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ODs can benefit from refractive surgery comanagement trends
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As refractive surgery technology develops, primary care optometrists may find themselves forced to relinquish some control over the management of their patients. Refractive surgery centers have on hand technology not found in most optometrists’ offices including the Orbscan (Bausch & Lomb, Rochester, N.Y.) and wavefront analysis equipment. Combined with the pressure to minimize service fees, optometrists are looking for answers to questions on leveraging patient evaluation and consultation on refractive surgery and related fee structures, while offering a valued service. Primary Care Optometry News reached out to several optometrists to offer some insight on this challenging issue.
Patient evaluation
Optometrists are adapting the way they evaluate patients to continue offering value while maintaining their influence on patient care. This technique requires optometrists to spend an equal amount of time with patients as in the past to complete a comprehensive evaluation that offers the full range of options.
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“We refer to our facility as an equal opportunity treatment center: Glasses, contacts or refractive surgery. So, we are very aggressive about letting patients know that refractive surgery is a treatment modality equal to glasses or contact lenses,” Arthur A. Medina Jr., OD, said during an interview with Primary Care Optometry News.
A Primary Care Optometry News Editorial Board member, Dr. Medina noted that he attends to all of the patient education within the office and will accompany his patient on the day of refractive surgery. He also uses these centers for preoperative assessments with the Orbscan and Visx CustomVue system (Santa Clara, Calif.). This information is then used during an office consultation. “From that, I am better able to determine which laser works best and which procedure will work best for them, conventional vs. custom, Visx or Allegretto (WaveLight, Sterling, Va.) vs. ICL (Staar Surgical, Monrovia, Calif.),” said Dr. Medina.
Hans Kell, OD, FAAO, takes a similar approach. “I find I am spending the same amount of time today as I have in the past,” he said in an interview with Primary Care Optometry News. “I perform a comprehensive assessment and only refer evaluation to the refractive surgery center when it can’t be performed in my office.
“I strive to be as closely involved as possible in the care of my patients and refer when management is outside of practice scope or further assessment requires specialist opinion or testing with equipment not provided within my office,” Dr. Kell continued. He noted as an example that his office is not equipped with a wavefront analyzer or a comprehensive imaging instrument such as an Orbscan or Pentacam (Oculus, Lynnwood, Wash.). Therefore, he will complete as much of the evaluation as possible and then refer the patient to a laser center for final analysis, as needed, and surgery.
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PCON Editorial Board member Ryan Parker, OD, also provides a comprehensive assessment before referral. Because the refractive surgery referral center is an hour and a half away from the town in which he practices, Dr. Parker makes sure he takes the time to determine if the patient is indeed a good candidate for a refractive surgery procedure.
“We run additional tests (pachymetry and topography) and spend extra time answering questions and educating the patients to make sure they qualify for refractive surgery and also have reasonable expectations,” he said during an interview with Primary Care Optometry News. “Our goal is to not refer any nonqualified candidates.”
Diminishing fees
Only Dr. Parker has found his practice’s comanagement fees diminishing. Dr. Kell attributes the maintenance of fee schedules to improvements in refractive surgery technology, and Dr. Medina’s method is to refer to privately owned laser centers.
“Denver is a progressive refractive surgery market,” Dr. Kell said. “With excimer laser technology moving from broad beam to scanning, and keratome technology moving from bladed to femtosecond laser, I find laser refractive surgery fees have stayed relatively the same when incorporating these new technologies. Therefore, comanagement fees have remained stable as well.”
“What we have done as an optometric network is try to use a privately held center and reduce the facility fees as low as we possibly can,” Dr. Medina said. “Then, the primary care provider along with the surgeon is able to take an appropriate sum for the amount of work they’ve each done.”
Staying in the loop, educating patients
Cooperation, respect and understanding with the refractive surgery referral center along with a rigorous approach to staying current with refractive surgery information are the prominent pieces of advice for staying in the loop and being viewed as a primary contact by patients. “First, use a surgery center that believes ODs are the primary contact in refractive surgery,” Dr. Parker said. “Second, the OD must remain up-to-date on the latest refractive surgery technologies.”
Dr. Parker noted that it is critical to discuss LASIK surgery with all patients so they are aware of all options. For this approach to be successful, staff must be educated on LASIK to be able to answer patient’s questions.
“When a patient asks if we do LASIK the answer goes: ‘We do all the pre- and postoperative care in our office and refer you to our surgery center for the procedure,’” he said. “I have been in other offices and have heard staff say, ‘No, we don’t do LASIK,’ and the conversation stops there. Educating our patients on the important role that ODs play in a successful refractive surgery outcome is key.”
Dr. Kell commented that staying in the loop is a matter of being as intimately involved with the process as possible. “When appropriate, I always mention that there are three options: glasses, contact lenses and refractive surgery,” he said. “Although often that leads to a longer discussion, by doing so I am offering my patients all the options available to them. With that information, they can then make an informed choice regarding their refractive management.”
Dr. Kell also noted that if an OD makes a habit of omitting discussion regarding all the available refractive error correction choices, they risk the chance the patient will be lost to another provider who does.
Dr. Medina stated that patients will only perceive value in the optometrist if there is active participation rather than passive during education and comanagement. “If they [optometrists] are simply a passive referral source, then there is no value to continue with that primary care provider,” he said. “So it is imperative that the primary care provider have a command of the information, know exactly how the technique and the technology can benefit and assist that patient and then be able to participate in the patient’s continued care.”
Dr. Medina also mentioned it is critical for ODs to view the laser surgery center and the surgeon in the same way they would an optical component lab. “They [optometrists] carefully select their lab by assessing and evaluating the products they are using and the outcomes,” he said. “They are responsible for selecting that lab, getting them all the proper information initially, doing the follow-up and, if there is a problem, actively participating in that care. The laser surgery center and the surgeon serve the same purpose as an optical lab.”
For more information:
- Arthur A. Medina Jr., OD, is a member of the Primary Care Optometry News Editorial Board. He can be reached at 1110 McCullough, San Antonio, TX 78212; (210) 225-4141; fax: (210) 229-9400; e-mail: medinaa@airmail.net.
- Hans M. Kell, OD, FAAO, can be reached at 1220 Summit View Dr., Louisville, CO 80027; (303) 665-7797; fax: (303) 673-9578; e-mail: HansKell@FrontRangeEye.com.
- Ryan Parker, OD, is a member of the Primary Care Optometry News Editorial Board and practices at Parker Family Vision Center, Ardmore, Okla. He can be reached at 1201 Kiawa, Ste. A, Ardmore, OK 73401; e-mail: rlpeyedoc@yahoo.com. Drs. Medina, Kell and Parker have no direct financial interest in the products mentioned in this article, nor are they paid consultants for any companies mentioned.