Eyeworld

EW FEATURE 40 January 2011 D espite historic clashes be- tween ophthalmology and optometry, especially over scope of practice is- sues, more clinicians are partnering to treat patients in an in- tegrated setting. About 55% of ophthalmic prac- tices now include optometrists on staff, according to a 2009 member survey by the American Academy of Ophthalmology (AAO) and the American Academy of Ophthalmic Executives. That's good news for ophthal- mologists who have seen the need for eye care services explode thanks to an aging baby boomer popula- tion. Optometrists on staff take over primary care of the patient, while ophthalmologists focus on surgery and pathology cases that have been referred to them. "It's becoming a more prevalent model," said David Durfee, M.D., who serves as senior secretary for ophthalmic practice on the AAO Board of Trustees. "Most of us feel that with the manpower issues and the lack of ophthalmologists that need to be seen, the answer is inte- grated eyecare team and to create a partnership with optometry. Frankly, I think that's going to increase. As an association, we are promoting the integrated eyecare model." But how will these integrated eyecare settings be affected by the massive federal overhaul of the na- tion's health care system, especially when it comes to their Medicare pa- tients? "It's pretty clear that our gov- ernment now is taking a much more proactive stance for managing our healthcare, and that includes figur- ing out ways to reduce costs in healthcare," said Derek A. Preece, M.B.A., BSM Consulting Group, Orem, Utah. Controlling the cost of health- care, especially with increased de- mand and a decreasing number of ophthalmologists will put down- ward price pressure on reimburse- ments, Preece said. "Ophthalmology practices will have more patients to see and more surgeries to do, but they may not get reimbursed as much per visit or per surgery as they have in the past, which will mean that they will need to become very efficient so that the costs of providing care are reduced," he advised. "If they don't reduce their costs, then the margin between costs and revenues will shrink, and that will shrink ophthalmologists' income." Widening margins One way to widen those margins is by hiring optometrists to see routine patients, saving tertiary and second- ary care for M.D.'s. "It's pretty much well estab- lished that it is less expensive in vir- tually all cases for an optometrist to provide a routine eye exam to a pa- tient than for an ophthalmologist to provide that same exam," Preece said. "That's because ophthalmolo- gists tend to make significantly more money than optometrists. The more practices can lower the costs of providing that exam, the better able they will be to roll with the punches of healthcare reform as reimbursements are adjusted and probably lowered in some cases." What about ACOs? Another industry expert believes the trend to create more integrated eye- care settings will continue to esca- late in the wake of healthcare changes that create incentives for "accountable care organizations" (ACO). Although there still is a firestorm of controversy over the definition of ACOs and their roles, most agree that a typical ACO would be a collective of physicians, hospi- tals and other healthcare profession- als who work together to treat patients. Ophthalmologists who are wary of more hospital or government control over their patients or wallets might be driven toward aligning themselves with others in the eye- care field instead. "In the future, there will proba- bly be drivers for eyecare practices— mixed M.D./O.D./optician prac- tices—to be getting larger," said John Pinto, president, J. Pinto and Associates. "Those incentives will in- clude localized developments toward ACOs and institutional control of healthcare. If that unfolds the way some market analysts believe under Obamacare, then there will be strong motivations to form larger in- tegrated group practices. by Jena M. Passut EyeWorld Staff Writer Integrated eyecare: demographics and healthcare changes AT A GLANCE • Integrated eyecare becoming a more prevalent model—about 55% of ophthalmic practices now include optometrists on staff • Changes in healthcare will put more pressure on surgeons to reduce costs, become more efficient • Working with optometrists and other eyecare professionals will help lessen the sting of funding cuts • Medicare cuts still a "cloudy picture" • More costs being shifted to patients continued on page 42 Thomas W. Samuelson, M.D., and Scott Hauswirth, O.D., work together in an inte- grated eyecare setting at Minnesota Eye Consultants in Minneapolis Source: Anna Mueller

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