Successful Co-management in Eye Care


How collaboration between O.D.s and M.D.s can improve patient care and boost success for both

Historically, the subject of ophthalmologists co-managing patient care with optometrists has been controversial. However, co-management has become more accepted and beneficial for both types of providers—and patients—as health care evolves. 

Of the surgeons who report co-managing patients with optometrists, the vast majority co-manage cataract patients, followed by refractive surgery patients and glaucoma cases. Proponents of co-management say it can improve patient care, increase referrals, and grow your practice. With good communication and the right tools, your eye care practice can build successful co-managing relationships.

A mutually beneficial partnership

While at one time the perception of co-management was mutually distrustful—O.D.s accused M.D.s of “stealing” their patients, while M.D.s questioned O.D.s’ competence and feared losing their patients to “the competition”—those fears have not proven true. In fact, successful co-management can be mutually beneficial, according to optometrists and ophthalmologists alike.

An optometrist has the opportunity to boost patients’ perception of care by referring them to an M.D. or D.O. practice that truly believes in co-management, according to Paul C. Ajamian, O.D., of the Omni Eye Centers of Atlanta, one of the pioneers of co-management. He told the Review of Optometry: “The patient’s perception of us is enhanced when they see first-hand that we do more than prescribe glasses. They learn that we handle all primary care—from red eyes to retina—and that we act as the quarterback in the cases that require a specialist.”

Mutual respect is key to a good co-management relationship. An O.D. may have been caring for a patient for a decade or more, and can impart important information to the M.D.

As for M.D.s, some of them have found that O.D.s play an important clinical role, as Rajen U. Desai, M.D., reported in an article for the Review of Ophthalmology. “I’ve seen instances in which a well-trained O.D. caught something an experienced M.D. missed,” he wrote, giving the example of one of his own relatives misdiagnosed with glaucoma. 

Mutual respect is key to a good co-management relationship. Eric Donnenfeld, M.D., noted the importance of the optometrist’s recommendations in Ophthalmology Times. “A doctor who has been taking care of that patient for a decade is going to know a lot more about that patient’s personality, history, and vision care experiences than I can learn in a short consultation, so their counsel becomes very important in my decision as to what lens the patient should receive.”

‘Pre-framing’ the surgical visit

A collaborative relationship between surgeons and optometrists and strong communication are crucial for any successful co-managing relationship, according to James C. Loden, M.D. “The underlying theme is the setting of realistic expectations,” he wrote in the Optometry Times

This extends to patients, too. Dr. Loden explains the necessity of what he terms “pre-framing”—a way of preparing patients so that they know exactly what to expect before and after their exams and procedures. For example, he says, an optometrist might say to a patient: 

“I am sending you to see Dr. Loden. I am confident he will do a great job and give you the outcome you are looking for. When you go to the clinic, he and his staff will perform several tests, he will discuss laser surgery, and he will make a recommendation based on what is best for you. I know you have worn monovision contact lenses for years, and monovision can work well with cataract surgery. I will recommend to Dr. Loden that you proceed with monovision cataract surgery, but he will discuss that more after he has the results of the preoperative testing. After the surgery, I will see you back here for the one-day postoperative exam.”

According to Dr. Loden, “Having a specific conversation in advance is a much more effective method of communication, rather than having to ‘reframe’ the patient’s expectations later.”

This goes for setting patient expectations about surgical outcomes as well. And it’s even better if you can show patients what to expect rather than just telling them. Rendia’s Outcome Simulator was designed to help doctors better communicate the value and tradeoffs of cataract and refractive surgery to their patients by showing them pre- and post-surgery simulations of what their vision could look like with various procedures. Using Rendia ensures consistent patient communication from the O.D. to the M.D. and back again, with our full library of videos to prime patients on the value of the procedure, flag patients who have no tolerance for any visual disturbances, and educate them on pre-op prep and what to expect post-operatively.  

The effect of co-management on profits

Opinions of and participation in co-management between ophthalmologists and optometrists varies, ranging from adversarial or neutral to moderately engaging in the practice or “avidly co-managing,” according to EyeWorld.

‘Avidly co-managing’ practices in which 50 percent or more of surgical cases are referred by O.D.s are among the most profitable in the U.S.

The practices of avidly co-managing surgeons—defined as practices in which 50 percent or more of their surgical cases are referred by O.D.s—are among the most profitable in the U.S., especially when measured in terms of net profit per physician hour, reported EyeWorld. These practices tend to be those that are located in rural areas, or urban and suburban practices putting significant resources into outreach.

Though some M.D.s fear losing revenue if O.D.s co-manage more of their patients, “my experience has been the opposite,” wrote Dr. Desai in the Review of Ophthalmology. “I’m booking three times as many surgeries as before, and arguably doing more good for my community with my 30 patients per day than I used to do with 40, because I’m seeing more patients who truly need my expertise. My practice pattern of co-managing with O.D.s has helped, not hurt, my finances.”

“A collaborative relationship between surgeons and optometrists shows patients that we work as a team to prioritize their care,” wrote Dr. Loden. Staying on top of advancements in refractive cataract surgery, advanced IOLs, and laser procedures is essential to ideal co-management, he added. “Optometrists and surgeons who participate in the latest innovations and share their knowledge can experience immensely enjoyable partnerships and—more importantly—provide the best care to their patients.”

Check out Outcome Simulator to see how this patient education tool can improve the patient experience and facilitate better doctor-patient communication. Get in touch with us today for a demo. 

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