September 10, 2011
3 min read

Is it better to use co-management with optometrists or hire ancillary personnel to reduce practice demands?

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Ancillary personnel enhance care, bottom line

Robert J. Weinstock, MD
Robert J. Weinstock

Hiring optometrists, hiring ancillary personnel such as physician assistants, for some ophthalmic practices, can be very advantageous, profitable, and improve the overall efficiency and quality of care. Nurses and technicians play a vital role in the operation of a successful, efficient practice. Co-management with optometrists outside a practice can also ease the growing burden of caring for so many patients.

Physician assistants (PAs) can perform valuable, revenue-producing services. Some practices use PAs as surgical assistants. For more complex retinal and glaucoma cases, there is a reimbursable code for this role. If trained properly, PAs may see clinic patients independently and bill for these services, just as a doctor would. A PA can obtain hospital privileges to see consults, make patient rounds, and perform preoperative histories and physicals on surgical patients. This gives the surgeon peace of mind and adds to the revenue stream. If trained properly, the PA can truly be a “jack of all trades” within the practice and add to the quality of care, profitability and efficiency of a practice, potentially performing more roles than an optometrist could.

Nurses also have a significant potential role in a growing ophthalmology practice. In practices affiliated with an ASC, nurses are needed in the preop and postop areas and the OR. For practices that have taken an interest in clinical research, without a nurse research coordinator, it is difficult to secure significant studies and their associated revenue.

Co-managing clinical and surgical care with optometrists outside of the practice can be effective in delivering quality care to a larger population of patients, provided there is good communication between the providers and the patients understand the process.

Robert J. Weinstock, MD, is a cataract and refractive surgeon at The Eye Institute of West Florida, Largo, Fla. Disclosure: Dr. Weinstock has financial interests in Bausch + Lomb, Ista, WaveTec and TrueVision.


Optometrists provide surgical referrals

Ella Faktorovich, MD
Ella Faktorovich

While optometric co-management may not be ideal for a comprehensive ophthalmology practice, it makes sense for a practice focused primarily on surgery. Optometric co-management accomplishes three things. It brings in patients who are likely to be surgical candidates, reduces patient chair time and allows surgeons to see more surgical patients and do more surgery, and limits the number of different services the practice provides, allowing the practice to streamline resources and reduce overhead.

A practice that relies primarily on advertising and/or patient referrals may see patients come in for surgical consultations who may not be surgical candidates. For example, some patients may come in for a cataract consultation in hopes of getting an IOL to help their near vision, but they may be plano presbyopes with excellent distance vision and no sign of a cataract. Other patients with poor vision due to AMD or glaucoma may come in for a cataract consultation hoping to improve their vision, but their cataracts may not be visually significant. This can be sorted out by a good optometrist who can refer patients who are likely to benefit from cataract surgery.

Patients coming from an optometrist may already be educated about what to expect during and after surgery and the different IOL options. An optometrist may have been seeing the patient for years and may have tried different optical solutions. He or she may know that the patient did especially well with monovision, for example, and know the amount of monovision that worked for the patient. An optometrist may have discovered that the patient either loved or hated multifocal contact lenses. This information may be useful in guiding the surgeon to decide what type of IOL is best suited for the patient. A well-informed optometrist can save a surgeon a lot of time. Postoperatively, the optometrist can answer many of the patient’s questions as well.

It takes time, effort and money to run a practice that provides multiple services, which may be so different that it is like running several distinct businesses. Running an optical dispensary within an ophthalmology practice is one example. Outsourcing some services may allow the practice to streamline operations, reduce overhead and save money.

Ella Faktorovich, MD, is director of the Pacific Vision Institute, San Francisco. Disclosure: Dr. Faktorovich has no relevant financial disclosures.