By Scott Huffer, OD, FAAO
Jan. 11, 2017
Health care reform requires ODs to work collaboratively with other healthcare practitioners to serve patients’ total health needs. That process requires that we build relationships with co-managing doctors. Make those relationships profitable.
My five-OD practice in Nashua, N.H., co-manages patients with 15-20 MDs and OMDs in our community–so that the total eyecare needs of our patients are met–and we maximize revenues from this. There also are several specialty ODs we refer to regularly, one for vision therapy and one for specialty contact lens fitting. Occasionally we refer to a low vision specialist. The OMDs we work with are mainly fellowship-trained surgeons.
We rent space inside our office to a fellowship-trained cornea surgeon two days a month. She does the vast majority of our cataract surgeries. We average 20 cases per month. This relationship allows us to keep the procedure mostly in-house. The surgery is completed in a local surgery center a few miles from the office, and all other visits are at our office.
We also have two retina surgeons in the area whom we send patients to for repairs of retinal tears and smaller detachments. Larger detachments we typically send to specialists in Boston, the largest major city to our office. We typically do not refer to general ophthalmologists. However, we have two LASIK-based practices where we send patients, and that practice will often send us local patients for post-operative care.
Set a Goal Recognize a Revenue-Generating Opportunity
Some 10-20 percent more medical eyecare has probably been generated in our practice from the doctors we co-manage with sending us patients. Medical eyecare, on average, pays 30 percent better than routine eyecare.
So, $30,000-$70,000 of annual exam revenue in our office may be attributed to our co-management of patients. And that would not include any additional imaging or testing associated with these visits, which would probably be at least another $20,000 of revenue generated conservatively.
When I joined the office a little over five years ago we were not really co-managing LASIK patients. Our patients were having the procedure, but we were not involved, and we were losing the patients. Now I probably co-manage two patients per month with the other ODs in my office probably adding two more. This patient volume, at four patients per month at $650 per patient, equals $2,600 per month of additional revenue.
I have also had reverse referrals from our LASIK practices in which someone who lives near our office will complete their post-surgical care with us, despite not having previously been a patient.
The co-managing fees for cataracts are $150, accounting for another $3,000 of monthly revenue. Many of these patients get glasses at the one-month post-operative appointment. These purchases add approximately another $2,500-$3,000 of monthly revenue.
Some of the larger OMD groups in our area host continuing education dinners. We almost always have at least one OD from our practice in attendance, and will ask good questions when we can.
There are many different strategies to reach out to other local health care providers, such as sending gift baskets with consult forms and practice information. Scheduling a lunch with a local provider is sometimes helpful for establishing a relationship. If you are lucky enough to have a local provider in your chair, be sure to impress them, and ask if there is anything they would like you to do better when managing their patients.
Vet Potential Co-Managing Doctors
Knowing whether the doctors you are sending patients to have completed a fellowship in their specialty is important. After you have determined that, talk to other ODs who have sent patients to the doctor you are considering co-managing with. My practice is active in our state optometric association, and usually if I have a question about a provider, I will ask a colleague.
Most of all, we want to ensure the doctor is competent and keeping up with technology. After that, we want to know that our patient will have a pleasant experience at the office. We also want to know that the results of the co-managing doctor’s exam, and any tests that are conducted, will be quickly and effectively communicated back to us.
Establishing co-management relationships with surgeons enables you to make sure your patients have LASIK with the best surgeon locally and not choosing someone based on a marketing offer. Further, it allows us to maintain the relationship with annual exams in which we discuss eyewear needs like plano sunwear and near-vision correction.
Build Relationships for Patients with Systemic Diseases
A good relationship with local endocrinologists and rheumatologists can provide a significant patient stream. It is important that these specialists recognize optometrists can care for their patients just as effectively as an ophthalmologist, and often with a much better patient experience.
When I meet MDs at community events, such as my Rotary Club meetings, or a medical community event, I introduce myself, and let them know that we are a good practice for them to send patients to for vision and eye health needs.
Use EHR to Help You Co-Manage
For diabetics and plaquinil patients without complications, we have a template in our EHR to make communicating effectively with the patients’ other doctors simple. A diabetes-without-complications diagnosis triggers a task to a receptionist to generate and send a letter to the PCP and endocrinologist. Mostly we communicate by letters, but are starting to try the secure direct e-mail platform that is part of every modern EHR.
Ask Doctors to Communicate Back
Any pertinent history the co-managing doctor can share with you is helpful, and it is also important that they let you know if there is anything in particular they wish you to do for the patient. Any new patient in our practice has a medication list request sent to their PCP for confirmation of current treatments.