Cultivating referral relationships with optometrists?

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4ophtho

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I am in a large metropolitan area
I imagine most optoms already have referral relationships with some of the high-volume refractive factories in the area, but not all of them
Any recs on how to start a new referral relationship with optometrists ?
What do these referring optoms expect in return?
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4ophtho said:
I am in a large metropolitan area
I imagine most optoms already have referral relationships with some of the high-volume refractive factories in the area, but not all of them
Any recs on how to start a new referral relationship with optometrists ?
What do these referring optoms expect in return?
Click to expand...

If you had to guess, what do you think optometrists want in return?
 
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DrZeke said:
Money? Everything is about money.


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I don't know if the OP is talking about refractive surgery specifically or if he's including cataract surgery and other anterior segment procedures as well but here's what I'm looking for....

1) I would like some referrals too. This is really the biggest one. Referrals are not a one way street. Have some weird CL case you don't want to deal with? Send it my way. Someone needs VT or has a binocular vision issue? Send them my way, SPECIFICALLY. Don't just tell the patient "see an optometrist." Call up my office and make the appointment, just like I would call up your office to make the appointment for surgery.

2) I expect your office staff to be nice and for you to run reasonably on time. If patients come back to me or call my office complaining that you kept them waiting for two hours or your desk staff are rude, it's not going to work because the people I refer to reflect on me. No one likes going to the doctor but it should be as pleasant an experience as possible. Everyone understands that emergencies happen but there is no reason for an office to consistently run two and half hours behind. If that's you, it's going to be hard to send patients your way.

3) Co-management.....this is one that I really don't give a hoot about. If you need me to do it, I can but truth be told, I LOSE money doing cataract co management and I about break even doing refractive surgery co-management. Taking up three slots (and sometimes more) on my schedule for post op cataract visits all for the princely sum of whatever 20% of the surgical fee is these days is a money loser.

4) I expect these patients back. Don't do that stupid thing where you tell the patient that they have some "unusual astigmatism" and you need to see their whole family. Don't tell them that they have a "freckle" inside their eye that needs to be checked by you every six months. Don't tell them that they are at risk for macular degeneration and need to be seen twice a year because there are three tiny drusen way out by the ora. Just don't play those stupid games. Word spreads really quickly with that type of garbage.

Now.....this is the part where people start telling me that sometimes the patients want to stay with the surgeon. And yes.....that sometimes can happen. However, I expect a reasonable effort be made to encourage the patient to return to our office. I will assure you that our office has spent a lot of time and effort cultivating loyal relationships with patients and we put a lot of effort into delivering a top notch experience. We are not a little optical shop with an exam lane in the back located in some strip small between a pizza parlor and a Payless Shoe Source. So it's not going to be hard to figure out if patients are being poached. Please.....just don't get involved in that type of behavior.
 
I'm curious how exactly you think this should be handled. I always try to send patients back, but it's an inherently awkward conversation.

KHE said:
I don't know if the OP is talking about refractive surgery specifically or if he's including cataract surgery and other anterior segment procedures as well but here's what I'm looking for....

Now.....this is the part where people start telling me that sometimes the patients want to stay with the surgeon. And yes.....that sometimes can happen. However, I expect a reasonable effort be made to encourage the patient to return to our office. I will assure you that our office has spent a lot of time and effort cultivating loyal relationships with patients and we put a lot of effort into delivering a top notch experience. We are not a little optical shop with an exam lane in the back located in some strip small between a pizza parlor and a Payless Shoe Source. So it's not going to be hard to figure out if patients are being poached. Please.....just don't get involved in that type of behavior.
Click to expand...
 
kwr7126 said:
I'm curious how exactly you think this should be handled. I always try to send patients back, but it's an inherently awkward conversation.
Click to expand...

I realize I am not the one of whom you requested a reply, but I am a (primarily) cataract surgeon who co-manages with several ODs and an MD or two who have recently retired from surgery, thus are medical ophthalmologists. This issue of patients not wanting to return rarely comes up when the referring provider is highly skilled with a good bedside manner, i.e., patients trust him/her and want to return. But, as you know, it does come up occasionally, and I do not find the conversation all that awkward because of how I prep the patients pre-operatively.

In my pre-op discussion with the patient, I say, "Dr. X sent you here for a cataract evaluation. When we finish with your cataract surgery(ies), Dr. X will see you soon thereafter to take back over your care." With those expectations set, I probably have less than 1% of patients give me a hard time about not wanting to go back. And again, when I do have problems, it's almost always with patients of the one provider who has less-than-stellar bedside manner. It also helps that every patient who is referred to me signs a "co-management agreement" with his/her referring provider in which he/she agrees to return to the referring provider for the post-op care. If a patient still gives me a hard time, I tell the patient that I have given my word to and have a signed agreement with the referring providers to send patients back to them.
 
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KHE said:
3) Co-management.....this is one that I really don't give a hoot about. If you need me to do it, I can but truth be told, I LOSE money doing cataract co management and I about break even doing refractive surgery co-management. Taking up three slots (and sometimes more) on my schedule for post op cataract visits all for the princely sum of whatever 20% of the surgical fee is these days is a money loser.
Click to expand...

KHE,

Great post overall, and I agree with almost everything you said. I was surprised, though, and maybe naively so, by the co-management part. The ODs I co-manage with actually seem to want all the co-manage they can get. Even for Medicare patients, 20% of $600-700 is not bad for a quick look at the eyes and a refraction that in most cases is near plano and thus quite easy/fast. $120+ for an easy exam and refraction sounds pretty nice to most people I've talked to. Maybe I'm missing something? Not being sarcastic, sincerely curious about your perspective.

Again, thanks for your insight. It's valuable to see both sides of the coin.
 
clayito said:
I realize I am not the one of whom you requested a reply, but I am a (primarily) cataract surgeon who co-manages with several ODs and an MD or two who have recently retired from surgery, thus are medical ophthalmologists. This issue of patients not wanting to return rarely comes up when the referring provider is highly skilled with a good bedside manner, i.e., patients trust him/her and want to return. But, as you know, it does come up occasionally, and I do not find the conversation all that awkward because of how I prep the patients pre-operatively.

In my pre-op discussion with the patient, I say, "Dr. X sent you here for a cataract evaluation. When we finish with your cataract surgery(ies), Dr. X will see you soon thereafter to take back over your care." With those expectations set, I probably have less than 1% of patients give me a hard time about not wanting to go back. And again, when I do have problems, it's almost always with patients of the one provider who has less-than-stellar bedside manner. It also helps that every patient who is referred to me signs a "co-management agreement" with his/her referring provider in which he/she agrees to return to the referring provider for the post-op care. If a patient still gives me a hard time, I tell the patient that I have given my word to and have a signed agreement with the referring providers to send patients back to them.
Click to expand...

That makes a lot of sense. We don't have the right setting for co-managment, but I imagine it would be less awkward to do the surgery and send them right back vs seeing them repeatedly afterward. By the one month visit for the second eye some of them have seen me more times than the referring doctor. I may start prepping them all like that at the consult though. Thanks for the tip! and yeah, it's literally always been the same two providers...
 
clayito said:
KHE,

Great post overall, and I agree with almost everything you said. I was surprised, though, and maybe naively so, by the co-management part. The ODs I co-manage with actually seem to want all the co-manage they can get. Even for Medicare patients, 20% of $600-700 is not bad for a quick look at the eyes and a refraction that in most cases is near plano and thus quite easy/fast. $120+ for an easy exam and refraction sounds pretty nice to most people I've talked to. Maybe I'm missing something? Not being sarcastic, sincerely curious about your perspective.

Again, thanks for your insight. It's valuable to see both sides of the coin.
Click to expand...
That $120 is usually for 3 separate exams. In my area the MDs who co-manage see patient on day 1 then the OD gets them for 2 weeks, 4 weeks, and 3 months (which is when the final refraction happens). That's $40 per exam, and even though its a quick visit that's still not very impressive.
 
VA Hopeful Dr said:
That $120 is usually for 3 separate exams. In my area the MDs who co-manage see patient on day 1 then the OD gets them for 2 weeks, 4 weeks, and 3 months (which is when the final refraction happens). That's $40 per exam, and even though its a quick visit that's still not very impressive.
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I do the POD1 exam just as you mention, but most of the ODs see the patient at 3 weeks for exam and refraction and that's it unless the patient calls with problems. Thus the ODs usually only see the patient one time, and let's not forget that in most cases they are getting a co-management fee for two eyes.

I guess I can see some value in doing a 3 month exam from a refraction standpoint, although it's pretty minimal and making patients wait that long before they get their glasses can be an issue, e.g., a patient with lots of astigmatism who could not afford a Toric IOL. I do not see why someone would check the eye at both 2 weeks and 4 weeks. If the eyes look ok at 2 weeks and you're waiting until 3 months to do the final refraction, the 4 week visit is fairly useless in my opinion.

Anyway, to each his own, but I still think co-managing on two eyes and seeing the patient once or even twice in the 90 day period is fairly good $ considering the simplicity and efficiency of the visits.
 
clayito said:
I do the POD1 exam just as you mention, but most of the ODs see the patient at 3 weeks for exam and refraction and that's it unless the patient calls with problems. Thus the ODs usually only see the patient one time, and let's not forget that in most cases they are getting a co-management fee for two eyes.

I guess I can see some value in doing a 3 month exam from a refraction standpoint, although it's pretty minimal and making patients wait that long before they get their glasses can be an issue, e.g., a patient with lots of astigmatism who could not afford a Toric IOL. I do not see why someone would check the eye at both 2 weeks and 4 weeks. If the eyes look ok at 2 weeks and you're waiting until 3 months to do the final refraction, the 4 week visit is fairly useless in my opinion.

Anyway, to each his own, but I still think co-managing on two eyes and seeing the patient once or even twice in the 90 day period is fairly good $ considering the simplicity and efficiency of the visits.
Click to expand...
Maybe things have changed, but the MD I worked for before med school had the same schedule - probably why the ODs did it since they were co-managing his surgery. Plus, KHE above says he sees them 3 times; though on what schedule I don't know.
 
KHE said:
I don't know if the OP is talking about refractive surgery specifically or if he's including cataract surgery and other anterior segment procedures as well but here's what I'm looking for....

1) I would like some referrals too. This is really the biggest one. Referrals are not a one way street. Have some weird CL case you don't want to deal with? Send it my way. Someone needs VT or has a binocular vision issue? Send them my way, SPECIFICALLY. Don't just tell the patient "see an optometrist." Call up my office and make the appointment, just like I would call up your office to make the appointment for surgery.

2) I expect your office staff to be nice and for you to run reasonably on time. If patients come back to me or call my office complaining that you kept them waiting for two hours or your desk staff are rude, it's not going to work because the people I refer to reflect on me. No one likes going to the doctor but it should be as pleasant an experience as possible. Everyone understands that emergencies happen but there is no reason for an office to consistently run two and half hours behind. If that's you, it's going to be hard to send patients your way.

3) Co-management.....this is one that I really don't give a hoot about. If you need me to do it, I can but truth be told, I LOSE money doing cataract co management and I about break even doing refractive surgery co-management. Taking up three slots (and sometimes more) on my schedule for post op cataract visits all for the princely sum of whatever 20% of the surgical fee is these days is a money loser.

4) I expect these patients back. Don't do that stupid thing where you tell the patient that they have some "unusual astigmatism" and you need to see their whole family. Don't tell them that they have a "freckle" inside their eye that needs to be checked by you every six months. Don't tell them that they are at risk for macular degeneration and need to be seen twice a year because there are three tiny drusen way out by the ora. Just don't play those stupid games. Word spreads really quickly with that type of garbage.

Now.....this is the part where people start telling me that sometimes the patients want to stay with the surgeon. And yes.....that sometimes can happen. However, I expect a reasonable effort be made to encourage the patient to return to our office. I will assure you that our office has spent a lot of time and effort cultivating loyal relationships with patients and we put a lot of effort into delivering a top notch experience. We are not a little optical shop with an exam lane in the back located in some strip small between a pizza parlor and a Payless Shoe Source. So it's not going to be hard to figure out if patients are being poached. Please.....just don't get involved in that type of behavior.
Click to expand...

This adds nothing to the discussion but this is a really great post. I'm about to be in the situation of having to maintain or start new referrals.

I do think point #2 is great. In retina it's not unusual for patients to wait two hours before being seen (due to dilation, ancillary imaging especially if fluorescein angiography is required), but I do feel bad for them once the wait time breaks the 2 hour mark. One of the attendings I work with in my fellowship is consistently two to three hours behind, sometimes four. There are emergencies that pop in but really, there's no reason for someone to wait 3 hours to be seen. I'm glad to see that other people also understand that waiting that long is pretty unacceptable if it's on a consistent basis.
 
Breaking into the Optometry market can be very difficult depending on the town. Some big groups in the town I started in have full time marketing specialists whose sole job is to cater to the Optoms, and visit them every week. I spoke to an Alcon drug rep, and asked his advice about breaking into the Optom market. He said not to bother, and they were all in bed with the big groups in town. The big groups have their marketing specialists visit them every week, buy the whole office lunch every week, give them lavish ($500) Christmas presents, give the Optoms equipment (like an old Pentacam) when they upgrade. He basically laughed and said good luck, and said to focus on word of mouth and other forms of marketing.
 
corneainterviewseason said:
Breaking into the Optometry market can be very difficult depending on the town. Some big groups in the town I started in have full time marketing specialists whose sole job is to cater to the Optoms, and visit them every week. I spoke to an Alcon drug rep, and asked his advice about breaking into the Optom market. He said not to bother, and they were all in bed with the big groups in town. The big groups have their marketing specialists visit them every week, buy the whole office lunch every week, give them lavish ($500) Christmas presents, give the Optoms equipment (like an old Pentacam) when they upgrade. He basically laughed and said good luck, and said to focus on word of mouth and other forms of marketing.
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$500 Christmas presents and equipment??

Damn.....I'm doing something wrong.
 
KHE said:
How do I get involved in some of this "sketchy stuff?"
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I have no idea. All I know is that it happens, according to multiple drug reps and other MDs in the area. Some may not consider it "sketchy", but I feel it violates the anti-kickback statute.
 
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corneainterviewseason said:
You probably think I'm exaggerating. Sadly I'm not. Some sketchy stuff going on out there.
Click to expand...

This is 100% true. I interviewed with a group who would give their referrimg optometrists the co-management fees but would do all of the post-op checks and would send them back to the optom office with a glasses Rx in hand. Optoms were getting the comanagement fee + glasses sale just for their referral. This same group would give free care (including multifocal lenses) to local docs, clergy, and anyone else in the community who might have the power to persuade people to come in their direction.
 
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