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Comanagement: What's the prognosis?
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Fundamentally, comanagement is a good thing. In fact, it's an integral part of contemporary health care. As medicine has become more sophisticated, providers have increasingly relied on specialization. Hence, primary care physicians comanage with rheumatologists, internists with cardiologists and, yes, optometrists with ophthalmologists.
For a variety of reasons the OD/MD comanagement relationship has been particularly strong. For starters, the optometrist - who has provided the patient's primary eye care for years - is able to offer continuity. Additionally, the ophthalmologist devotes more time to surgery, thereby becoming more technically proficient and enhancing outcomes. And, most importantly, the patient benefits.
Patients enjoy comanagement benefits
Generally speaking, patients are apprehensive about surgery. They take solace in knowing their "non-surgeon" optometrist endorses the procedure, that they're being referred to a highly skilled surgeon and that they will promptly be returned to their primary eye care provider for postoperative care. Furthermore, many patients like the second opinion afforded by comanagement.
Despite the obvious benefits, comanagement has not been without its critics. There are those who contend that only a surgeon can provide appropriate perioperative care. While this may be true in a select few, high-risk cases, optometrists have repeatedly demonstrated their ability to provide competent perioperative care. Through appropriate training and ongoing interoffice dialogue, the vast majority of complications are detected, treated or averted altogether. After all, comanagement doesn't mean the patient can never be returned to the surgeon!
Others contend comanagement is nothing more than a subverted attempt at fee-splitting. While both comanaging providers do receive compensation from the same patient (or insurer), their fees should reflect the services provided. Indeed, these fees have been well established by Medicare for cataract surgery and are continually reevaluated in the refractive surgery arena. The key, of course, is full patient disclosure. Personally, I know of no comanagement arrangement in which the patient is not apprised of each provider's compensation.
While eye care comanagement has proven itself over the past decade, it faces yet another formidable challenge: greed. As insurers reduce surgical reimbursements and as free market forces drive down refractive surgery fees, the very tenet of comanagement is at risk. With fewer fees available, the optometrist might be tempted to comanage with the most "generous" surgeon. Likewise, to maximize compensation, the surgeon might be inclined to seize comanaging entirely! Simply put, there are those who will make the wrong decision for the wrong reasons.
All things considered, however, I have great faith comanagement will prevail. The reason is that most optometrists and ophthalmologists comanage for the right reasons. They don't do it for the money - or lack thereof. They do it because it's the right thing for their patient.