Do you support Optometrists doing surgery? - ODs allowed to do scalpel surgery in OK!

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Originally Posted by DOCTORSAIB

Yes, of course. Might as well...

If the patient needs it, let's get 'err done!

This is exactly what I was talking about above. You have no idea if OD's want to do this, but you assume that we do. Just like Hello, I do not speak for all OD's, but I have never heard any OD mention intravitreal injections with respect to scope expansion. That's not to say that some fringe OD didn't mention it while talking in the bathroom where an OMD happened to be in one of the stalls, but no one within a leadership role has said that's something we will request. I would like to think that while OD's may feel confortable monitoring AMD and DM, they realize that more advanced treatment really belongs in the hands of a specialist.

I would like to give a current example of the frustration than ODs feel with regards to ophthalmology.

In Alberta, Canada, ODs have been able to Rx therapeutics to treat eye conditions for the last 12 years. Unfortunately, the Provincial Ministry of Health does not cover visits to an OD for treatment of medical eye conditions, and the patients must pay out of pocket, which they do. OMDs, however, are reimbursed by the government. Many patients do not have reasonable access to OMDs so for an eye infection they simply see their, OD, pay for the exam, and away they go. Alberta ODs, understandably are not happy with the disparity, and have been lobbying the government to pay for the "medical - related" visits, as is the case with other provinces. The government is likely going to make these changes, which is good.

Here's the thing...in the Calagary Herald, there was an article by the Alberta OMDs stating that allowing ODs to be compensated by the governement for treating medical eye conditions will result in harm to patients.....despite the fact ODs have been doing just that, without government reimbursment, for over a decade without incident. Can you see why ODs get frustrated?!?!?!

Originally Posted by Tony.

for anyone who doesnt know:
I begin optometry school this year and I cant wait to begin!

I really hope that by the time I finish, OD's and MD's would be able to work WITH each other and not AGAINST each other.....

hahahaha.........so funny. Tony, thumps up. now, to all the ophthalmologists, in case you haven't noticed, no optometrist is paying attention to you. they are all tired of you plotting and undermining. let's all grow up together. professionally. don't be left behind.

Originally Posted by dmaxGh

hahahaha.........so funny. Tony, thumps up. now, to all the ophthalmologists, in case you haven't noticed, no optometrist is paying attention to you. they are all tired of you plotting and undermining. let's all grow up together. professionally. don't be left behind.

Thank you Max. Thank you for needlessly reviving a contentious 8 month old thread that finally looked like it had died a peaceful death. Good job!

Originally Posted by KHE

Thank you Max. Thank you for needlessly reviving a contentious 8 month old thread that finally looked like it had died a peaceful death. Good job!

yeah...why is it that students seem to try to talk/pick fights more than anyone else on here?

alleyesonme,

I am a second year student in Optometry School and I have to say that I am worried about being proficient in retinoscopy, monocular subjective, gonioscopy, biomicroscopy, Indirect Ophthalmoscopy, diagnosing and treating ocular disease medically, etc... Intravitreal Injections are not even in the lexicon of any optometry students. We are not trained to do procedures like that---hell even the general ophthalmologists that I know will not touch that--they refer to a retinologist in that situation. So why the hell would an OD think about doing something like that?

OD's are primary eye doctors practicing in the realm of primary ocular care. Intravitreal injections don't even enter the "thought process" of primary eye care. OD's are more concerned about having a consistent scope of practice regarding TPA's (Therapeutic Pharmaceutical Agents) consisting of topical and oral medications. In the Oral medication realm 46 states have oral therpeutic authority while the state of Florida, New York, Maryland (has only one oral drug), and Massachussetts have no oral authority. Insurance reimbursement issues are another huge area that OD's are far more concerned about. There are no optometrists that I know that want intravitreal injections Don't pay attention to the vitreal and vinegar on this forum---you just asked a question--nothing wrong with that.

Originally Posted by Oculomotor

alleyesonme,

I am a second year student in Optometry School and I have to say that I am worried about being proficient in retinoscopy, monocular subjective, gonioscopy, biomicroscopy, Indirect Ophthalmoscopy, diagnosing and treating ocular disease medically, etc... Intravitreal Injections are not even in the lexicon of any optometry students. We are not trained to do procedures like that---hell even the general ophthalmologists that I know will not touch that--they refer to a retinologist in that situation. So why the hell would an OD think about doing something like that?

OD's are primary eye doctors practicing in the realm of primary ocular care. Intravitreal injections don't even enter the "thought process" of primary eye care. OD's are more concerned about having a consistent scope of practice regarding TPA's (Therapeutic Pharmaceutical Agents) consisting of topical and oral medications. In the Oral medication realm 46 states have oral therpeutic authority while the state of Florida, New York, Maryland (has only one oral drug), and Massachussetts have no oral authority. Insurance reimbursement issues are another huge area that OD's are far more concerned about. There are no optometrists that I know that want intravitreal injections Don't pay attention to the vitreal and vinegar on this forum---you just asked a question--nothing wrong with that.

The fields of optometry and ophthalmology are continually changing. Some good, and some bad. However, they are both unique and much valued fields in eye care.

Thank you for this insight!

With my experience, most optometrists do not want to do surgery. Unfortunately, there are a few that do and we will see continual pressure on lawmakers at the State and Federal level for optometry scope expansion and surgery.

Originally Posted by Andrew_Doan

The fields of optometry and ophthalmology are continually changing. Some good, and some bad. However, they are both unique and much valued fields in eye care.

Thank you for this insight!

With my experience, most optometrists do not want to do surgery. Unfortunately, there are a few that do and we will see continual pressure on lawmakers at the State and Federal level for optometry scope expansion and surgery.

With all due professional respect to the oMD's; LASIK is not surgery! RK, CK are more surgical refractive procedures than iLASIK/eLASIK or PRK. Our fellow ODs in Oklahoma were performing LASIK with ease until the greed of organized Ophthalmology intervened there.

Also SLT/MLT, LPI and YAG should not be considered "surgery." Using a low pulse laser to "paint" the CBB is hardly surgical, and you all know this better than us ODs. But oMDs perpetuate that only their skill & knowledge are able to perform these and ODs who would undergo training in these procedues are a health hazard.

Don't get me wrong here, there are many procedures oMDs perform that are truly surgical and that only they should perform due to their rigorous training (ie Catracts, Trab/Valves, DSAEK/PKP, chalazion injections? etc); but there are some procedures that can be performed by ODs just as competently, if not more...

We should work towards a 3-O (Optician, Optometrist, Ophthal) mentality, not just an egocentric 1-O. Now lets go save some eyes

Originally Posted by Meibomian SxN

With all due professional respect to the oMD's; LASIK is not surgery! RK, CK are more surgical refractive procedures than iLASIK/eLASIK or PRK. Our fellow ODs in Oklahoma were performing LASIK with ease until the greed of organized Ophthalmology intervened there.

Also SLT/MLT, LPI and YAG should not be considered "surgery." Using a low pulse laser to "paint" the CBB is hardly surgical, and you all know this better than us ODs. But oMDs perpetuate that only their skill & knowledge are able to perform these and ODs who would undergo training in these procedues are a health hazard.

Don't get me wrong here, there are many procedures oMDs perform that are truly surgical and that only they should perform due to their rigorous training (ie Catracts, Trab/Valves, DSAEK/PKP, chalazion injections? etc); but there are some procedures that can be performed by ODs just as competently, if not more...

We should work towards a 3-O (Optician, Optometrist, Ophthal) mentality, not just an egocentric 1-O. Now lets go save some eyes

You are one of the few that see it this way; hence, the continual political battles that we face state-to-state and at the federal level.

Originally Posted by killbill2

Breathe: intransitive verb: to draw air into and expel it from the lungs

Breath: noun: an act of breathing

your so freaking smart!

Optoms...just stay in your scope of practice and there will be no blood spilled in the future ;-) If you want to do LASIK or other invasive procedures, just go to medical school and residency to begin with... it's really a no-brainer!


-J

Originally Posted by WhatNEyeTem

Optoms...just stay in your scope of practice and there will be no blood spilled in the future ;-) ...

-J

oooooohhhhhh, I shakin' in my boots.

Originally Posted by gochi

your so freaking smart!

Sigh.

I had an optometrist order a carotid doppler to r/o a CC fistula--does anyone really want those guys operating??!!

Originally Posted by katieg715

I had an optometrist order a carotid doppler to r/o a CC fistula--does anyone really want those guys operating??!!

I had a GP "treating" uveitis with topical anitbiotics. Do we really want PCPs "treating" eye disease??!!

Originally Posted by katieg715

I had an optometrist order a carotid doppler to r/o a CC fistula--does anyone really want those guys operating??!!

Thank you for reviving a 5 month old dead thread that had long ago lost value and became an embarrassment to all involved. Nicely done.

Originally Posted by PBEA

I had a GP "treating" uveitis with topical anitbiotics. Do we really want PCPs "treating" eye disease??!!

Thank you for not being able to just ignore it, very big of you.

Originally Posted by VA Hopeful Dr

Thank you for reviving a 5 month old dead thread that had long ago lost value and became an embarrassment to all involved. Nicely done.

Well, it is a 'sticky' on the forum for all to see. No need to revive something that is for all to see.

This is just like how DOs got equivalency to MDs. They sued and got active politically.

Now MD = DO, will OD (only eye training) = MD + Opthamology residency?

I don't know at all. What do you think?

Originally Posted by allenthecowboy

This is just like how DOs got equivalency to MDs. They sued and got active politically.

Now MD = DO, will OD (only eye training) = MD + Opthamology residency?

I don't know at all. What do you think?

I think you should become a professional first and stop watching Brokeback Moutain.....

Patient safety should be FIRST not SECOND to a provider's billing!

http://www.optometric.com/article.as...ry\0105044.htm

Originally Posted by Andrew_Doan

Patient safety should be FIRST not SECOND to a provider's billing!

http://www.optometric.com/article.as...ry\0105044.htm

Wow, pretty disgusting. When would it ever be in the patient's best interest to NOT see the surgeon who performed their surgery post op day 1???

Originally Posted by Andrew_Doan

Patient safety should be FIRST not SECOND to a provider's billing!

http://www.optometric.com/article.as...ry\0105044.htm

A few things here and though I'm hesitant to get involved in this, I think a few things need to be stated:

1) I don't think you have a good sense of who that doctor is and how he's perceived in our industry.

2) Has nothing to do with billing for post op care, though that article gives that impression. Seriously....$250 for what...a one day, a one week, a one month and perhaps a 90 day post op visit?

Please....that's 4 exam slots on my schedule. I could EASILY fill those 4 slots with patients who will bring faaaar more money into my office than $62.50 per visit. As far as I'm concerned, co management is more of a burden for me, the optometrist than anything else. You guys can have it.

Originally Posted by bungo

Wow, pretty disgusting. When would it ever be in the patient's best interest to NOT see the surgeon who performed their surgery post op day 1???

When the Px can be examined by a doctor just as competent. If the Px requests the surgeon, then accomodations can be made; although the surgeon's availability is not the same as the optometrist...

Originally Posted by Meibomian SxN

When the Px can be examined by a doctor just as competent. If the Px requests the surgeon, then accomodations can be made; although the surgeon's availability is not the same as the optometrist...

If YOU were to have your cataract surgery, who do you want to do your pre-op and post-op?

It's a post-op day one, so the surgeon's schedule is slotted for those visits. Availability is not an issue.

Originally Posted by Andrew_Doan

Patient safety should be FIRST not SECOND to a provider's billing!

http://www.optometric.com/article.as...ry\0105044.htm

These days the IOL calcs are just as important as the surgery itself, especially when dealing with premium IOL's. Being off by just a half diopter can lead to a very unhappy patient in some cases.
Yes most ophthalmologists have a technician do the A scans, K's, etc but usually it's a technician that is trusted by the surgeon and provides him/her with consistent results each time. There are so many variables that can go into picking IOL powers, the more things you can keep consistent the better.
With this in mind, I don't think most surgeons would be very happy if they spent the time reviewing the A scans, K's, etc their technician performed only to find out they won't be reimbursed for their efforts because the referring optom already did the measurements.

Originally Posted by Andrew_Doan

Patient safety should be FIRST not SECOND to a provider's billing!

http://www.optometric.com/article.as...ry\0105044.htm

billing aside, your assertion is that anyone but the surgeon seeing post-ops is "endangering" the pt?

Originally Posted by bungo

Wow, pretty disgusting. When would it ever be in the patient's best interest to NOT see the surgeon who performed their surgery post op day 1???

don't they teach humility in medical school? If you are a MERE medical student, then you have neither the education nor the experience to comment in any way, shape, or form (except as a layperson).

Originally Posted by PBEA

billing aside, your assertion is that anyone but the surgeon seeing post-ops is "endangering" the pt?

At the minimum, the surgeon should be doing the pre-op and one day post-op. Do you not agree?

.

Originally Posted by JMK2005

At the minimum, the surgeon should be doing the pre-op and one day post-op. Do you not agree?

I think its a fine idea, and I have no problem with any surgeon that does so, but I don't believe it is absolutely necessary. Since it happens everyday, all across the country, without adverse outcome, then I'm sure you will agree that NO patient is being "endangered". EVER.

Originally Posted by PBEA

I think its a fine idea, and I have no problem with any surgeon that doofes so, but I don't believe it is absolutely necessary. Since it happens everyday, all across the country, without adverse outcome, then I'm sure you will agree that NO patient is being "endangered". EVER.

Not every post-op is uneventful. It is in that instance that the care is suboptimal. The standard of care should be what you would want done for yourself. Are you OK with with only seeing the surgeon on the operative day, then only "as needed" thereafter? That is certainly not my preference.

Originally Posted by PBEA

don't they teach humility in medical school? If you are a MERE medical student, then you have neither the education nor the experience to comment in any way, shape, or form (except as a layperson).

Well, I know enough to recognize when someone is putting their pocket book, their own ego, and the advancement of their own profession ahead of patient care. That dude is slimy. If you guys want to be considered "real doctors" don't do these sorts of things. Optometrists and Ophthalmologists should be working together, not having to argue over who gets the 60 bucks to see a patient post op.

The patient gets nothing out of this sort of arrangement, and like KHE said, optometrists don't either.

As ophthalmology residents and fellows, I think we are very sheltered from the realities of private practice comprehensive ophthalmology. There are many cataract surgeons around the country that only operate. The do 40-50 cases every day and never see the patient again. This is certainly not the norm, but it is prevalent. These ophthalmologists have numerous optometrists that refer and co-manage these patients. The same is true with refractive procedures. The optometrists send their cataracts and refractive patients to the highest bidder i.e. the ophthalmologist willing to pay the highest co-management fee. Often this fee is paid prior to the surgery even being performed. I'm not suggesting that this is appropriate, or something that I would ever consider doing, but if you started or joined an ophthalmology practice, and the only way you were able to generate sufficient cataract or refractive referrals from optometrists was to agree to co-manage, you may not be so judgmental about these practices.

Out of curiosity, in a co-managed patient who ends up liable if something does go wrong during the post op care? Is it the optom taking care of the patient or is the surgeon ultimately responsible?
A couple of months ago a local ophthalmologist that does a lot of co-managing referred a patient to me with a temporal wound abcess s/p phaco. There was a long note in the the patients medical record from the ophthalmologist stating that the optom had been managing the abcess over the last couple of days without notifying him regarding what was going on? Thankfully the patient ended up doing ok and didn't perforate (but came darn close).

On a side note, if a patient does have a wound abcess with a large hypopyon using Vigamox every 2 hours really isn't going to work very well.

Originally Posted by MullerCell

As ophthalmology residents and fellows, I think we are very sheltered from the realities of private practice comprehensive ophthalmology. There are many cataract surgeons around the country that only operate. The do 40-50 cases every day and never see the patient again. This is certainly not the norm, but it is prevalent. These ophthalmologists have numerous optometrists that refer and co-manage these patients. The same is true with refractive procedures. The optometrists send their cataracts and refractive patients to the highest bidder i.e. the ophthalmologist willing to pay the highest co-management fee. Often this fee is paid prior to the surgery even being performed. I'm not suggesting that this is appropriate, or something that I would ever consider doing, but if you started or joined an ophthalmology practice, and the only way you were able to generate sufficient cataract or refractive referrals from optometrists was to agree to co-manage, you may not be so judgmental about these practices.

The bolded practice is quite illegal, at lest in my state.

The ODs around here all send to one MD, the one that is sure to send the patients back to the OD after all is said and done. He does pre-op and 1 day post-op (more if there's something serious going on). I'm sure the ODs would like to do all of that themselves, but the key thing is that they mostly want the patient to come back in the end. I don't think that's unreasonable.

Originally Posted by bucknut101

Out of curiosity, in a co-managed patient who ends up liable if something does go wrong during the post op care? Is it the optom taking care of the patient or is the surgeon ultimately responsible?
A couple of months ago a local ophthalmologist that does a lot of co-managing referred a patient to me with a temporal wound abcess s/p phaco. There was a long note in the the patients medical record from the ophthalmologist stating that the optom had been managing the abcess over the last couple of days without notifying him regarding what was going on? Thankfully the patient ended up doing ok and didn't perforate (but came darn close).

On a side note, if a patient does have a wound abcess with a large hypopyon using Vigamox every 2 hours really isn't going to work very well.

I've practiced in 3 different states and have never heard of this type of arrangement for cataract surgery and have not heard of that for refractive in over a decade. I think in the late 90s when PRK/LASIK was at the height of it's popularity, there were a few select practitioners (mostly in Southern California that I recall) who would in fact try to "bribe" ODs with higher than standard comanagement fees.

But as far as cataract surgery, it's a non starter. Cataract reimbursement is so miniscule (from medicare at least, at lets be honest, that's gotta by 90% of cataract cases) that if you go with the standard 20% comanagment arragement, the OD gets what......somewhere between $120 and $150 per eye for what essentially amounts to 3-4 post op visits.

I can assure you that in my practice, each appointment slot generates a lot more than $120-$150 per slot. I actually LOSE money comanaging cataract surgery.

Refractive is only marginally better. Most reputable LASIK mills around here charge $2000-$3000 for both eyes. So at 20%, that's at most $600 for a free pre-op exam in most cases, a one day, one week, one month, and 3 month post op visit. More visits of course needed if there's any sort of dryness or transient vision blur (there always is of course) and God forbid someone needs an enhancement....look out.

So again, I barely break even co managing LASIK AND for that big $600, I get to deal with high strung, perfection demanding middle aged nurses. Yay!! Sign me up for some more comanagement please!!

I don't think you guys really have any understanding of the economics of the industry, and certainly not in the economics of running a practice. I'm going to go out and buy an A-scan machine so I can....what? Do measurements on the few cataract patients I send out in a month? How much does an A-scan machine cost? How much does it reimburse? That makes zero sense for 99.99% of optometric practices.

Here's the deal....I could give a fiddler's fart about comanagment. Virtually all ODs feel the same. As far as I'm concerned, you guys can do it ALL.

Here's what I look for in any referall relationship, and we had this discussion on another thread a few months back:

1) A reasonable and concerted effort to return patients to my care when you're done with them.
2) How about a referal or two sent MY way for something?
3) A reasonable and concerted effort to not bash me or optometry to patients I send over.

That's it.

Originally Posted by JMK2005

Not every post-op is uneventful. It is in that instance that the care is suboptimal. The standard of care should be what you would want done for yourself. Are you OK with with only seeing the surgeon on the operative day, then only "as needed" thereafter? That is certainly not my preference.

I'm sure you have no problem if another ophtho sees the the pt day one, yes? If so, then all your saying is that this isn't about the operating surgeon seeing the pt, but an OD seeing the post-op. Your feeling is that the OD won't see the TASS, endophthalmitis, etc, or know what to do for it. Am I correct?

Originally Posted by PBEA

I'm sure you have no problem if another ophtho sees the the pt day one, yes? If so, then all your saying is that this isn't about the operating surgeon seeing the pt, but an OD seeing the post-op. Your feeling is that the OD won't see the TASS, endophthalmitis, etc, or know what to do for it. Am I correct?

No, I think the operating surgeon should see the patient, especially on post-op day one. I don't see the value to the patient in transferring the care so soon, be it MD or OD.

Originally Posted by MullerCell

As ophthalmology residents and fellows, I think we are very sheltered from the realities of private practice comprehensive ophthalmology. There are many cataract surgeons around the country that only operate. The do 40-50 cases every day and never see the patient again. This is certainly not the norm, but it is prevalent. These ophthalmologists have numerous optometrists that refer and co-manage these patients. The same is true with refractive procedures. The optometrists send their cataracts and refractive patients to the highest bidder i.e. the ophthalmologist willing to pay the highest co-management fee. Often this fee is paid prior to the surgery even being performed. I'm not suggesting that this is appropriate, or something that I would ever consider doing, but if you started or joined an ophthalmology practice, and the only way you were able to generate sufficient cataract or refractive referrals from optometrists was to agree to co-manage, you may not be so judgmental about these practices.

what nonsense, you make it sound like its "greedy ODs" driving this. Wake up pal, "co-management" is a wholly owned ophthalmology concept. YOU guys started it, NOT us. You want to point fingers, then look in your own house, and stop casting aspersions on OD character.

Originally Posted by JMK2005

No, I think the operating surgeon should see the patient, especially on post-op day one. I don't see the value to the patient in transferring the care so soon, be it MD or OD.

good answer. Their are a few exceptions to this (long distance to travel), but otherwise, I agree.

Originally Posted by bungo

Well, I know enough to recognize when someone is putting their pocket book, their own ego, and the advancement of their own profession ahead of patient care. That dude is slimy. If you guys want to be considered "real doctors" don't do these sorts of things. Optometrists and Ophthalmologists should be working together, not having to argue over who gets the 60 bucks to see a patient post op.

The patient gets nothing out of this sort of arrangement, and like KHE said, optometrists don't either.

WE DO work together, often covering each other in various ways, AND (gasp!) we often get paid to do so. Typically ODs will handle routine pre/post-ops, etc, anything atypical pops up then we talk to the surgeon. The patient benefits from the highest standard of care, and from excellent outcomes. In these cases, all of us benefit greatly.

There, now that you have actually learned something today, why you run along and play with your stethescope.

PBEA, in no way did I state that ODs are responsible for co-management or motivated by greed. If anything, I suggested that certain ophthalmologists were unscrupulous. I personally wouldn't feel comfortable with anybody, MD or OD, seeing my post-operative patient, especially on day 1. If they come from far away and look good day 1, I often suggest that they see the referring provider, and if there is any problem I would gladly see them back.

Originally Posted by PBEA

There, now that you have actually learned something today, why you run along and play with your stethescope.

Well you see, playing with my stethoscope USED to be fun, but its been four years now, and I just don't enjoy twisting the end thingy between the bell and diaphagm anymore.

Originally Posted by KHE

But as far as cataract surgery, it's a non starter. Cataract reimbursement is so miniscule (from medicare at least, at lets be honest, that's gotta by 90% of cataract cases) that if you go with the standard 20% comanagment arragement, the OD gets what......somewhere between $120 and $150 per eye for what essentially amounts to 3-4 post op visits.

Respectfully, co-management arrangements like what you have described are against federal kickback law, is illegal, and considered to be a felony. This law prohibits splitting/sharing/paying/soliciting/receiving money for ANY service covered by Medicaid/Medicare. With cataracts, nearly all are billed to Medicare.

With LASIK, you can co-manage all you want as this is a non-Medicare entity.

Thus, for BOTH optometrists and ophthalmologists in these arrangements, you can be reported and the Feds can shut you down.

What is the anti-kickback law?

The federal anti-kickback statute, 42 U.S.C. § 1320a-7b(b), prohibits individuals or entities from knowingly and willfully offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid or any other federally funded program (except the Federal Employees Health Benefits Program). Some courts have interpreted the law to cover any arrangement in which one purpose of the remuneration is to induce or compensate for program referrals. However, one federal appellate court has ruled that to prove a violation of the anti-kickback statute, the government must prove that a defendant had a specific intent to disobey the law.

What penalties does the anti-kickback law impose?

A violation of the anti-kickback law is a felony offense that carries criminal fines of up to $25,000 per violation, imprisonment for up to five years and exclusion from government health care programs.
The Balanced Budget Act of 1997 created an alternate sanction. The government may levy a civil fine of up to $50,000 for each violation of the statute and an assessment of three times the amount of the kickback. Previously, the only anti-kickback enforcement tools available to the OIG and DOJ were excluding a physician from the Medicare and Medicaid programs, which is a lengthy process, or seeking conviction under the higher burden of proof required for criminal cases. The government likely will use the new "intermediate sanction" authority more aggressively in anti-kickback cases because it will be easier to impose.

http://www.acr.org/SecondaryMainMenu...tsFAQDoc3.aspx

Originally Posted by Andrew_Doan

Respectfully, co-management arrangements like what you have described are against federal kickback law, is illegal, and considered to be a felony. This law prohibits splitting/sharing/paying/soliciting/receiving money for ANY service covered by Medicaid/Medicare. With cataracts, nearly all are billed to Medicare.

With LASIK, you can co-manage all you want as this is a non-Medicare entity.

Thus, for BOTH optometrists and ophthalmologists in these arrangements, you can be reported and the Feds can shut you down.

What is the anti-kickback law?

The federal anti-kickback statute, 42 U.S.C. § 1320a-7b(b), prohibits individuals or entities from knowingly and willfully offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid or any other federally funded program (except the Federal Employees Health Benefits Program). Some courts have interpreted the law to cover any arrangement in which one purpose of the remuneration is to induce or compensate for program referrals. However, one federal appellate court has ruled that to prove a violation of the anti-kickback statute, the government must prove that a defendant had a specific intent to disobey the law.

What penalties does the anti-kickback law impose?

A violation of the anti-kickback law is a felony offense that carries criminal fines of up to $25,000 per violation, imprisonment for up to five years and exclusion from government health care programs.
The Balanced Budget Act of 1997 created an alternate sanction. The government may levy a civil fine of up to $50,000 for each violation of the statute and an assessment of three times the amount of the kickback. Previously, the only anti-kickback enforcement tools available to the OIG and DOJ were excluding a physician from the Medicare and Medicaid programs, which is a lengthy process, or seeking conviction under the higher burden of proof required for criminal cases. The government likely will use the new "intermediate sanction" authority more aggressively in anti-kickback cases because it will be easier to impose.

http://www.acr.org/SecondaryMainMenu...tsFAQDoc3.aspx

I think it would be difficult to prove that in court. The law states that using the co-management money to induce referrals is the illegal part. All you'd have to do is say something about the MD that you refer to being, to your professional judgment, the best at X procedure.

That being said, if this is illegal, why does Medicare allow for a procedure fee to be split into procedure only and post-op care?

Co-management is NOT ILLEGAL. If services are rendered during the global period by the comanaging doctor then Medicare will reimburse for those services. Call Medicare, ask them.

http://www.ophmanagement.com/article...0014550pm.html

You guys should make sure of the facts the next you attempt to disparage ODs. Which BTW is pretty much all you guys do. I find it very telling (as in self-serving) when I hear an OMD calling foul whenever an OD takes a breath.

Originally Posted by VA Hopeful Dr

I think it would be difficult to prove that in court. The law states that using the co-management money to induce referrals is the illegal part. All you'd have to do is say something about the MD that you refer to being, to your professional judgment, the best at X procedure.

That being said, if this is illegal, why does Medicare allow for a procedure fee to be split into procedure only and post-op care?

The splitting of post-op care by Medicare was really for patients in the rural areas where the surgeons are not available AND for special circumstances where patients want their optometrist to follow them. However, you have to have patient consent. Second, the co-management must be decided by the PATIENT and not the physicians.

How many patients do you know want to be co-managed? Very few of mine want to be co-managed, even by other physicians in the same practice. Most patients meet the surgeon and want the surgeon to care for them post-operatively.

If the patient did NOT pick to be co-managed, and the optometrist-ophthalmogist decided this, then it is illegal. There are many circumstances where the physicians decided this.

I am sure it is difficult to prove in court if this was clearly indicated on the consent, but do you really want to practice medicine illegally like a con-artist and not allowing patients to have a choice? This is not why I went into medicine. Patients should have a choice, but these "co-management" arrangements are not really in the best interest of patient care and seldom do patients really have informed consent when they are co-managed.

http://www.ophmanagement.com/article...0014550pm.html

Step one: patient consent

It's crucial to understand that the co-managing decision must be made by the patient -- not the physicians.

Prior to surgery, the patient must give informed consent for the procedure. This includes being informed about proper care following the procedure: the need for post-op care, what post-op care entails, and the choices of qualified professionals to provide post-op care. (This discussion may have been initiated in the optometrist's office, but all the key points should be restated and all options explored with the surgeon.)

Yes, it is NOT illegal to co-manage when there is proper patient consent AND the patient picked it.

Yes, it IS ILLEGAL to co-manage when this relationship is established by the providers. It's a kick-back for surgical referals.

Originally Posted by PBEA

You guys should make sure of the facts the next you attempt to disparage ODs. Which BTW is pretty much all you guys do. I find it very telling (as in self-serving) when I hear an OMD calling foul whenever an OD takes a breath.

Now before I make this statement, look at my history...it's rare that I knock ODs on the forum

BUT

if you dont like what's said here, then get the heck out of the forum...I honestly dont care enough about ODs' opinions of us to troll the forums you guys run on here...so why should you care what we say about you here? do you really have THAT much free time? I mean, I know never being on call is awesome and all...but still...

(yes, you can say: It's b/c of lies/mistruths/insults/etc that you are here to respond to, but let's be honest...if we went to the OD forums, it'd be full of the same or worse)

Originally Posted by Andrew_Doan

Respectfully, co-management arrangements like what you have described are against federal kickback law, is illegal, and considered to be a felony. This law prohibits splitting/sharing/paying/soliciting/receiving money for ANY service covered by Medicaid/Medicare. With cataracts, nearly all are billed to Medicare.

With LASIK, you can co-manage all you want as this is a non-Medicare entity.

Thus, for BOTH optometrists and ophthalmologists in these arrangements, you can be reported and the Feds can shut you down.

What is the anti-kickback law?

The federal anti-kickback statute, 42 U.S.C. § 1320a-7b(b), prohibits individuals or entities from knowingly and willfully offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid or any other federally funded program (except the Federal Employees Health Benefits Program). Some courts have interpreted the law to cover any arrangement in which one purpose of the remuneration is to induce or compensate for program referrals. However, one federal appellate court has ruled that to prove a violation of the anti-kickback statute, the government must prove that a defendant had a specific intent to disobey the law.

What penalties does the anti-kickback law impose?

A violation of the anti-kickback law is a felony offense that carries criminal fines of up to $25,000 per violation, imprisonment for up to five years and exclusion from government health care programs.
The Balanced Budget Act of 1997 created an alternate sanction. The government may levy a civil fine of up to $50,000 for each violation of the statute and an assessment of three times the amount of the kickback. Previously, the only anti-kickback enforcement tools available to the OIG and DOJ were excluding a physician from the Medicare and Medicaid programs, which is a lengthy process, or seeking conviction under the higher burden of proof required for criminal cases. The government likely will use the new "intermediate sanction" authority more aggressively in anti-kickback cases because it will be easier to impose.

http://www.acr.org/SecondaryMainMenu...tsFAQDoc3.aspx

20 % is the percentage that MEDICARE ITSELF says is the acceptable rate to not be in violation of any sort of anti-kickback problems.

Virtually ALL of the patients I refer out wish to be co-managed because the surgeon is a 20 minute drive away in the next town over and I'm a 3 minute drive away. Is 20 minutes drive a burden? Not for most of us I would say but for seniors and/or their caregivers and/or the nursing home they live in and/or their children who shuttle them around, 40 minutes round trip in a day as compared to 6 can be a pain in the middle of a busy day.

And again Dr. Doan, if I had my druthers, you guys could ALL TAKE ALL THE SURGICAL MANAGEMENT YOU WANT! I don't WANT to do it. I LOSE MONEY doing it! I already showed you that.

The article you posted is from 2000. Here, it's 10 years later and this whole issue is a non starter. I already said that YES, at the very height of the refractive surgery boom 10-15 years ago there were probably some illegal relationships throughout the country though most of them seem to be concentrated in southern California, and as another person said most were initiated by ophthalmologists! But even in that outdated and tired article, the example shown is that the OD takes over 90% of the postop management and receives the grand total of $133. Oooooohhhhhh......someone call my stock broker and my travel agent to book that trip to Tahiti. A whole big $133! For how many office visits? 2? 3? Ooooooooooooo. Be still my beating heart.

But that $133 represents only 90% of the post operative period. What if I was one of those crazy, renegade, money grubbing ODs who cared only about money and not about patient welfare and I insisted on doing the one day and the one week visit as well? That would get me an extra $13.30.

YESSSS!!!!!!

This whole thing is much ado about nothing.

Originally Posted by Andrew_Doan

The splitting of post-op care by Medicare was really for patients in the rural areas where the surgeons are not available AND for special circumstances where patients want their optometrist to follow them. However, you have to have patient consent. Second, the co-management must be decided by the PATIENT and not the physicians.

How many patients do you know want to be co-managed? Very few of mine want to be co-managed, even by other physicians in the same practice. Most patients meet the surgeon and want the surgeon to care for them post-operatively.

If the patient did NOT pick to be co-managed, and the optometrist-ophthalmogist decided this, then it is illegal. There are many circumstances where the physicians decided this.

I am sure it is difficult to prove in court if this was clearly indicated on the consent, but do you really want to practice medicine illegally like a con-artist and not allowing patients to have a choice? This is not why I went into medicine. Patients should have a choice, but these "co-management" arrangements are not really in the best interest of patient care and seldom do patients really have informed consent when they are co-managed.

http://www.ophmanagement.com/article...0014550pm.html



Yes, it is NOT illegal to co-manage when there is proper patient consent AND the patient picked it.

Yes, it IS ILLEGAL to co-manage when this relationship is established by the providers. It's a kick-back for surgical referals.

Everyone I saw referred from an OD was given a consent form that, yes, was filled out as though the patient was going to go back to the OD but I did see a few request to stay with the surgeon after surgery.

At the OD offices (at least the 2 I worked in) the patients were told how the co-manage deal worked and referred to the surgeon that participated. Not all the patients went to him. Some already knew a different MD, some went to the pre-op appointment and didn't like the co-managing MD.

Perhaps my experience is unusual, but I'm just not seeing the paternalistic handing off of patients that you seem to have encountered.