Early on in my private practice experience, I expected comanagement to be relatively simple: An optometrist refers a patient to me, I do the surgery and send the patient back for postoperative follow-up. Perform good surgery, which means a happy patient, and thus everyone wins, right? What I’ve learned is that it takes a little more effort to ensure that everything goes smoothly. Here are three lessons learned:
Define the roles of internal and external optometrists.
We took a deep dive, examined and redefined the scope of our practice about a decade ago in order to better serve the patient and referral community. In order to be a consultational medical and surgical practice, within our MD/OD practice, we made a conscious decision to not prescribe glasses or contact lenses, and gave up any considerations of having an in-house optical. It’s important that the optometrists in our community, whose referrals account for about 74% of our cataract cases, understand the role of our internal ODs. Our in-house ODs are vital associates of our practice, and I could not manage the patients in our several offices, across a very spread-out community, without my ODs, who serve as physician extenders. They participate in the immediate postop care of my surgical patients, as well as help to triage urgent medical patients and provide follow-up care of our more stable patients. We work with our collaborative OD partners to help provide refractive care (spectacles, contact lenses) as well as some primary eye care as well, particularly with those ODs who have received extra residency training and have the clinical acumen to do so.
Faxing the operative note is not enough.
All of the clinicians within the ophthalmology practice — not only the surgeon — need to communicate with referring clinicians. For example, if an optometrist or ophthalmologist identifies a corneal abrasion or IOP spike on postoperative day 1, that information needs to be relayed back to the referring doctor directly so that the referring doctor isn’t caught off guard if for some reason the notes get lost in the hand-off. A quick phone call, email or secure text can legitimately create significant goodwill for you and your referring doctor.
Connect on billing issues.
It is critical that someone from your business office works closely with a contact person
or administrator from the referring office. For example, if I find during otherwise routine surgery that the pupil is miotic and I need to use a Malyugin ring, my office will bill the primary procedure as a 66982 code instead of routine cataract surgery (66984). This change needs to be relayed to the referring optometrist’s billing department, so it can bill the same primary code for its comanagement services. Otherwise, if our codes don’t match, the optometrist’s claim will be denied. The resulting delay in payment can cause the referring clinician to lose faith in the system, especially if it occurs more than once. This is also information that I immediately notify my business office about, and I also copy or securely text the optometrist as well.
As we build relationships with our comanaging partners, each of these steps is important to coordinate care and avoid misunderstandings.
Disclosure: Yeu reports she is a consultant/adviser for Alcon, Allergan, ArcScan, Bausch + Lomb/Valeant, Bio-Tissue, BVI, i-Optics, J&J Vision, Lensar, Kala Pharmaceuticals, Novartis, Ocular Science, Ocular Therapeutix, Ocusoft, Omeros, Science Based Health, Shire, SightLife Surgical, Sun, TearLab, TearScience, Veracity and Zeiss; does research for Alcon, Allergan, Bausch + Lomb, Bio-Tissue, i-Optics, Kala and Topcon; and has an ownership interest in ArcScan, Modernizing Medicine, Ocular Science, SightLife Surgical and Strathspey Crown.
Elizabeth Yeu, MD, is assistant professor, Eastern Virginia Medical School, and partner, Virginia Eye Consultants, Norfolk, Virginia.