SARAH: Welcome back to the Southeast Ohio QI Hub. Today, we are joined by Dr. Shane Foster, who is actually from Shade, Ohio. SHANE: I am. And I'm glad you mentioned that because my grandma will be very proud that you brought that up. SARAH: I love that. I love that so much. I feel bad that I did not know that you were local. Yeah. That's a terrible thing. Yeah. That's a terrible thing on me. So Dr. Foster works here at the Athens Eye Care, here in Athens, Ohio. And Dr. Foster also works a lot for our community. So, he has also been at the community health programs, helping with eye programs there, along with other things that you do for the community and for the greater good for eye care all over. So we have asked Dr. Foster to come today to help our primary care docs navigate these eye exams for our patients with diabetes. So I think we just wanted to talk a little bit about thoughts on that. So maybe talking about eye exams first, I don't know. Where do you want to start? SHANE: Sure. I think eye care is such an essential part of healthcare. I like to tell people that just through an eye exam, we can identify over 200 systemic diseases. The effects of those diseases, anyway. SARAH: Wow. SHANE: By looking at the retina, because the retina's the... Well, first of all, it's a direct extension of the brain. It's the nervous system that we can see just looking in through the pupils. SARAH: That is so cool. SHANE: So, we can identify neurological diseases- Yeah ... and then certainly, a lot of vascular conditions as well. So, it's the only place in the body where we can see the blood vessels in their natural state without having to cut through the skin or do imaging. We can look through the pupils, look at the surface of the retina, and see those tiny blood vessels, and look for any kind of vascular diseases. Certainly diabetes but there's also hypertension, high cholesterol, those kind of things. SARAH: That is so cool. I'm going to sit here for three hours and ask you a bunch more questions about the eye. Okay? SHANE: Yep, sure. SARAH: So a lot of our eye docs, they have cameras in their office. And in some of the conversations with them, one of our docs had said, "I'm afraid I'm going to miss something if that's all I do, is with that one camera." So what are your thoughts on that? SHANE: I think there's certainly the cameras and the technology that's out there. Yeah. There's AI technology, or you can read those retinal photos at a reading center. Yeah. And I think that that's, certainly, it's not a bad thing. But it could sometimes give people a false sense of security. You say, "Your retina looks healthy. We don't see any retinopathy." Right. But retinopathy is not the only thing we're looking for. We are looking for glaucoma. We're looking for these neurological diseases. We're looking for a neoplasm in the choroid that could turn into a malignancy. SARAH: Wow. SHANE: Those are things that are super important to detect, and that technology may not be detecting those. So, yes, we're looking for diabetes when we do an eye exam, but we're looking for so many other things as well. SARAH: That is so cool. So, Dr. Foster, do you have any really cool stories that you can tell us about any of your patients you've had? SHANE: Yeah, there's one in particular with a patient who had been a steady patient with us year over year, had a vision plan that covered their eye exams, but was unable to afford medical insurance. It's that gap where somebody is under-insured. And I did a retinal exam and found some dot blot hems, found some things that looked suspicious. And I asked him, "Do you have any vascular conditions? Do you have diabetes?" He said, "Well, no, I'm fine." And I said, "Well, when's the last time that you had your lab work done?" He said, "Oh, I probably haven't seen a doctor in seven or eight years." SARAH: Wow. SHANE: So it shows that people don't know what they don't know. He was coming to us year over year but didn't realize that going to a primary care provider was important. Yeah. So it just shows sometimes we are the first entry into the healthcare system. And we're detecting those things in the retina that can be a sign of something much more severe. Preventative eye health. And it did turn out that he went and got lab testing, and he was diabetic, and he didn't know it. SHANE: Wow. So- Awesome SHANE: That doesn't happen a lot. I think patients are pretty well educated, especially- the doctors in this area are great about educating patients on getting their regular lab work and getting their eye exams and that kind of thing. SARAH: Yeah. I love that, though. What a great story. I think that helps to remind everyone how important each piece is- Right ... to the care. I think that is a nice segue into the next discussion about insurance. So we had had a conversation about that before, so I'm going to let you talk about what the coverage looks like, because I think that will be really helpful for our primary care docs whose patients are concerned they're going to get double-billed, or their insurance isn't going to cover it, or whatever. SHANE: Right. So, we often hear what a patient walks into our office. And we say, "What is your medical insurance?" And they say, "VSP"-"or EyeMed." Which those are vision plans. Those are vision plans. And so we're like, "No, what's your medical insurance?" And they're like "I..." We have to prompt them, "If you go to your regular primary care doctor, or you go to the hospital, what's your major medical insurance?" And they forget that we can bill that as well. SARAH: Oh, that's cool. SHANE: So, that's something that we always have to educate the patients on, is that we do medical and vision. Now, for all of you out there, we know insurance is really fun to work with all the time, so we get to deal with vision and medical, which is not the easiest to deal with. SARAH: Oh, that's so much fun. SHANE: But at least it does help the patient get to where they need to be. Okay. So if a patient has a vision plan and no medical we can bill their vision. Okay. Certainly, if they have any kind of underlying medical condition. Diabetes is, number one. But any medical condition. If they have dry eye if they have eye strain, they have headaches, those are all things that are billable codes that go to their major medical. SARAH: That is cool. SHANE: And then often we can, coordinate the benefits between the medical and the vision. So oftentimes the patient doesn't have a deductible. They don't have an out-of-pocket at all. SARAH: That's great. SHANE: So we do get a lot of patients that'll say, "My insurance only covers me." Or they'll say, "I can only get an eye exam every two years." Okay. I say, "Well, you can get an eye exam anytime you want, but your vision plan is only going to pay every two years." SARAH: The vision plan. Okay. SHANE: Right. But we can bill the medical for any of those patients. And certainly, I let the patient know too that it's a benefit. It doesn't mean that that should dictate when you get the care. It's just when that is going to help pay for it. SARAH: Okay. That makes sense. That really makes sense. So tell me also, just because we had had this conversation before about Medicaid, so what office that you have has Medicaid services? SHANE: Yeah. So we are contracted with Medicaid both in Athens and Logan. SARAH: Oh, okay. Okay. SHANE: We always ask for a referral for those. And I think a lot of the doctors do try to get a referral for Medicaid patients. But any referral from a primary care physician is going to be accepted. And we certainly accept children with failed school vision screening because that's super important. SARAH: And Medicare, just because I think of our patients with diabetes and that age, usually what that looks like. So Medicare plans. SHANE: Medicare, well, we take traditional Medicare, and with the Medicare Advantage plans getting more and more confusing we are working on adding all of those, but just the other day, we found out we're not in-network for United Healthcare Medicare. We didn't know that, because a lot of things changed January 1st of this year. And so my staff and I, we're working on it, trying to get as many of those as we can. SARAH: Yeah, that's a lot. SHANE: Because we want to make sure we can take care of all the patients in the area and not just dependent on what plan they have. SARAH: So true. It's a lot. Insurance is a lot. How would you say is the best way for a primary care doc to get to you or to get information? What's the best way for communication there? SHANE: I think the easiest way, and every office operates a little bit differently but our staff is always just like, "Send the referral over." If you include contact information and the patient's demographics, their insurance information, that helps us triage that a little bit more. Certainly, if it's just for their annual diabetic eye exam there may be a bit of a wait for that because it's just worked into the general queue. But if there's something more severe, like you suspect retinopathy, or you suspect a posterior subcapsular cataract that needs address those are things that we can work in a little sooner. SARAH: That's cool. SHANE: It just depends on how we triage that. But I think getting us the information, our staff is happy to follow up with the patient and make sure that we get them scheduled appropriately. SARAH: Okay. That sounds good. How long does it usually take to get in? SHANE: It varies. But I think right now we're booking out about two months. So we would like that to be sooner, of course. SARAH: I understand. We all get that. SHANE: We expanded two years ago. And we're getting to a point where we can get a lot more people in, but then we're looking at hiring another doctor because there's just such a need here. SARAH: There's such a need. Yeah. SHANE: We're full in all of the optometry practices in town, and the ophthalmology practices. SARAH: Wow. SHANE: So working to continue to build the infrastructure and make sure we can see even more patients. SARAH: That is so cool. So Dr. Foster is with Athens Eye Care. Is there anything else you wanted to share with us about eye exams? I think we did good. Yeah. I think we did really good. SHANE: I just always like to reiterate that eye care is such an essential part of healthcare. Absolutely. And it sometimes gets overlooked for some reason. And I find this a lot. I work a lot in the pediatric space and working for access to care for children. And it's one of those things that... I don't know why it gets overlooked, but people don't really make the link between vision and development or vision and learning until we point it out. SARAH: Wow. SHANE: And then you'll see teachers or other providers kind of go, "Oh, right. Yeah, that makes sense." You can't learn to read if you can't see well. How about that? And that's something that I've always worked really hard on to try to get that message out there. And that goes to adults too, obviously. SARAH: I think it's fantastic. SHANE: Just because you can see well doesn't mean that your eyes are healthy either. So we get a lot of people that say, "Oh, I don't need to come and see you." And it's like: Well, what do you mean you don't need to come and see me? And they're like: Well, I see 20/20. Well great, but you might have glaucoma, and you don't even know it. SARAH: That's right. SHANE: Because glaucoma has no symptoms. It has no signs in the early stages. And that's something that we need to make sure we're educating all patients on, that an annual eye exam is important for everyone. Not just diabetics, not just children but really, we recommend an annual eye exam for every patient every time. At least annually. Some of them more frequently. SARAH: Thank you so much for having us here today, Dr. Foster, to talk about our patients with diabetes and eye exams. I think this is very important for our providers in the region. So we appreciate the time here. Tell your grandma we said hi. SHANE: Yeah, I will. SARAH: And she can watch this from Shade with the link. It'll be fantastic. And again, you're with Athens Eye Care, and we'd like to thank Dr. Foster for his time today. SHANE: Thanks so much for having me. SARAH: Oh, it was wonderful. Surprised we didn't spend three hours. SHANE: I know. SARAH: Thank you.