EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/220233
October 2013 There are no written agreements between me and referring ODs. In the rare event that a patient has a complication, I do not allow ODs to co-manage them. Dr. Lindstrom: Once the patient's care is transferred to me, I will care for the patient as the patient's care plan dictates and as the patient desires. I have some patients who never return to the referring doctor for one reason or another, and in some cases it is simply a patient preference issue. I strongly believe in the patient being involved in all decision making including who provides what care and where. The compensation issue to me is straightforward: The individual who does the work should get paid an appropriate fee for his or her efforts. We can argue about the fairness of our compensation system in the U.S., and whether an inexperienced ophthalmologist should be paid the same for a unit of work, such as a postop visit, as an experienced ophthalmologist, and of course, whether an optometrist should be paid the same as an ophthalmologist. But state and federal laws, regulations, and licensing boards are where these standards are set, and they are usually set in stone regardless of how any of us individually feels about their fairness. Dr. Sundell: Patient-centeredness and transparency are central in any co-managing I do. Patients definitely have a right to choose who provides their care. And if you are not truthful with them, they will eventually find out. I think it is better for them to have a clear understanding of any co-management arrangement before surgery. Dr. Banja: You mentioned that you like to use the OMIC consent form with patients. Dr. Sundell: Yes. I ask that the referring ODs have patients sign a consent form that states they have chosen to have their postoperative care with their referring OD, and they have to list a reason. This is usually stated as due to travel distance. I always refer to that form when I consent patients for surgery and make sure that they are comfortable going back to their referring OD. The OMIC consent form has been helpful to me to make the co-management arrangement more transparent, and it clearly states that patients are free to call me, the operating surgeon, for any problems or questions, even if they choose to return to the co-managing OD. Dr. Banja: Any final thoughts? Dr. Lindstrom: In my practice, patient-centered co-management of surgical patients occurs on a daily basis with both referring optometrists and ophthalmologists. In fact, I might not have a single patient who I do not cooperatively co-manage with several other caregivers. Our co-management must be patient-centered and transparent, however, and the doctor who does the work should get paid for the work. Dr. Sundell: So often when this topic comes up, I hear providers agonizing about feeling trapped if they don't co-manage patients with ODs because then they won't get the referrals. I have to admit that I'm fortunate to live in a more remote area. There aren't as many ophthalmologists in my geographical area as opposed to very saturated markets like California. Nevertheless, while it can be a real challenge to remain ethical in many co-management type situations, failing to do so can be very problematic. EW *The OMIC consent form is available online at www.omic.com/comanagement-after-eyesurgery. EW NEWS & OPINION Contact information Banja: jbanja@emory.edu Lindstrom: rllindstrom@mneye.com Sundell: bsundell@sundelleye.com 23