Out of curiosity, in a co-managed patient who ends up liable if something does go wrong during the post op care? Is it the optom taking care of the patient or is the surgeon ultimately responsible?
A couple of months ago a local ophthalmologist that does a lot of co-managing referred a patient to me with a temporal wound abcess s/p phaco. There was a long note in the the patients medical record from the ophthalmologist stating that the optom had been managing the abcess over the last couple of days without notifying him regarding what was going on? Thankfully the patient ended up doing ok and didn't perforate (but came darn close).
On a side note, if a patient does have a wound abcess with a large hypopyon using Vigamox every 2 hours really isn't going to work very well.
I've practiced in 3 different states and have never heard of this type of arrangement for cataract surgery and have not heard of that for refractive in over a decade. I think in the late 90s when PRK/LASIK was at the height of it's popularity, there were a few select practitioners (mostly in Southern California that I recall) who would in fact try to "bribe" ODs with higher than standard comanagement fees.
But as far as cataract surgery, it's a non starter. Cataract reimbursement is so miniscule (from medicare at least, at lets be honest, that's gotta by 90% of cataract cases) that if you go with the standard 20% comanagment arragement, the OD gets what......somewhere between $120 and $150 per eye for what essentially amounts to 3-4 post op visits.
I can assure you that in my practice, each appointment slot generates a lot more than $120-$150 per slot. I actually LOSE money comanaging cataract surgery.
Refractive is only marginally better. Most reputable LASIK mills around here charge $2000-$3000 for both eyes. So at 20%, that's at most $600 for a free pre-op exam in most cases, a one day, one week, one month, and 3 month post op visit. More visits of course needed if there's any sort of dryness or transient vision blur (there always is of course) and God forbid someone needs an enhancement....look out.
So again, I barely break even co managing LASIK AND for that big $600, I get to deal with high strung, perfection demanding middle aged nurses. Yay!! Sign me up for some more comanagement please!!
I don't think you guys really have any understanding of the economics of the industry, and certainly not in the economics of running a practice. I'm going to go out and buy an A-scan machine so I can....what? Do measurements on the few cataract patients I send out in a month? How much does an A-scan machine cost? How much does it reimburse? That makes zero sense for 99.99% of optometric practices.
Here's the deal....I could give a fiddler's fart about comanagment. Virtually all ODs feel the same. As far as I'm concerned, you guys can do it ALL.
Here's what I look for in any referall relationship, and we had this discussion on another thread a few months back:
1) A reasonable and concerted effort to return patients to my care when you're done with them.
2) How about a referal or two sent MY way for something?
3) A reasonable and concerted effort to not bash me or optometry to patients I send over.
That's it.