Optometry Simplified: Vision vs. Medical - Who Is Winning in Your Practice?


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Welcome to Optometry Simplified.

In this weekly newsletter, I've curated the best resources to help you grow personally and professionally.

My mission is to find what's best for my patients and my practice.

Here's what I've found...


Links I Liked

AI may be reshaping eye care faster than most ODs realize.

A new industry website, ODs on Technology, covers the intersection of artificial intelligence, diagnostics, and emerging clinical tools. It's a clean, well-curated resource for independent ODs who want to stay ahead of the curve without spending hours hunting down what matters. ODs on Technology

The price of greatness is responsibility.

Vance Thompson, MD, offers a good reminder that quality care requires persistence, and that is our responsibility. As much as I get annoyed and want to rebel and throw away or avoid the whole system, it is my responsibility to see my recommendations through to the end. Ocular Surgery News


Research I'm Reading

Nothing like a miserable kid at home to sharpen your clinical thinking.

I'm seeing a handful of pediatric VKC cases roll in this spring — the worst of which is my own 7-year-old. The American Academy of Ophthalmology just published an Ophthalmic Technology Assessment reviewing corticosteroid-sparing topical options for VKC in children. Ophthalmology


Deep Thoughts

Where is your practice in terms of medical eye care? How well are you managing the tension between vision and medical insurance?

Most doctors in private practice answer confidently. They point to a full schedule of glaucoma patients, diabetics, and red eyes. They point to OCT and visual field volumes. By every surface measure, they look medical.

However, when we perform audits on these practices, their charts and billing habits tell a different story.

What we find, more often than not, is undercoding and underutilization of medical codes and insurance.

Undercoding in that 992x2s and 992x3s are above normal distributions, and 992x4s are severely under typical distribution patterns.

As for underutilization, we see many of those supposed "medical patients" are cared for but billed under vision insurance.

That is not what we mean by growing medical optometry.

Here is a simple metric worth pulling right now: What is your ratio of 992xx codes to refractions? In a practice doing genuine medical care, that number is well over 50%.

So, where is your practice?

One framework that practice owners have found clarifying is the three levels of comprehensive care. Rather than asking whether you are "doing medical," it asks a more honest question: how completely are you owning the care your patients actually need? Here is how most practices map onto it.

Level one: Routine and Reactive Care

Annual exams, glasses, contact lenses. Chronic disease gets detected and referred. Acute care is handled when it walks in. Vision plans are the primary payer by default, not by design. This practice cannot grow without volume, and it cannot serve a patient with a serious disease at the level they deserve.

Level two: Expanding Protocol Care

Something has shifted. The practice is separating routine from medical appointments. The doctor is comfortable managing two or three chronic diseases. OCT and visual fields are used regularly. Some medical billing is happening, though inconsistently.

The main gap is incompleteness. Patients with medical diagnoses still slip through under the vision plan. Coding is uncertain. The right things are happening — just not reliably, and not yet in every chart.

Level three: Total Patient Care

Every patient is evaluated beyond refractive status. Medical insurance is the default payer when a medical diagnosis exists. E/M coding reflects the actual complexity of the visit. Chronic disease has defined protocols — repeatable systems that drive frequency, testing, and documentation.

At this level, the insurance company is still a factor, but it is no longer the primary driver of clinical decisions. The standard of care is.

That is a fundamentally different practice — clinically, financially, and culturally.

The question is not whether this level is possible. We see it regularly. The question is whether you are building toward it or drifting away from it.

If you are not sure where your practice sits, that is worth knowing. Chris Wolfe, OD and I work with practices through chart audits, workflow reviews, and building the systems that move practices from one level to the next.

If you are ready to make real and lasting changes in your practice, sign up for our Comprehensive Optometry Program.

Or become a PPP Pro member and get the program, plus everything else your practice needs for compliance and education.

Either way, the first step is the same: see clearly where you are.


Practice Performance Partners Pick

I recently joined Aaron Werner, OD, on his podcast to unpack why busyness isn't the same as effectiveness and how intentional systems drive real practice growth.

We dug into the practical pillars of myopia management, dry eye, and glaucoma care through the lens of mindset, metrics, and implementation.

Enjoy!


Can you do me a favor? If you found any of these resources helpful, share this newsletter with one of our colleagues!

See you next week!

--Kyle Klute, OD, FAAO

1515 S 152 Avenue Circle, Omaha, Nebraska 68144
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