By David Geffen, OD
Feb. 7, 2018
Co-managing refractive surgery is an opportunity to create satisfied patients and build relationships with local eye surgeons. Both of those things can help you build your practice.
My primarily surgical practice sees over 100 LASIK patients a month with our staff of six surgeons and four ODs. We do over 100 eyes per month, which is not exactly 50 people per month, as some only do one eye for various reasons. We co-manage the procedure with over 200 local ODs, most of whom we have had a relationship with for over 20 years.
In our practice, the ODs are doing some of the patient pre-testing and counseling with the surgeons, as well as most of the follow-up visits. In our co-managing practices, they typically do a complete eye exam, and refer the patient to us for a refractive consultation.
After the consult, we will set a surgery date and notify the referring doctor of our findings. The patients will either come back to us for their one-day visit or go back to the referring doctor depending on their choice. After the one-day visit we send the patient back for the rest of their post-op care.
Typical co-management fees are 20 percent of the surgeon’s fee, and this includes one year of follow-ups. This can be quite a revenue generator for an optometric practice. If you are referring one patient a week this could generate another $25,000 a year with no cost of goods associated with it.
Sometimes we are asked to do a follow-up exam for a LASIK patient from out of town, and we typically will charge a per-visit fee for those. One of the reasons surgeons like LASIK is the fact that there is no insurance coverage at this time. Since this is strictly a cash procedure there are no specific insurance codes to worry about. You can count on the fee you are expecting with no deductibles or decreased reimbursement amounts.
You Likely Have the Equipment You Need
The instrumentation for pre- and post-op care is the typical equipment most any office should have. A slit lamp is absolutely necessary as is a phoropter. A topographer is not a necessity as the surgery center will always do a pentacam and/or topography to look for irregularity of the cornea. Since the equipment is the normal equipment that one should have in practice, there is no instrumentation outlay especially for performing co-management of LASIK patients.
Seek Education at a Local Surgery Center
It is important for optometrists to familiarize themselves with the LASIK procedure in detail. We recommend spending a half day with a surgery center to observe post-ops to get a feel for what is normal, and what needs to be taken care of. Patients lose confidence in the referring optometrist when they are sent to a surgeon, and told there is a problem, which the optometrist missed.
We try to have open communication lines, so a referring doctor can call us and speak with either the surgeon or OD in the practice to help determine if the patient needs to be sent back. Also, observing a consultation and being able to see the process from beginning to end will help you educate the patient about the process. This ensures that your patient sees you as the expert. Many surgical centers offer CE at no charge to help educate the community’s optometrists. We do this several times a year. There are courses offered at the AOA, AAO and Vision Expo on these topics at every meeting. Several journals also address many of the topics we need to know about refractive procedure.
Educate Support Staff
Your staff is an extension your practice. Many patients feel more of a bond with staff than the doctor. It is imperative that the practice shows a unified approach. You need to educate your staff at office meetings about LASIK, so they have a basic knowledge base to answer patient inquires. Talking about how your office will manage these patients is important. Having consistent office meetings is the first place to start, and sending staff to meetings, where they can take courses on co-managing LASIK patients, also helps.
Explain Process to Patient
It is important that you talk to your patient about the process. Don’t let the surgery center be the first to mention co-management; patients sometimes think of this as a kickback. If you are upfront, and speak about how you have taken care of their visual needs, and are a partner with the surgeon, you will look much better in the patient’s eyes. Tell the patient when they will be back at your office, and how frequent the visits will be. Talk about your expertise in this area and the many patients you have treated. During the post-op care try to be positive and celebrate the patient’s new vision. Too often an OD sees a patient, who is 20/25, day one, and expresses dismay. We know it will take a few weeks for the vision to stabilize, especially with certain prescriptions. Prepare the patient for the likely course of events after the surgery.
Near-vision correction is very commonly misunderstood by our patients. Many come for LASIK and think they will be corrected for all distances. We still only have techniques which can correct some near with certain limits. LASIK can be done in a modified monovision approach, or even full monovision. Multifocal LASIK has not been successful enough to become common place at this time. Clear lens extractions and inlays are newer technologies to correct our patients’ near vision. It is important to be educated on these topics to be able to answer our patients’ questions properly.
Keep Patients in Your Practice Beyond Surgery
If you have been providing care for the patient for years you should be speaking about the importance of annual eye examinations beyond seeing better. Instilling in our patients the importance of general eyecare for the benefit of the health of their eyes is critical to our long-term success. When going for surgery, stress this fact again, and explain to them how this surgery does not prevent glaucoma, cataracts and retinal disorders–that they still need you to monitor their eye health.