The Case of the Missing Patient
BY DAVID I. GEFFEN, O.D.
OCT. 1996
The last time you referred a patient for refractive surgery, did he return to your office for follow-up care? If not, did you ever find out why? The biggest problem in comanaged care is improper communication between the optometrist and the surgeon, the optometrist and the patient, and the surgeon and the patient.
MAKE AN EDUCATED CHOICE
The first step toward a successful comanagement relationship is to learn about the surgeons in your area. Observe how they treat patients and choose only a surgeon whose skills and manner you're comfortable with. Make sure you know what procedures he recommends in most situations and if he's willing to spend the necessary time to teach you what to look for in comanaging patients. Make sure the office is a place you're proud to recommend and refer your patients to.
Once you've selected your comanagement partner, make sure you and the surgeon have a clear understanding of each other's roles. Know what information you should supply. Determine an appropriate time frame for patient follow-up. Develop a specific protocol, including forms that facilitate transfer of information between you and the surgeon.
BE AN ACTIVE REFERRING SOURCE
Optometrists who fail to educate their patients about comanagement care are most likely to lose them. Responding to interest in refractive surgery by giving the patient a surgeon's card and telling him to call for an appointment almost guarantees that you'll never see that patient again. Often, the patient will list a 'friend' or 'phone book' as the referring source and the surgeon has no knowledge that you referred the patient. You receive no report and the patient doesn't return to you.
If the patient does list you as the referring source, the surgeon will explain the breakdown of fees, including the comanagement fee. Patients often perceive this as a referral fee or kickback, and the surgeon's office is left to do damage control. Some patients say they don't want to go back to the referring optometrist. Since the surgeon is obligated to treat the patient, somewhere there's an angry optometrist who feels the surgeon is stealing his patients.
When you prescribe contact lenses, you emphasize how important follow-up care is. You must do the same when referring patients for refractive surgery. Explain what to expect at the surgeon's office and when to return to your care. Explain the comanagement fee and the working arrangement between you and the surgeon. Decide how to handle potential problems so the patient will know whom to contact. Our office has forms for pre- and postoperative reporting. Our patients sign comanagement agreements to show they understand procedures.
This may sound like it's too much trouble, but avoiding these steps leads to many problems with patient relationships. The more knowledgeable your patients are , the more loyal they are to your practice.
SAMPLE COMANAGEMENT PROTOCOL
- OPTOMETRIST'S OFFICE - INITIAL APPOINTMENT:
Discuss risks/benefits of refractive surgery, schedule surgical consultation and complete comanaged care agreement and referral forms.
- SURGEON'S OFFICE:
Consult visit: Surgeon enters patient in comanagement log and sends consultation report to referring optometrist.
Day of surgery: Surgeon collects first half of fees from patient, sends fees and surgery report to referring optometrist and schedules patient for postsurgical follow-up as determined by physician and guidelines below:
PRK: 1 day, 3 days, 1 week, 1 month
RK: 1 day, 1 week, 4-6 weeks
LASIK: 1 day, 1 week, 4-6 weeks
Postsurgical appointment at six weeks: Surgeon schedules follow-up appointment with referring optometrist, collects second half of fees from patient and sends fees and follow-up report to optometrist.
- OPTOMETRIST'S OFFICE - FOLLOW-UP APPOINTMENT:
Perform follow-up examination on patient, send postprocedure report to surgeon and schedule follow-ups as needed.
Note: in some states, the optometrist collects a pre- and postsurgical fee independent of the surgeon's fee. CLS
Dr. Geffen, an advisor to various contact lens companies, is in a joint refractive surgery practice in San Diego.