BLOG: Cross-linking ‘champions’ in your practice
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Key takeaways:
- Cross-linking is a resource-intensive procedure.
- Designating cross-linking “champions” will help improve and streamline keratoconus treatment.
Cross-linking is a unique procedure. As cornea surgeons, we depend on referring doctors to screen for keratoconus, a relatively rare disease.
with other ophthalmic procedures, cross-linking is resource-intensive; it requires the acquisition of drugs, which is unusual for surgical procedures, and there are significant payer requirements for documentation and preauthorization. To ensure that all these steps happen in a coordinated fashion, it helps to designate both clinician and staff “champions” within the practice.
In our academic practice, a member of the cornea faculty serves as the primary liaison with local optometric partners. This doctor visits referring optometrists and primary care ophthalmologists and educates them about warning signs of keratoconus, when to refer, what information to provide with the referral, candidacy for cross-linking and what to expect from the procedure. In addition, he makes sure that referring doctors know that we will send their patients back after cross-linking for follow-up care, including contact lenses or glasses. We very much view this as a collaborative effort, so it is important that someone takes ownership for letting community doctors know about us as a resource and feel comfortable referring to us. In private practices, this internal “champion” may be the surgeon, an in-house optometrist or even a community liaison.
When I diagnose a patient with progressive keratoconus and determine that cross-linking is necessary, I initiate the insurance authorization through Epic, our electronic health system. Through Epic, I’m also able to flag the front office staffer we have designated as our cross-linking champion so that she can see my treatment plan and begin to work with the patient and other parties. This individual needs to be someone with access to computer systems related to billing and insurance, a desire to learn about keratoconus and cross-linking, and a helpful and persistent personality.
The cross-linking champion shepherds each cross-linking case through a host of steps:
- Confirm coverage and preauthorization.
- If needed, provide additional materials to insurer (documentation, letter from doctor).
- Determine the patient’s out-of-pocket (OOP) charges.
- If needed, work with patient assistance program and/or donor program to cover out-of-pocket charges.
- Schedule cross-linking for the first eye as soon as possible and book a later slot for the second eye (assuming both are progressing).
- Make sure the drug is ordered and available for the day of surgery.
- Communicate consistently with the patient or family.
The Gavin Herbert Eye Institute is fortunate to have generous private donors who ensure that the majority of patients who needs cross-linking have access to the procedure. Our staff champion plays a critical intermediary role in navigating that process, so that precious donor funds (and donated physician time) are gifted to patients who truly need them.
Having a dedicated person who is focused on cross-linking is important because providing this service is so nuanced. By having one person focused on cross-linking, we capitalize on that individual’s expertise in working with insurance plans and efficiency in being far along the learning curve. While many other staffers are involved along the way, having one or two spearhead the process makes it a better experience for everyone.
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