies are met in the agreement and it is enforceable, I would go after it immediately. Another part is who owns the files in the office. That should be negotiated as well.

    Bill K.
    Houston, Tx

    Bad terms of agreement upfront. Starts bad, ends bad.
    1. More concrete terms and understanding.
    2. Cost of trials? Ever hear of fitting sets?
    3. Non-compete should hold up if written correctly.
    Not a bunch of 2-year-olds at play. Grow up and live up to your commitments. “I don’t feel like I am respected.” Blah blah blah.

    Anna T.
    Claremont, CA

    First of all, they should have spoken more about what was expected from the lease. Possibly going through a broker to have a legal agreement prepared with terms stating that the lease was to be paid every week and that X amount of patients were expected per week. Also, they should have agreed upon the costs of the lenses, and who was paying for shipping charges in the agreement. Ultimately, I think that the doctor just did not have the right work ethic for this sort of collaboration. I think that the doctor’s fees should cover the trial shipping costs. I believe the non-compete is justified. However, since this doctor did not spend very much time working at the location, I am not sure that she would be much competition if she were to set up office in a nearby location. Most likely with her work ethic she would not be much of a business owner in the future.

    Rigo L.
    Indio, CA

    Ohh, the drama! It’s always easier to blame the other person. Both Roxanne and Dr. King gave up too soon; communication is key. It was unprofessional for Dr. King to quit. It’s not expected but the doctor should feel heavily responsible — in this case it looks like it was all business. The shipping and other stuff could have been worked out if both were willing to keep to their agreement; at the end of the day they still made a profit. As far as pursuing the non-compete clause, it sounds exhausting, expensive and time-consuming, but if this is going to save my business, I would go ahead with it.

    Darrell L.
    Goodlettsville, TN

    The contract should have spelled out the particulars of fees, bills and supplies. Leaving things open-ended always creates problems. The non-compete is justified and was agreed to in writing, therefore it is binding. If the tables were turned, the doctor would likely pursue reimbursement for damages from the optician.

    Frank U.
    Bakersfield, CA

    No lawyer; lesson learned, find another doctor.

    Wilfredo M.
    Philadelphia, PA

    Unless Roxanne and the doctor agreed to bringing another doctor to work more hours, I don’t see how. Two or three exams a day doesn’t justify the expense of equipment, or cutting the space to put in an exam room.

    The optical should pay for shipping for trials, but also keep in mind that for trials at least a commitment for the sale of the contacts should be engaged, or an order for glasses should be placed — and then seen as a courtesy from the optical, not from the doctor.

    Whatever is the right and legal thing to do. If the income was not the issue based on Dr. King’s answer, why work in a place that close? People should not be allowed to conduct a market study while working with you and then become your competition! Keep in mind that patients are the “property” of the doctor, who did the billing.

    What’s the Brain Squad?

    If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

    Continue Reading

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