AAO and ASCRS set guidelines on postop co-management, transfer of care

The American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery have issued a joint position paper with guidelines on co-management and transfer of care after ophthalmic surgery.

“Co-management is a relationship between an operating ophthalmologist and a non-operating practitioner for shared responsibility in the postoperative care when the patient consents to multiple providers, the services being performed are within the providers’ respective scope of practice and there is agreement between the providers to share patient care,” the paper said. “Transfer of care occurs when there is complete transfer of responsibility for a patient’s care from one qualified health care provider operating within his/her scope of practice to another who also operates within his/her scope of practice.”

The paper stated that federal Medicare policy on co-management has been adapted and interpreted by states and carriers with “variations in details and restrictions.”

“The qualified operating ophthalmologist has the ultimate responsibility for the preoperative and postoperative care of the patient, beginning with the determination of the need for surgery and ending with completion of the postoperative care contingent on medical stability of the patient,” the paper said. “Economic considerations, such as inducement for surgical referrals or coercion by the referring practitioner, should never influence the decision to co-manage, or the timing of the transfer of a patient’s care following surgery. This is unethical and, in many jurisdictions, illegal.

“The management of a patient with the participation of a non-operating practitioner rather than solely by the operating ophthalmologist, whether as part of a co-management arrangement or as a transfer of care, may be appropriate when the conditions set forth in this position paper are met.”

Circumstances in which co-management and transfer of care are appropriate include a patient’s inability to return to the operating ophthalmologist’s office for follow-up care, the operating ophthalmologist’s unavailability and patient prerogative. The paper also spells out guidelines on change in postoperative course in cases in which complications or comorbid disease develop.

Several criteria must be met when the operating ophthalmologist enters into a co-management arrangement or transfers care.

“The operating ophthalmologist should consult with qualified legal counsel and other consultants to ensure that his/her co-management practices are consistent with federal and state law and best legal practices,” the paper said. “Above all, patients’ interests must never be compromised as a result of co-management.”

Eric D. Donnenfeld, MD, past ASCRS president and OSN Cornea/External Disease Board Member, described the position paper as appropriate and long overdue.

“ASCRS and the AAO have released an updated co-management guideline document, which is in my opinion fair, balanced and long overdue,” Donnenfeld told Healio.com/OSN. “The three pillars on which the document is supported are the patient’s inability to return to the operating ophthalmologist’s office for follow-up care, the operating ophthalmologist’s unavailability and, most importantly, the patient’s prerogative. The overriding principle of the position paper is that co-management should be performed when it is in the best interest of the patient, the guiding concern we should employ in every patient interaction.”