Comanagement or Kick-back?

Letter from a physician: "Thanks for exposing the co-management game. I am an ophthalmologist in Southern California and I am appalled at what is going on in my field. Most ophthalmologists feel the same way. In fact at the American Academy of Ophthalmology meeting in 2000 in Orlando the president of the Academy addressed this issue by calling co-management a "kick-back" plain and simple. I just wanted to let you know that I appreciated your website and that most ophthalmologists are sickened by co-management."

10 Things Your Eye Doctor Won't Tell You :

From the article: " 'Open your eyes and I'll be gone'... Ever heard of "co-management? It's a controversial trend in eye care in which an eye surgeon can share postoperative checkups with an optometrist — who, in turn, gets a cut of the surgery fee. This arrangement sometimes makes sense for patients, especially those who live in rural areas and have had surgery far from home.

But it can also be disastrous, since the risk of complications — bleeding, infection or retinal detachment — are much greater in the first 10 days after surgery, says Alan Mendelsohn, president of Florida's Broward County Medical Association. "There's no other specialty in medicine," he says, "where a surgeon doesn't see his patients postoperatively."

Such agreements are causing outrage in Florida, where it was found that some optometrists, unable to handle severe complications, dumped their patients off at emergency rooms. "Some optometrists in Pensacola were shipping patients to [an ophthalmologist in] Tallahassee for surgery because they were getting $700 per eye in kickbacks," says Mendelsohn. "But if three days later the patient said, 'My eye hurts like hell,' they didn't want to drive 250 miles back to Tallahassee." If you're referred to an out-of-town surgeon by your local eye doctor, ask for the qualifications of the surgeon, the terms of your postoperative care and whether your optometrist has any financial incentive in the referral."  

Link to full article


EyeWorld, September 2001
by Lisa B. Samalonis Contributing Editor

From the article: "The practice of surgical comanagement - the operating surgeon and another healthcare provider (usually an optometrist) sharing postoperative responsibilities - is garnering more scrutiny as refractive surgery gains popularity.

Two major issues arise with comanagement, one involving the surgeon and the other involving patient consent, said Priscilla E. Perry, MD, associate clinical professor at Louisiana State University School of Medicine, Shreveport. She helped draft the American Society of Cataract and Refractive Surgery's position paper on comanagement that was released last year.

"Under comanagement, there is an inherently increased burden of responsibility in a situation in which a surgeon delegates the postoperative care and decision making for a patient to another caregiver. That burden is increased if the caregiver does not have the same level of training or knowledge as the surgeon ...," said Perry, who is also ASCRS' primary delegate to the American Medical Associations.

In addition, it is necessary that the patient understand and agree to the transfer of care, and that the patient be aware of the comanager's level of expertise and training, she said.

Leon D. Solomon, MD, associate professor, McGill University, in practice in Montreal, said that optometric comanagement and "assembly-line" laser in-situ keratomileusis practiced by large corporate centers are dangerous."

Link to full article

ASCRS/ASOA position on comanagement

“Our mission is to educate‚ not to regulate. We believe that our members are fully committed to giving the best eyecare to the public and will do it in the best way possible under the circumstances in which they practice. For some‚ it will be in university settings‚ for others it will be in practices with referrals from closed panels‚ such as HMOs and PPOs. For others‚ it will be from optometric networks‚ some of which will require them to comanage. Each ophthalmologist must do that which he feels is best for his patient and with which he feels most comfortable."

“We can advise and recommend‚ but regulation and enforcement are not a part of our mission or intent. Some may abuse the system‚ but things have a way of righting themselves with time and peer pressure.”

— Spencer P. Thornton‚ MD‚ former president of the American Society of Cataract and Refractive Surgery/ American Society of Ophthalmic Administrators.