AOA: Revised AAO, ASCRS comanagement policy reflects positively on OD care

Cooperative care is in the best interest of patients, the AOA says.

Issue: November 2015

The American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery have released a joint paper updating their positions on transferring care and comanagement.

In a statement on its website, the American Optometric Association (AOA) said that the shift in policy reflects “optometry’s effectiveness in delivering this quality service.”

“Comanagement is a relationship between an operating ophthalmologist and a nonoperating 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 joint paper stated. “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 detailed examples of when transfer of care or comanagement are appropriate, including inability to return to the ophthalmologist’s office, ophthalmologist availability, change in postoperative course or by the patient’s own request. Additionally, the paper specifies the list of criteria that must be met when a comanagement arrangement or transfer of care is made.

“Comanagement means that there is cooperative care with both providers working together in the best interests of the patients,” AOA Vice President Christopher J. Quinn, OD, told Primary Care Optometry News. “If both providers are doing that, it’s a win-win for providers and their patients.”

The AAO agrees. “The guidelines reflect the standards-driven approach in which patients are managed in the current health care environment,” David Glasser, MD, team lead for the American Academy of Ophthalmology’s (AAO’s) Review and Revision Committee for the comanagement joint position paper, said. “They provide surgeons with a means to identify circumstances in which comanagement is appropriate and provide criteria for acceptable arrangements that ensure this is done with all ethical, legal and patient safety considerations in mind.”

“The operating ophthalmologist should consult with qualified legal counsel and other consultants to ensure that his/her comanagement 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 comanagement.”

From the AAO’s standpoint, “It is the result of 2 years of discussion between the academy and the American Society of Cataract and Refractive Surgery (ASCRS) to modify original guidance first issued in 2000. As more of our members move toward integrated care models and employ optometrists, we wanted to reflect the role of integrated care in postsurgical management,” Glasser said.

One important point from the paper is that patients are credited as the ultimate decision-maker in who they visit for postsurgical care, Quinn told PCON

“This is the first time that, organizationally, these groups have recognized that patients should be able to make their own choice about where they get their postsurgical care,” he said.

“This is a very positive acknowledgement of what has become standard practice,” Quinn said on the AOA website. “It’s a reflection of the many years of successful patient care and good work that our members provide. Anything that would have restricted an optometrist to provide care to which they are authorized and qualified to provide was not something we were in support of. This is something that we’ve been working toward for many years and something that will serve patients very well going forward.” – by Chelsea Frajerman Pardes and Abigail Sutton

References:
American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery. Ophthalmic Postoperative Care. http://www.ascrs.org/sites/default/files/resources/ComanagementJointPositionPaperSept2015.pdf. Approved June 2015. Accessed September 21, 2015.
American Optometric Association. Significant policy change in postop comanagement. http://www.aoa.org/news/practice-management/significant-policy-change-in-post-op-co-management?sso=y. Posted September 15, 2015. Accessed September 21, 2015.

For more information:
The American Academy of Ophthalmology can be reached at www.aao.org.
The American Optometric Association can be reached at www.aoa.org.
The American Society of Cataract and Refractive Surgery can be reached at www.ascrs.org.

Disclosures: No products or services were mentioned in the article that would require financial disclosure.