To say that co-management is a hot topic in ophthalmology and optometry circles is an understatement. The ASOA, OOSS, and other leading organizations are running webinars seemingly every other week; podcast episodes on the subject abound. And the leading attorneys and consultants in the space are busier than ever. 

With more than 3,000 surgeons and optometrists on the CoFi platform, we have done a significant amount of informal consulting and sharing of what we’ve assessed as best practices – always with the caveat that we are not attorneys, of course. When it comes to elective procedures, particularly within the context of premium IOL implants, confusion can arise. In the wake of the recent settlements of three high-profile lawsuits relating to the totality of the relationships between certain ophthalmology practices and area optometrist, we thought it would be useful to provide a short discussion of best practices. This is based on information we have heard articulated by the experts and processes implemented by practices that are conscientious about implementing co-management the right way.

There are four pillars that come to the forefront of factors that, when followed diligently, can help comprise a proper approach to co-management:

• Patient choice

• Continuity/quality of care and clinical relationship 

• Fair market value (FMV) for services rendered

• Price transparency and payment separation

First, patient choice is the hallmark of proper co-management. Nearly every provider we’ve encountered understands this: Patients must be educated that it is their decision to be co-managed. That conversation should be documented in writing and retained in their record. Surgeons need to avoid explicit or implicit agreements or understandings with comanagers that patients will be automatically or routinely referred back to them for postoperative care.

Second, there must be continuity of the clinical relationship and quality of care above all else. The optometrist must be a capable, competent, and communicative clinical partner. Post-operative protocols need to be understood and adhered to, and their completion documented on a per-patient basis. Notes need to be shared between the surgeon and the OD and vice versa.

We recommend practices periodically take stock (or audit) the quality of their clinical relationships. One way to think about it: An optometrist who repeatedly has postoperative patients “land in their chair” without notes from the surgeon will simply stop referring to and co-managing with that surgeon. Ophthalmologists would be smart to consider whether ODs are returning postop notes and communicating as they should.

Third, practices need to show that the amount of compensation reflects the FMV of the services to be provided. Co-management can be thought of as surgeons reducing their fee based on the value of the work they are not performing. This value will vary by procedure type, as well as the location of the practice. 

For example, if the surgeon’s fee is $2,000 per eye for a premium cataract surgery and they've determine that the time- and material-value of the postoperative work factored out to 15% of the total premium service workload ... and $200 of the $2,000 was for a femtosecond laser click fee ... the ophthalmologist would be ascribing $270 per eye as their rate for postop work.  

The optometrist need not charge the patient $270. The OD should set his or her own FMV rate for the services provided. They may consider $270 to be FMV but they may value their time performing the postoperative protocol at $250 or $300.  

For practices that want their co-managing ODs to set their own FVM rates, CoFi’s software stores custom OD fees that vary by procedure and by OD. This makes it easy to manage what otherwise would be an incredibly cumbersome pricelist.

Fourth, payment separation is crucial to avoid impropriety and the appearance of impropriety. Fundamentally, ophthalmologists should not be paying referring providers – even if collecting their fee and remitting a payment to them is being done for the convenience of everyone involved. See the next blog to learn why this is so critical and how CoFi can help.