Eyeworld

APRIL 2022 | EYEWORLD | 69 C Relevant disclosures Maloney: None Raviv: CoFi require significantly more work postoperative- ly." The work includes additional visits related to optimizing uncorrected vision or performing enhancements. For patients who have advanced technology lenses who are comanaged, Dr. Maloney said it's customary for there to be an additional coman- agement fee paid to the doctor who is doing the postop care to cover the extra work involved. "The key issue in terms of best practices is that additional fees should be commensurate with fair market value of the extra work required," he said. Dr. Raviv uses comanagement in his prac- tice, though he noted that it's only a small part. "We do work with some community optome- trists and medical ophthalmologists who have extensive experience in delivering refractive postop care," he said. "When initially construct- ing a comanagement framework for our prac- tice, I set out to exceed any compliance hur- dles associated with historical comanagement arrangements." Dr. Raviv noted that most refractive cataract surgical services involve multiple fees: a pro- fessional fee for the surgical provider, non-sur- gical eyecare provider, and facility charges. "Historically, one global fee was collected from the patient, with the surgeon's practice later 'passing on' payments to any outside parties," he said. "With today's increased regulatory scruti- ny, enforcement of anti-kickback statutes, and poor optics of MDs making payments to out- side ODs, many of these older practices are no longer tenable." He added that it's important for individual practices to seek guidance from con- sultants and/or lawyers to construct their own collaborative care agreements. But he did note four guiding principles: patient choice, price transparency, fair market value, and payment separation. Dr. Raviv's first comanaging arrangement was with an experienced comprehensive opto- metric group that was cash pay (did not con- tract with any third-party payers). "They told me what their charge was for their package of postoperative refractive cataract services. This was a fair price, and we started breaking down our own refractive fee structure," he said. At booking, patients were presented with a written invoice showing the price of surgical care, postop care, and facility. They were also given a choice of postop providers—either the inter- nal care team or their optometrist. "We then collected only the surgical professional fee (or surgical and postop fee, if patients chose), with the patient paying their ODs directly on their first postoperative visit," he said. This payment plan did work, but Dr. Raviv noted that he had some problems. A few pa- tients, particularly those who scheduled their surgeries months after the booking visit, would forget about the postop services payment when seeing their optometrist, creating unnecessary Dr. Raviv's four guiding principles for collaborative care agreements Patient choice: All patients should be presented, in writing, with a choice for postoperative refractive care—either with the surgeon's in-house care team or with the patient's outside eyecare provider. Price transparency: All patients should be presented, in writing, the costs for each ser- vice provider, such as surgeon, facility, and postop eyecare provider. Fair market value: The old 80/20 Medi- care rule is a guideline some use, but more importantly, each provider payment should be consistent with the fair market value for each party's refractive services. Payment separation: The patient should make a payment directly to each party for their portion of the service. Having the sur- geon collect one global credit card payment from the patient with later payouts to an outside optometrist will become more and more difficult to defend. continued on page 70

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