Co-Management

Retain Boomers by Providing Pre- and Post-Op Cataract Care

By Jeanmarie Davis, OD


More Boomers are having cataract surgery–and opting for premium multifocal IOLs. Providing pre- and post-op cataract care can yield co-management fees, and you can keep these Boomers active in your practice.

The aging of the Baby Boomer population and the expansion of medical eyecare services in optometry offer ODs a practice growth opportunity. The majority of cataract patients still opt for single-vision IOLs because insurance plans and  Medicare cover them–versus  multifocal IOLs that require at least $2,000 out of pocket. But as more Boomers age, more will likely choose the more costly, out-of-pocket-paid multifocal implants. Now is the time to grow your cataract co-management practice sector so you can take advantage of the increasing number of Boomers who will opt for cataract surgery with multifocal implants.

Share in Surgical Fees

ODs typically receive 20 percent of the surgeon’s fees for providing pre- and post-operative care of cataract patients. That means the OD can earn between approximately $200 and $500 per eye for surgeries in which a single-vision lens is implanted in the eye to $400 to $1,000 per eye for surgeries in which a multifocal lens is implanted. Establishing your practice now as a source of co-management ensures you will not lose the growing number of Boomers who will choose multifocal implants in the coming years. Even more important, you are increasing patient loyalty and keeping patients in your practice by managing their cataract care.

Establish Criteria for Referring Patients for Surgery

Send Patient for Consult NOT Referral

You may be inadvertently sending patients off permanently when working with other doctors.

Refer means you intend to transfer the patient to another doctor with no expectation of seeing the patient back.

Consult means you expect to see the patient back. You are sending the patient to another doctor for a treatment plan and needed treatment, but then that doctor is sending the patient back to you for long-term care. –ROB Editors

Once diagnosed–usually during a routine examination–most ODs continue to monitor the cataracts annually until the cataracts have reduced visual acuity to 20/50. Most insurance companies will not cover the surgery until visual acuity has decreased to that level. At that point, most ODs will send the patient to a surgeon for a consultation for evaluation for surgery. Age-related cataracts can present as early as a person’s mid-50s, with nearly all people developing cataracts by the time they reach their mid-70s.

Prepare Patient for Evaluation by Surgeon

After the optometrist determines it may be time for the patient to have surgery, the OD should give the patient a full dilated exam as well as a full refraction and examination of the patient’s intraocular lens. The surgeon needs this information to determine the kind of new lens the patient requires and what power that lens needs to have. The goal is to get the patient to see as clearly as possible after the surgery. Pre- and post-operative instructions and a prescription for post-operative drops are commonly given to the patient by the optometrist at this time if the patient meets all the criteria. The surgeon confirms whether the patient’s eyes are healthy enough for the surgery and if the patient meets the surgeon’s requirements. Then the patient will be scheduled for surgery.

Manage Patient Expectations

If a patient opts for a single-vision implant, their distance vision will be corrected, but you must explain to patients that they will still require correction for near vision. Multifocal intraocular lenses offer correction for both distance and up-close vision, but they are not covered by Medicare. Due to cost and concern about visual quality, most patients still opt for single-vision lenses. For patients who do opt for multifocal lenses, manage their visual acuity expectations the same way you would for a patient prescribed multifocal contact lenses. For example, you can explain that their vision may not be as crisp at a distance. So, a small correction may be needed, but that their dependence on spectacle correction will be greatly reduced if not completely eliminated.

Monitor the Patient Post-Operatively

The day after the surgery, the patient returns to the surgeon for an evaluation. The patient will be treated  with steroid eye drops to control inflammation as well as other drops that may vary depending on each surgeon’s protocol. One week after the surgery, the patient visits the optometrist. If the patient is doing well with no sign of an infection and no inflammation, the OD tapers down the steroid eye drops. The next appointment with the OD occurs one month after the surgery. The optometrist conducts a dilated exam at that point to check on the placement of the intraocular lens and also has to make sure there is no inflammation inside the eye. In addition, the optometrist has to examine the retina to make sure there is no macular edema. If everything eye health-wise is OK at that visit, the OD also should conduct a refraction to assess the need for eyeglasses.

Partner with Several Surgeons

It is important for optometrists to partner with at least a few surgeons to accommodate varying insurance plans. You also should partner with surgeons in varying locations so patients won’t be logistically inconvenienced. In many parts of the country–especially in those with large senior populations–large ophthalmological groups seek out ODs to partner with and receive cataract surgery consults from. If that doesn’t happen, attend local networking events such as continuing medical education events where you can ask other local ODs which surgeons they partner with.

By partnering with a surgeon to manage the care of cataract patients, you can build a new sector of your practice. More importantly, you can ensure that patients receive the best possible care from the beginning to the end of the cataract surgical process and beyond.

Resources

Click here to download coding and billing guidelines for cataract co-management.

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Jeanmarie Davis, OD, recently joined Alcon’s Global Performance Development department as manager, global performance development.

To contact her: drdavis2020@yahoo.com.

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