Are Your Referral Decisions Based
on Ethics or Income?

BY DAVID I. GEFFEN, O.D.
AUG. 1997

Arecent issue of Newsweek magazine features an article entitled "Zapping the Eye," which generally provides a good overall view of refractive surgery, but contains some areas of great concern. In particular, the article warns consumers to be wary of any advice on refractive surgery that comes from an optometrist. It reports that many optometrists have agreements with laser centers to receive high referral fees, and therefore, may not be referring their patients to the best surgeons.

DISCOVERING AN ETHICAL DILEMMA

At first I was offended by the implications of this article. But after discussing referral practices with several colleagues around the country, I learned there may be reason to be concerned. Some practitioners confessed that they allow refractive surgery comanagement fees to influence their referral decisions.

This issue is just beginning to come to the forefront, and our profession needs to address it before the media has the final say. Otherwise, optometrists will be portrayed as money-hungry scavengers, and optometry will have a major public relations problem.

IN WHOSE BEST INTEREST?

Refractive surgery has become an important part of all our practices, whether you believe in it or not. If you don't, explain your reasons and be true to your convictions. But if you do, then you must evaluate your referral pattern.

Do you want to comanage? Some optometrists prefer to not see patients again until all surgical follow-up has been completed. If you choose to comanage, you must educate yourself and your patients about the process.

Are you referring patients to the best surgeon? Are they being charged fair fees for the surgery and for postoperative follow-up under your care? Patients must understand you are acting in their best interests and not in the best interest of your wallet!

CHOOSING THE RIGHT CENTER FOR THE RIGHT REASONS

I've heard of many patients who were referred to certain laser centers because of high comanagement fees. These centers often charged patients higher fees than other centers that offered lower comanagement payments. In fact, the difference in patient fees was more than the difference in comanagement payment. We must ask ourselves, is this in the best interest of the patient or the optometrist?

Many disgruntled patients found that they could have saved $500 to $1500 on their excimer laser surgery had they been referred somewhere else. I'm not trying to imply that cheaper is better, but you must be able to justify to your patient that you are sending him to the best surgeon for the correct reason.

Look closely at the centers with which you affiliate. Many have opened, and many have already failed. Fewer PRK candidates than expected actually opted for surgery, so many laser centers desperate to bring in patients may be offering generous comanagement fees to entice you to fill their open schedules. This may be of little concern in and of itself, but is the center able to keep its standard of care at a superior level? Are the surgeons performing enough procedures to stay current? Is the center financially strong enough to be around long enough to pay you and provide further service to the patients?

MAINTAINING TRUST

Comanaged care is the natural course for optometry to pursue. Our understanding of the visual system enables us to best treat and care for the patient who has undergone refractive procedures.

Optometry has had a long history of going to great lengths to prove that we act in the patients' best interests. We must be extremely careful not to break the trust we have built with the public.

We are worth every penny we earn from the patient fees and comanagement. But patient care and welfare must always be our first concern, and income will follow from doing a good job. CLS

Dr. Geffen is in a joint refractive surgery practice in San Diego.

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PHOTO ICON BY CHRIS GALLO