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Surgical comanagement continues to thrive in 2005
In April 1999, Primary Care Optometry News published an article about the status of surgical comanagement. At that time, ophthalmology organizations and health care providers in some states launched initiatives that would restrict comanagement with optometrists.
As part of our 10-year anniversary retrospective series, Primary Care Optometry News re-examines the issue of surgical comanagement and provides updated information on the latest developments in this area.
“Not much has changed since the Office of the Inspector General (OIG) issued the comanagement regulations in November 1999,” said Jon Hymes, deputy executive director of the American Optometric Association’s Washington office, in an interview with Primary Care Optometry News. “The federal regulations have pretty much stayed the same. Efforts to restrict comanagement at the state level have failed in every state since 1999, although the Nevada Optometric Association passed a comanagement bill in 2001. The reality is that the field is already adequately regulated by the federal government.”
Connecticut’s successful policy
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In 1999, the comanagement issue was addressed in Connecticut when a local Medicare carrier questioned the necessity of optometric comanagement to patient care. In response, the U.S. Health Care Financing Administration (HCFA), both locally and nationally, participated in the development of a new medical review policy for Medicare.
The policy delineated the situations in which comanagement is allowed and those in which comanagement rules are violated. According to J. James Thimons, OD, FAAO, a Primary Care Optometry News Editorial Board member who practices at Ophthalmic Consultants of Connecticut, the policy has been working well.
“What’s happened over the past 6 years is that the policy required that patients be notified of the fact that comanagement is going to take place,” Dr. Thimons said in an interview. “The notification then needs to be documented in the medical records of the patient, both at the surgeon’s and the referring and comanaging clinician’s offices.”
Dr. Thimons said this new procedure has run quite smoothly so far. “For the most part, clinicians are very good about making sure their documentation is in order before they work through comanagement,” he said. “This technically permits the health agency, whether it is Medicare or another, to reimburse them properly for their professional services.”
However, Dr. Thimons said comanagement has been thwarted to some extent by ophthalmology organizations. “Not everybody in the state comanages anymore, because there are some issues that have arisen from the American Academy of Ophthalmology that have placed a damper on the process,” he said. “I think the academy’s current recommendation is that optometrists do not participate in comanagement. So not every practice chooses to offer comanagement for patients from a surgical perspective.”
Nevertheless, Dr. Thimons said, comanagement continues in Connecticut. “We’ve had success in maintaining a positive status with comanagement,” he said. “There have been ups and downs with the billing and subsequent reimbursement processes, but they are always remedied with appropriate intervention.”
New Jersey petition on hold
In New Jersey, a petition for rulemaking was filed in 1999 by the state academy of ophthalmology, seeking “a regulation that would prohibit ophthalmologists from delegating postoperative care to optometrists.” This petition was initially filed with the New Jersey State Board of Medical Examiners.
After careful review and discussion, a subcommittee of the State Board of Medical Examiners recommended that the board deny the petition. At the subsequent board meeting, the board voted to table the denial pending additional input from the New Jersey Academy of Ophthalmology (NJAO).
According to Christopher Quinn, OD, a practitioner in Iselin, N.J., the situation has not moved forward much since 1999. “The medical board had to impanel the subcommittee, and the subcommittee recommended no regulation. Then, the medical board did in fact vote to adopt a regulation — which might limit comanagement,” Dr. Quinn said in an interview.
Dr. Quinn said the proposed regulation’s wording deliberately restricts ophthalmologists in their delegation of comanagement, not optometrists, who are specifically authorized by the board of optometry to comanage postsurgical care. “The medical board cannot control what optometrists do, but they can control what their licensees do,” he said.
Dr. Quinn said the matter now rests in the hands of the Division of Consumer Affairs. “Whenever there is a proposal from one board that is in direct conflict with a sister board, the Division of Consumer Affairs has to act as a traffic cop and figure out what is appropriate and in the patient’s best interest.”
Illinois bill introduced
Legislation recently introduced in Illinois is designed to amend that state’s Optometric Practice Act, according to Sherry Cooper, manager of the AOA’s State Government Relations Center.
The bill states that “Surgical comanagement of patients by eye care providers is permitted in certain circumstances” and provides that “no comanaging eye care provider may receive a percentage of the global surgical fee that exceeds the relative value of services provided to the comanaged patient.”
The amended bill essentially explicates comanagement guidelines similar to those that have been previously defined by the OIG, Ms. Cooper told Primary Care Optometry News.
“This legislation would more or less spell out the same sorts of regulations that were established by the OIG on the appropriate comanagement of ophthalmic surgical patients,” she said. “This begs the question, why have a state law saying the exact same thing?”
Alaska’s restrictive legislation
Alaska is the only state in which legislation has been introduced so far this year that would restrict comanagement, according to Mr. Hymes.
House Bill 151, introduced in February, would prohibit any comanagement with an OD for the first 5 days after surgery.
The bill states that “a surgeon who performs eye surgery in this state may delegate the responsibility for the first 120 hours of postoperative care for the patient to another person if the delegation occurs through a comanagement agreement that meets the requirements of this section and the person to whom the responsibility is delegated 1.) is an ophthalmologist, and either a.) holds a license to practice medicine or osteopathy that was issued under this chapter; or b.) is exempt from the requirement to have a license or permit under this chapter.”
The bill has been sitting in committee since its introduction, Ms. Cooper said.
According to Sheryl Lentfer, OD, president of the Alaska Optometric Association, a second part of the bill makes it difficult for outside surgeons to provide care in Alaska, especially in rural areas.
“It requires the surgeon to be here 120 hours after surgery and states that they cannot transfer the comanagement care unless it is with another surgeon,” she told Primary Care Optometry News. “The bill further states that an ophthalmologist or optometrist may not require, as a condition of making referrals to a surgeon, that the surgeon must enter into a comanagement agreement with the ophthalmologist or optometrist for the postoperative care of the patient who is referred.”
Dr. Lentfer said the legislation is extremely restrictive and potentially damaging to successful patient care through comanagement. “It is a four-page bill with lots of restricting verbiage against comanaging optometrists and makes the practice of comanagement a class-A misdemeanor,” she said. “The bill restricts physician availability, patient choice and competition.”
According to Ms. Cooper, in a March 17 hearing the bill was passed from the House Committee on Health, Education and Social Services into the House Committee on Labor and Commerce. Future hearings on the legislation are expected.
For Your Information:
- Jon Hymes is deputy executive director for the American Optometric Association’s Washington office. He can be reached at 1505 Prince St., Alexandria, VA 22314; (703) 739-9200; fax: (703) 739-9497.
- J. James Thimons, OD, FAAO, is a Primary Care Optometry News Editorial Board member practicing in Connecticut. He can be reached at Ophthalmic Consultants of Connecticut, 75 Kings Highway Cutoff, Fairfield, CT 06430; (203) 366-8000; fax: (203) 334-2401; e-mail: jthimons@sbcglobal.net.
- Christopher Quinn, OD, can be reached at Omni Eye Services, 485 Rt. 1, Iselin, NJ 08830; (732) 388-7130; fax: (732) 388-7138; e-mail: cqod@comcast.net.
- Sherry Cooper is manager of the AOA’s State Government Relations Center. She can be reached at 243 N. Lindbergh Blvd., St. Louis, MO 63141; (314) 991-4100; fax: (314) 991-4101; e-mail: SLCooper@aoa.org.
- Sheryl Lentfer, OD, president of the Alaska Optometric Association, can be reached at 1345 W. 9th Ave., Anchorage, AK 99501; (907) 272-2557; fax: (907) 274-4932; e-mail: sherry_lentfer@yahoo.com.