Eyeworld

EW FEATURE January 2011 43 D ecades before the term "integrated eye care" was coined, several ophthalmology prac- tices in the U.S. incor- porated versions of the model either out of necessity or simply because it made sense to do so. EyeWorld spoke with leading ophthalmologists in these prac- tices to see how well the model has worked for them. Q. When did your practice incorpo- rate the integrated eye care model? Stephen S. Lane, M.D., Associ- ated Eye Care, Stillwater, Minn.: In- tegrated eye care was actually part of our practice for quite awhile before it got a fancy name attached to it. Essentially to me an integrated eye care model is a practice model whereby ophthalmologists interact with optometrists, opticians, contact lens fitters, and ophthalmic techni- cians— a full array of ophthalmic ancillary care givers under one or- ganization and under one roof to better serve the needs of the pa- tients. We have participated in this for close to a decade. Edward J. Holland, M.D., direc- tor, Cornea Service at the Cincinnati Eye Institute, Cincinnati:It was a gradual process that began long be- fore I joined the practice 10 years ago. It first started with a collabora- tion of community optometrists, working with optometrists and ex- changing patients and having pri- mary care patients going to optometrists and tertiary care pa- tients and surgical patients coming back to the ophthalmologists in our group. Optometrists were then in- corporated within the group to work side by side with the MDs, which al- lowed the MDs to see more compli- cated cases and to spend more time in the operating room and it's moved forward from there. Louis D. "Skip" Nichamin, M.D., medical director, Laurel Eye Clinic, Brookville, Pa.: To be frank, we got into integrated eye care prob- ably 10 years before it was even rec- ognized that this was a formal option or entity. Because our prac- tice is in a rural part of Pennsylva- nia, we incorporated optometry and ancillary individuals to create a ver- tical integration and network more out of necessity than by premedi- tated design. We fell into this and found ourselves ahead of the curve because of the geographic and de- mographic nature of our practice. We've had this model for 25 years or even more. Q. Can you describe the integrated eye care model at your practice? Dr. Lane: Essentially we have 10 ophthalmologists, some of whom are sub-specialized. We have a retina subspecialist, a glaucoma subspecial- ist, a cornea subspecialist, refractive surgeons, a plastic surgical subspe- cialist a pediatric ophthalmologist and general ophthalmologists. In ad- dition to that we have around 35 ophthalmic technicians. We have three optometrists, one of whom is a pediatric optometrist and another works in low vision. We also have opticians. So that's the structure under which it all works. Dr. Holland: The model with the practice has over 40 ophthalmolo- gists, approximately 20 optometrists who are either part-time or full-time and work within the practice. In some circumstances, the op- tometrists work side by side with the ophthalmologists in the clinic and in some cases the optometrists have their own clinics. Most optometrists do both, they do clinics with oph- thalmologists and they have their own clinics. But equally as impor- tant is the collaboration with over 100 optometrists in the community. We provide some of their continuing education and are in constant col- laboration so that when a patient is stable, say from a post- surgical pro- cedure and needs routine eye care, that patient can go back to his or her primary care provider who is usually an optometrist. Dr. Nichamin: For these 25 to 30 years, we have had optometrists within our practice working hand in hand with the surgeons. We have networked with external local eye care practitioners and we have over 100 optometrists within our region that we work with, educate, train and in concert deliver care to the re- gion's patients. We have multiple of- fices covering an expansive area and deliver a wide range of care. Q. Is there a special formula for your model? By Enette Ngoei EyeWorld Contributing Editor Integrated eyecare in action Stephen S. Lane, M.D. Louis D. "Skip" Nichamin, M.D. Edward J. Holland, M.D. AT A GLANCE • Adding optometrists to the practice has given us an expansion of our contact lens services & our ability to see comprehensive patients, as well as the ability to extend our hours in different ways—earlier appointments, later appointments and weekend appointments. – Dr. Lane • First and foremost it's allowed the surgeon to do what the surgeon prefers to be doing: caring for a higher grade pathology of a complex medical and surgical nature. – Dr. Nichamin • I think the practice that incorpo- rates the ophthalmology integrated OD practice model will eventually be the model that wins out because it will be the most efficient model not only from patient care stand- point but also from an economic standpoint as well. – Dr. Holland • Potentially, I think that there may be some smaller practices where an ophthalmologist by choice and design delivers primary care in dispense to an isolated patient population and for he or she it may not make sense. – Dr. Nichamin continued on page 44 Experts describe their experiences with the practice model Dr. Lane: We incorporated op- tometrists within our practice later, about 5 or 6 years ago, and at that time we already had a very complete staff with a lot of ophthalmic tech- nicians who aided in seeing patients for the physician. When we added optometrists, it brought a new di- mension to our practice and as time has gone by, we have chosen to in- crease the work force at our office not by adding M.D.'s but by adding O.D.'s. I think the actual ratio that we're trying to get to as the need comes with potential retirement of MDs and hopefully an increase in business in our office, is one where there are two or three optometrists for every ophthalmologist. Dr. Holland: There is no specific ratio. Each individual ophthalmolo- gist can decide what he or she wants to do. Some ophthalmologists don't have optometrists in their practice but many of us do. I've been in this practice 10 years and when I first got

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