Co-Management

Expand Services with an In-House Cataract Surgeon

By Dave Anderson, OD


Dec. 16, 2015

Adding a cataract surgeon to our office this year has allowed us to provide greater ease-of-care to our patients requiring cataract surgery, allowing them to visit with their surgeon right in our office. It also has resulted in increased post-operative eyewear capture rates by 70 percent, and has generated more than 100 referrals to our office of patients who are being brought into the practice to visit with our surgeon in residence.

SYNOPSIS

Adding a cataract surgeon to your professional team provides patients with “one-stop shopping” for surgery consults, pre- and post-op care, and eyewear. The ROI is measurable.

ACTION POINTS

CREATE “ONE STOP SHOPPING.” Ease process-of-care for cataract patients, creating a seamless experience in which they can see their cataract surgeon right in your office.

DIVIDE WORK LOAD & COSTS. The in-house surgeon is sent patients by the ODs, and if not a formal member of the staff, helps to at least cover a portion of the office’s rent or mortgage.

MARKET SURGEON. Announce on your web site, social media and in your office, and also hold a press conference at the hospital where the surgeon is on staff.

Establish Goals for Addition of Surgeon

For many years, patients at our practice would ask if we were able to help them when it came time to have their cataracts removed. We always helped facilitate the surgery, both the referral and many of the follow-ups. Unfortunately, the closest surgery center that provided cataract surgery was 10 miles away. This doesn’t seem like much, but to an 80-year-old, this presents quite a challenge.

All that changed when we moved into a new office, across the street from our local hospital, and when we did, we added a cataract surgeon to our office. That’s when the idea of adding a surgeon to our office began to gain traction as a viable idea. Our goals were to make the cataract care and surgery process easier for our patients, and to have a seamless process in place for cataract surgery. In other words, our patients can now visit our office for all of their needs, and then just go across the street for their surgery, rather than being sent out of their way on a long drive to another office.

In order from left to right: Ohio State Representative Niraj Antani; Miamisburg Mayor Dick Church; Cataract Surgeon Maneesh Mehan, MD; Keith Basinger, OD (Dr. Anderson’s partner); Dr. Anderson; and Miamisburg City Council Member Charlie Case. These local officials were in Dr. Anderson’s office to commemorate the collaboration of his office with the hospital and Dr Mehan, in a groundbreaking/press conference to detail the joint effort. Dr. Anderson says patients appreciate the convenience of being able to stay in the practice when it comes time for their cataract surgery.

Find the Right Surgeon for Your Practice

At this point, the surgeon is not a partner in our office, but we are in negotiations to make him a full-fledged partner, and expect this addition to our practice to be something very positive for both him and us.

The surgeon came to us and asked about working in some capacity with us. He was always impressed with the way we did business, but also loved our new office. He was interested in doing surgery at the hospital across the street from us, and he worked hard to make that happen.

Before we made any arrangements, we did our due diligence and made sure we would work well together. We looked at our staffing situation, and made sure everyone was comfortable with the pre- and post-operative cataract care system we had in place, both his staff at the hospital,  and ours.

We also looked at how we would work together to eventually join as partners, and how that arrangement might work, before we even entertained him seeing any patients in our office.

Agree on Work Load for Surgeon

The surgeon sees the patients in our office when needed, but often, we are the ones handling the pre- and post-operative care in our office. Surgery is performed at the hospital across the street in the out-patient surgery center. This has worked well for our patients, as many are already familiar with the surgery center and hospital and our office, so everything is very comfortable for them.

The surgeon bills for the surgeries he does, and we bill for the post-op care that we provide.

Set Up a Cataract Surgeon in Your Office

Surgeon Proposed Plan: To see all of our cataract patients with consult in our office to prepare for surgery at the hospital across the street from our office.

Billing: Separate billing for all surgeries

Benefit from MD: Steady patient flow
Benefit to OD: Expands our services, provides ease and comfort to our patients at a time that is very stressful to many.
Impact on Revenues: A 70 percent increase of post-op prescription eyewear sales, and post-op care now provided for nearly 100 patients with revenue between $180- $400 per patient depending on the insurance. —Dave Anderson, OD

The surgeon works independently while seeing patients in our office. We have an arrangement regarding the rent he pays to us for use of our staff and facilities while in our office. However, In the near future, we are planning to combine forces, and have a situation where we are one entity to provide the full scope of care our patients have always expected, formally adding the surgeon to our practice as a partner.

“We’ll see you through the whole process,” our staff can now tell  cataract patients. “Our doctors see you before and after, but the surgeon performs the procedure right across the street. Now billing-wise, the surgeon’s staff will explain how they will bill your insurance.”

In most cases, we wait to refer the patients to the surgeon until their cataracts are affecting their quality of life. Sometimes patients may request a visit with the surgeon, just to hear what their options are, and what the process is like, but in most cases, patients are confident in our ODs’ services, and prefer to stay in our care until the time is needed for surgery. In fact, the relationship is much like that of a primary care doctor and a cardiologist. The patient only wants to see the cardiologist when needed, and the situation is the same with the cataract surgeon.

Capture Post-Op Visual & Eye Health Needs

The financial benefit of adding a cataract surgeon to our office is better capture of the post-op glasses need. From the moment surgery is discussed, up until the glasses prescription is presented, we are always talking about the best way to correct their vision after surgery. In the past, many patients just dealt with some distance blur and would use over-the-counter reading glasses for their near needs. Now, many are being put into progressives, as they are already accustomed to this, and it allows for better flexibility when they shop or in their everyday life.

The other revenue comes from the co-management of the cases. We are handling nearly 100 percent of the post-op visits, and this is an increase in service revenue that was not found in other co-management options. This amount varies tremendously depending on the medical plan, but also varies if they are having premium IOL’s, which increases the surgical cost and the needed follow up.

Prepare Staff for Addition of Surgeon

We spent several different staff meetings discussing the cataract care systems change we were implementing in our office. We discussed the work flows for the post-op visits, how to ensure proper scheduling, and what would be needed for care in our office on the days we saw post-operative cataract patients. By the end of the training, most staff were excited, but nervous about the change. Most staff worried that their work load would increase, but have found the change and addition to their work flow to be refreshing.
Our staff is excited to hear how the cataract patients are doing, as they are now seeing them the day after surgery and seeing the amazing results of the procedure for our patients.To help prevent congestion in the office and delays in patient care, we arranged for the surgeon to be in our office on days when our work flow is less demanding.

This has helped add revenue to slower times, but also has not caused any disruption in patient traffic and the typical office flow.

Market In-House Surgeon

We advertised and wrote articles for the local media on the new relationship with the surgeon. We also held a press conference with the hospital, the surgeon and our office to announce the surgeon’s new role in our office, and it was on all the local news stations, and we touted this to the community as a benefit for patient care and the community.

We mention the option of having cataract surgery done by our in-house surgeon in the first conversation after we diagnose the cataracts. We discuss the seamless transition to the cataract surgery and back to our ODs’ care at every opportunity.

Dave Anderson, OD, is a partner with Miamisburg Vision Care in Miamisburg, Ohio. To contact: doca@burgvision.com

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