Eyeworld

EW FEATURE 46 January 2011 A decreasing number of ophthalmologists, cou- pled with an increasing patient base, has led nu- merous physicians to em- brace an integrated eye care model—where optometrists, oph- thalmic technicians, and ophthal- mologists all work under the same roof to provide efficient and effec- tive patient care. Others prefer co-management— where different practices refer pa- tients across boundaries and leave the optometrist as the primary care physician to handle a majority of eye care complaints. In the majority of states, optometrists can diagnose and treat glaucoma, refractive errors, numerous anterior segment diseases (such as dry eye), and can prescribe oral and topical drugs. With the cur- rent healthcare reforms, it's likely that "co-management will take on a greater role, as will integrated eye care," said Michael Fu, OD, in pri- vate practice at D'Ambrosio Eye Care, Inc., Lancaster, Mass. "Primary care providers are going to provide more care to more people," and with some major insurance companies no longer accepting consultation codes, integrated practices may be more ef- ficient, he said. Noting that "integrated eye care can have nothing to do with co- management," the former is likened to a vertical integration in the same practice, and co-management com- prises different practices where both jointly manage the patient, said Jimmy Jackson, OD, president of In- Sight LASIK, Lafayette, Colo. The pressures of healthcare re- form—as it currently stands—"will favor practices with multiple practi- tioners in them, whether it's large optometry practices with consulting ophthalmologists on staff or vice versa," Dominick M Maino, OD, MEd, FAAO, FCOVD-A, a professor of pediatrics/binocular vision at the Illinois Eye Institute/Illinois College of Optometry, Chicago, and an ad- junct professor of pediatrics at the Centro de Optometria, Madrid, Spain, and is in private practice in Harwood Heights, Ill. He believes an area that has not yet fully embraced the idea of integration—but should to facilitate the best secondary and tertiary care and be an integral member of the post-op team," Dr. Jackson said. Dr. Fu agreed, saying co-man- agement/integrated eye care is a "more efficient way of treating pa- tients. The specialists are busy per- fecting their surgical techniques, and we can easily handle the pri- mary care aspects. In this model, we see numerous potential surgical can- didates, not just those who have no problems in their post-op or those who don't have a need for surgery." Of concern to the American Medical Association and the Ameri- by Michelle Dalton, EyeWorld Contributing Editor Ophthalmology and optometry: working together AT A GLANCE • Integrated eye care allows each eye care practitioner to focus on his/her strengths—whether surgery or primary care • For the time being, solo practition- ers are still viable • Healthcare reform will likely squeeze out single practitioners in favor of larger, multi-practitioner practices. • Optometrists likely will not be granted the ability to perform any kind of intraocular surgery in the majority of states, and most do not want the responsibility. • Integrated or co-managed eye care cannot succeed without mutual respect from both optometrists and ophthalmologists. continued on page 48 —is pediatric ophthalmology and optometry. When executed well, both op- tometrists and ophthalmologists benefit, experts say. The primary care physician (usually the op- tometrist) probably knows the pa- tient "better than anyone else, and is a fully engaged member of the team," Dr. Jackson said. The surgery centers win in this scenario, he said, because each member of the team has access to the most complete pa- tient records and ophthalmic sur- geons can spend more time on surgery and less time on routine care and post-op care. Optometric prac- tices benefit as well—"the best way to retain patients in the long-term is With the current state of healthcare reforms, most optometrists think working with ophthalmologists pro- vides the best patient care model

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