Why are Surgeons
Jilting Us?
Edited by Paul C. Ajamian, O.D.
Submit a question to Dr. Ajamian
Question: I just got a letter from the cataract surgeon to whom I refer, saying that he will no longer be returning patients to me in the 90-day post-op period. What’s going on?Answer: Optometrists around the country are beginning to receive similar letters and phone calls from ophthalmologists who are no longer willing to comanage cataract patients. Ostensibly, they are basing their decision on a recent position paper released jointly by the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery. It states, “The decision to comanage should be the result of a determination of what is best for the patient and not economic considerations.”
It provides two justifiable circumstances for comanagement: when the
surgeon is unavailable (due to travel, illness, leave, etc.), and when
the patient can’t visit the surgeon (due to distance or illness).
If the surgeon does decide to transfer care of the patient, the position
paper stipulates the following guidelines, among others:
- Transfer of care must not occur unless it is clinically appropriate.
- The surgeon must inform the patient of any prearranged post-operative management plans, and send a letter to the O.D. stating that the care of the patient is being transferred.
- The surgeon must inform the patient of any financial implications of comanagement.
- The surgeon should follow the patient until stable, with no fixed time for when the patient returns to the referring provider.
Interestingly, the M.D.s who are interpreting it as such still want our cataract referrals. As one letter I received states, “I hope you will continue to refer cataract patients.” By not returning post-ops in the 90day period, they can keep control of our patients longer, increasing the likelihood that patients will be reluctant to leave the surgeon’s care. An added benefit is that they can pocket an extra 20% by not filing the 54 modifier under Medicare.
Remember that our true surgeon friends, of which there are still many, recognize this opinion for what it should be: a guideline for informing patients when their post-op care will be handled by an optometrist, and letting all parties know that the transfer of care has taken place whendeemed appropriate. The time frame of this transfer must vary depending the patient.
The AOA is coming out with a position paper of its own soon, and it should clarify that it’s fine to continue these relationships as long as patients are informed about where the post-op care will be performed.
Question: I am a relatively new graduateand enjoy a good relationship with the local O.D./M.D. in town. I have sent him a great deal of surgery in the last 3 years. However, I recently was disturbed to learn that he has been actively testifying against ourdrug bill, and is an officer of the state medical association. What should I do?
Answer: I would look for another surgeon. It’s time we as a unified optometric profession make a statement to these individuals: You cannot have your cake and eat it too. By supporting such individuals, we are allowing them to continue these activities that not only hinder our profession, but also give them a platform to vilify us in front of legislators and the public.
A recent scope-expansion battle in Georgia was a perfect example of that, with ophthalmologists from around the state (many of whom receive referrals from O.D.s) visiting legislators along with their other M.D.colleagues—including family practitioners, allergists and ob/gyns—trying to convince them that we are uneducated and untrained.
Send it to
Dr. Paul C. Ajamian
c/o Review of Optometry
11 Campus Blvd., Suite
100
Newtown Square, PA 19073
Attn.: CMQA
Or fax it to 610-492-1039,
or e-mail it to reviewofoptometry@jobson.com.
May 15, 2000