A Real Concern – Coverage With No Providers

A few years ago in Racine county only one dentist accepted Medicaid and she was a pediatric dentist.  The payments to dentists were so low that they couldn’t justify accepting them as payment in full, they would lose money on every patient visit.  We’re seeing more and more of that in the rest of the medical world.  As states ad thousands and thousands of people to their Medicaid programs, they have to pay for their care from a fixed sized pot of money, meaning that payments per visit will continue to shrink.

This article points this out with an actual example of billed charges and paid in full payments from Medicaid.  I don’t think that this is from Wisconsin and I don’t know how that state’s Medicaid payments mirror those in Wisconsin.  But I do know that here in Wisconsin, primary care providers (family practice doctors, eye doctors, pediatricians) are being paid pennies on the dollar compared to even other heavily discounted health insurance plans such as Medicare.

So before we start patting ourselves on the back about how great it is to have more people covered by government insurance plans, we need to consider that having a Medicaid ID card may get them seen in 8-10 weeks for non-urgent visits.  And history has shown that when that happens, people head to the incorrect source for care, urgent care clinics and the hospital emergency department for colds, sore throats and skinned knees.  Driving up the cost of their care and clogging the segment of our health care system that’s supposed to deal with truly urgent and emergent problems.

I don’t claim to have an answer to fix all of our health care system’s problems, but I can guarantee that putting hundreds of thousands or millions of Americans on Medicaid or other government programs isn’t the answer.

Dr. Warren


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Vision Restoration – Many, Many Patients Need It And I Provide It!

I’ve been practicing for over two decades now and I’ve seen incredible changes and advancements in eye care. I’ve seen the incidence of vision loss from Diabetic Eye Disease decline, I’ve seen more and more of my patients (as a percentage) have Macular Degeneration and I’ve seen more and more healthy young patients who can’t see 20/20 with standard glasses or contact lenses.

I’m seeing less vision loss in Diabetics due to earlier diagnosis and better treatment. More Macular Degeneration due to patients living much longer and developing more chronic eye diseases. And I’m seeing more patients with “sub-optimal vision” due to undergoing refractive surgery. I’m in no way “anti-refractive surgery”, the vast majority of patients do very well and have their vision correction goals met.

However, many patients are either left with glare and halos/starbursting around lights due to a small treatment zone and a high degree of correction, or with irregular astigmatism caused by improper healing, poor surgical technique or complications during their post operative period.

Many of the patients with glare and halos have simply “learned to live with it” and don’t realize that these symptoms can usually be reduced. Sometimes with just a standard soft contact lens, sometimes with topical eye drops and sometimes with standard glasses. Some of these patients however require a more advanced type of vision correction to truly correct their vision and remove their symptoms. I’ll get into the treatment in a bit.

Patients with irregular astigmatism are almost never truly corrected with traditional glasses or contact lenses and require either a custom RGP lens or what is called a Scleral Lens. Both of these lenses reduce or eliminate blur, glare and halos by acting as the single refracting surface of the eye/optical system. RGP lenses have been around since the mid 1980’s and can many times be designed in a manner that eliminates visual symptoms with decent lens comfort.

In order to more comfortably correct patients like this however, Scleral Lenses are often needed. These lenses are very large compared to a traditional RGP lens. Many times even a bit larger a soft contact lens. This puts the weight and contact point of the lens out onto the white of the eye instead of on the cornea (which is the irregular surface I’m trying to correct for. Because of this, lens comfort is typically far superior to that of RGP lenses, but still providing the desired vision correction. Its been amazing to refit patients (many whom I’ve fit previously) from RGP lenses to Scleral Lenses. The comfort difference is striking for the patients, and the vision is more stable too!

The drawback of the Scleral Lens is the cost. The fee for fitting these lenses and for the lenses themselves is about 2.5-3.5 times that of RGP lenses. Manufacturing these lenses is very time intensive, as is the design and fitting process. For this reason, not many eye doctors are fitting these lenses.

I’ve committed to fitting these lenses on patients for whom they are appropriate. I have invested in the necessary lens fitting sets and personal/professional education required to become proficient in their design and fitting. Patients who would like to find out if Scleral Lenses are right for them can see me for a no fee/no obligation consultation, just by calling my office at (262) 752-2020.