Eyeworld

EW FEATURE 48 January 2011 can College of Surgeons is that the most appropriate trained profes- sional be responsible for post-op care – and that co-management is not approved by those societies when based on economic decisions to transfer care of patients after sur- gery, and in fact, may be illegal. Keys to success As with most business plans, inte- grated eye care can only succeed if there is mutual respect between the ophthalmologists and optometrists. "There's no magic formula or true secrets that someone knows that will magically make your practice a suc- cessful one," Dr. Jackson said. "There's no secret beyond having a solid business plan, working really hard and paying attention to de- tails." His practice follows three tenets: high-touch (meaning every team member pays attention to every detail of patient care), high- tech (continuous investment in new technology and education for all staff members), and high respect of all team members in co-managing all patients. Some practices have continued to thrive simply by putting patient care first, said George Rickard, OD, in private practice at Laurel Eye Clinic, Brookville, Pa. "We've con- tinued to prosper over the years be- cause of our model. We support area ODs and our commitment to inte- grated eye care. When new surgeons join our practice, they have to share the company philosophy and show they're committed to the model we've created or they wouldn't fit in," he said. Laurel Eye Clinic has three main offices and several smaller offshoots, and each team member is committed to the founder's philosophy, he said. At Illinois Eye Institute, "we have 'advanced care area' with in- credible ophthalmologists who work with us. It is a very good working re- lationship. In that sense, it's an inte- grated environment," Dr. Maino said. In that case, there's a three- physician office with a full referral list of ophthalmologists "whom we know we work well with and with whom we've built a long history." As a practice, Dr. Fu said the group has "a mission statement to deliver the best possible eye care. You have to have a mission state- ment inn mind to focus on what you want to do. We have to continu- ally train and motivate staff. We close our office once a month to dis- cuss the mission statement with everyone on staff," he said. "The goal is to consistently ensure patient care is the first and foremost topic in our minds. It's imperative to the suc- cess of a practice to listen to the pa- tient, follow-through, etc. It doesn't have to mean spending a lot more time on the patient care. Our staff meetings include updating each other on the latest research and treatment, what's new in the jour- nals, etc." Pros and cons For some optometrists, the advan- tages of an integrated eye care prac- tice are numerous. For one, optometrists have readily available access to specialty care for their pa- tients, Dr. Fu said. "The patient already knows the practice and doesn't have to travel further to go see a specialist, or worry about not being familiar with the practice," he said. Additionally, he believes that for optometrists who are so inclined, working in an integrated practice can be a "great learning experience." Further, since everyone on staff has access to all the charts, there's an immediacy co- managed practices cannot offer. "Immediately after someone's been referred to the ophthalmolo- gists, we can see what the diagnosis was, or how patient care proceeded with their specialist. We're never caught waiting for referral letters back from another office," he said. Dr. Rickard noted one advantage of an integrated model is the ability to control the quality of care be- cause everyone is under the same roof. "There's nothing wrong with the quality of care of an independ- ent doctor, but an integrated model might be more attractive to groups of surgeons in terms of oversight and control whereas the traditional model of a single 'storefront' might be more applicable to a surgeon who's by himself because of logis- tics," Dr. Rickard said. "For instance, if you're the sole eye care provider in a small town, you might better serve your patients if you've got a network of specialists you can use." If surgeons prefer to maximize their time performing surgery, "then the integrated model is good be- cause the surgeon is using his skills and training to the maximum," Dr. Rickard said. "If you're the type of surgeon who enjoys handholding and spending a lot of time with pa- tients without necessarily doing a high volume of surgery, or you enjoy the interaction with patients after surgery, then co-management might be for you." The advantages of an integrated eye care practice are "significant if there is, indeed, mutual respect for the skills of each profession," Dr. Maino said. "What I find in the day- to-day interaction for most practi- tioners is that the mutual respect is there. Optometrists find the oph- thalmologists who value our abili- ties. Integrated eye care can only work when both professions have a god understanding of what each other does and allows each to do what we do best for the patient." Optometrists interviewed for this article could not name many disadvantages to an integrated eye care practice. For the most part, the only down side remains a somewhat territorial attitude about patients, where once referred to the practice's ophthalmologist, patients are not "handed back" to the optometrist until it's time for the annual vision exam. One disadvantage to a co- managed approach is a potential for poor communication between the two practices which could inadver- tently lead to complications with in- surance paperwork or even patient records if practices are on different electronic health records systems. Politics In most states, optometrists are not allowed to perform intraocular sur- gery or use lasers. Beyond that, how- ever, most optometrists believe their role as the primary eye care provider should place them in a leadership position, working in cooperation with a specialist. "Despite what the ophthalmic community might say, an appropri- ate healthcare system should be under the leadership of the primary eyecare provider, which is usually the optometrist," Dr. Maino said. "In most states, optometrists practice medical ophthalmology at the high- est level, diagnosing and treating glaucoma and anterior segment problems. When something goes be- yond our scope of expertise, we'll make an initial diagnosis and refer out to an ophthalmologist. What benefits everyone in that situation is that it frees up the ophthalmologist to do what he or she does best, which is more surgery. The more surgery they perform, the better they become, the better the patient out- comes. Conversely, the more op- tometrists are managing the patient as a primary care practitioner, that individual also becomes more skilled at a much higher level." In Massachusetts, optometrists are allowed to place punctal plugs and perform punctal occlusion, but "we can't prescribe oral medications. We can prescribe topical, but not oral," Dr. Fu said. The state legisla- ture has been debating the issue "for years and years," Dr. Fu said, but Massachusetts remains the sole state that makes it illegal for an op- tometrist to prescribe glaucoma medications. "Overall, optometrists have shown across the country they are well-trained to diagnose and treat glaucoma and are very willing to refer for those cases they can't handle or when patients are pro- gressing even with treatment." At the core of the issue, Dr. Jack- continued from page 46 " We found that there was a significant improvement in pressure control in all patients, but there weren't any " 2011 HOUSING AND REGISTRATION NOW OPEN! www.ascrs.org Early-bird Deadline January 28, 2011

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