Eyeworld

EW FEATURE 38 January 2011 by Faith A. Hayden EyeWorld Staff Writer Understanding integrated ophthalmology J ust because a doctor has the ability to do it all in their field, doesn't mean they should. Ophthalmol- ogy is no exception. From routine eye exams to contact fit- tings, a staggering one-third of an ophthalmologists' day is taken up by principal and senior consultant, BSM Consulting, Orem, Utah. "It's not uncommon for me to hear about doctors that are booked solid for 4–6 weeks out, unless it's an emergency." Relief, however, can be found. A business practice model called inte- grated eye care allows ophthalmolo- gists to focus on their highest, best possible work such as surgery and pathology cases, leaving the refrac- tive errors and routine exams to an optometrist. What it means Integrated ophthalmology brings to- gether the three O's — ophthalmologists, optometrists, and sometimes opticians—in one com- prehensive practice to take care of virtually any patient ophthalmic need possible, from glasses to cataract surgery. "It's having the ophthalmologist and the optometrist work together, each specializing in the area of eye care that they are licensed for and are best at," explained Preece. "Many ophthalmologists would love to do fewer routine eye exams so they can spend more time on pathology." In addition to freeing up a doc- tors time for pathology cases, the in- tegrated eye care model drives lower need patients to have lower cost exams, thus saving the patient, the practice, and the insurance company money. "The healthcare reform legisla- tion is moving our country in a di- rection to lower costs," Preece said. "There's going to be pressure to do this. It's virtually always cheaper to have an optometrist examine a pa- tient than an ophthalmologist." There are many levels of integra- tion. At its most basic form, a prac- tice will have an optometrist come in part time, one or two days a week during an ophthalmologist's surgery day. If that goes well, the practice may up the optometrist's hours to full time, perhaps assigning the op- tometrist a technician. At its highest functioning level, the integrated model delivers multispecialty care including retina, cornea, and glau- coma specialists. "These practices are probably owning part or all of a surgery center, and in most cases are providing eye ware," Preece said. How it works Before adopting an integrated model, the first thing a practice needs to do is evaluate its needs. The model centers on the patients de- mand for services, and if the oph- thalmologist doesn't have a full schedule, the model won't work. "The eye surgeons who really take to this model are those who have an overabundant population of patients and need a relief valve," Pinto explained. "If you're only see- ing 450 patients a month and you don't think you'll find more patients to take on, then this would be dis- economic." Not every type of ophthalmic practice will find the integrated model useful. For example, ocular plastics, glaucoma-only, and pedi- atric practices typically won't use an optometrist. "There are some op- tometrists that are trained well to handle children, but this is rare," Preece said. AT A GLANCE • One-third of an ophthalmologists' day is taken up by tasks a techni- cian or an optometrist can do • The integrated model will only work for ophthalmologists with full schedules • Integrated ophthalmology brings together the three O's— ophthalmologists, optometrists, and opticians—in one comprehen- sive practice. • It will take a practice about a year to become comfortable with the integrated model • Having confidence in the op- tometrist is sometimes the biggest hurdle practices face when using the integrated model tasks a technician or an optometrist can do, according to medical prac- tice management consultant, John B. Pinto, president, J. Pinto & Associ- ates, San Diego. Thanks to an ever-aging U.S. populating flooding an already satu- rated market, many ophthalmolo- gists don't have enough hours in a day to take care of their patients' de- mands. According to the Eye Disease Prevalence Research Group, age-re- lated eye diseases, including cataracts, diabetic retinopathy, glau- coma, and AMD, are expected to dramatically increase in the U.S., from 28 million today to 43 million by 2020. The problem, it seems, is only going to get worse. Incoming oph- thalmologists are only expected to grow from 21,200 today to a meager 25,200 in the same time frame, ac- cording to the U.S. Department of Health & Human Services. "More people are coming in than the ophthalmologist can han- dle, and we're not getting more oph- thalmologists," said Derek Preece,

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