How to develop a "Good" OMD relationship

[posner]

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Well folks, after many of my posts have been hijacked by OMDs on this board that pretend to be truly "concerned" for patients that receive anything more than glasses or contacts from ODs, I thought I would try to contribute what I feel has allowed me to develop a great relationship with local OMDs.

First of all, dont be intimidated by these folks. If they choose to call you by first name, be sure to return the favor even if it is in front of patients. If you get wind of an OMD that has seen one of your patients and perhaps said less than flattering things about the care the patient received while under your care(unless you really screwed up bad), be sure to call them and discuss it. While it is true that OMDs are intelligent(they have to be pretty sharp to match come residency time) they are not infalliable. Not only do they make mistakes, thier mistakes often result in far more serious consequences for patients(woops...sorry Mrs. Smith I didnt mean to blast your macula with my laser, sorry for the detached retina after cataract surgery but my partner the retina guy can hopefully restore some vision, etc). Demand your patients back from these guys, dont let them absorb them into their practice following surgery(they like to do this in some cases, because when they are not in the OR many times they can make money on these folks doing the same things you would otherwise be doing). I used to keep a log on patinets we sent out. If I didnt get them back, I would have my staff on the phone finding out why. I never hesitate to call and talk to the OMD about these kinds of things...If you dont call them on it they will often choose the passive aggressive route and just take the patients.

If you refer a patient that can be comanaged be sure to ALWAYS comanage the patient(dont be greedy here; you could technically comanage YAG patients and get a small reimbursement) and dont let them waste all the comanagement time with BS about how they feel the patient is not really ready for the OD to see them until 60 days post op. If the OMD doesnt want to dance to your tune for referrals, find another one, there are plenty. Call these guys and take them to lunch to discuss business. Let them know what you can do for their practice and what you are able to do for your mutual patients.

When you refer a patient, be sure to send over a referral that doesnt appear to have been written by a 6 year old. List differentials, describe in detail what you have done, what you found, and what exactly you want the OMD to due for the patient. Be sure to ask for a copy of his or her findings. If you dont get them, call their office and have them sent. Pick one or two OMDs that can handle the vast majority of your referrals. This will make it easier to develop a relationship, and will make your referrals of greater value since you will not be diluting them over multiple OMDs.

I will have more to say on this shortly. I hope this is of some help.

POsner

 

[POJO]

There is something call "push" and "pull" relationships. On the one hand, optometrists sometimes feel that they are pushing for a relationship and feel that they never get "pulled" into a interprofessional relationship.

In contrast to posner's approach, I would search for medical relationships that want optometric input. With success in non-ophthalmologic relationships, it is difficult for the ophthalmologist to paint the optometrist as some "big ugly monster". When the ophthalmologists does want to make a stink, they look pretty foolish because you've already have several years of good history which is difficult to refute.

In this circumstance, the ophthalmologist is also more likely to bregrudgingly accept the optometrist (" the pull relationship")

 

[ProZackMI]

Well folks, after many of my posts have been hijacked by OMDs on this board that pretend to be truly "concerned" for patients that receive anything more than glasses or contacts from ODs, I thought I would try to contribute what I feel has allowed me to develop a great relationship with local OMDs.

First of all, dont be intimidated by these folks. If they choose to call you by first name, be sure to return the favor even if it is in front of patients. If you get wind of an OMD that has seen one of your patients and perhaps said less than flattering things about the care the patient received while under your care(unless you really screwed up bad), be sure to call them and discuss it. While it is true that OMDs are intelligent(they have to be pretty sharp to match come residency time) they are not infalliable. Not only do they make mistakes, thier mistakes often result in far more serious consequences for patients(woops...sorry Mrs. Smith I didnt mean to blast your macula with my laser, sorry for the detached retina after cataract surgery but my partner the retina guy can hopefully restore some vision, etc). Demand your patients back from these guys, dont let them absorb them into their practice following surgery(they like to do this in some cases, because when they are not in the OR many times they can make money on these folks doing the same things you would otherwise be doing). I used to keep a log on patinets we sent out. If I didnt get them back, I would have my staff on the phone finding out why. I never hesitate to call and talk to the OMD about these kinds of things...If you dont call them on it they will often choose the passive aggressive route and just take the patients.

If you refer a patient that can be comanaged be sure to ALWAYS comanage the patient(dont be greedy here; you could technically comanage YAG patients and get a small reimbursement) and dont let them waste all the comanagement time with BS about how they feel the patient is not really ready for the OD to see them until 60 days post op. If the OMD doesnt want to dance to your tune for referrals, find another one, there are plenty. Call these guys and take them to lunch to discuss business. Let them know what you can do for their practice and what you are able to do for your mutual patients.

When you refer a patient, be sure to send over a referral that doesnt appear to have been written by a 6 year old. List differentials, describe in detail what you have done, what you found, and what exactly you want the OMD to due for the patient. Be sure to ask for a copy of his or her findings. If you dont get them, call their office and have them sent. Pick one or two OMDs that can handle the vast majority of your referrals. This will make it easier to develop a relationship, and will make your referrals of greater value since you will not be diluting them over multiple OMDs.

I will have more to say on this shortly. I hope this is of some help.

POsner

Listen, it's all a matter of personality, isn't it? I mean, if you, as an OD, conduct yourself in a professional manner and exude confidence, you'll get respect. If you know your stuff, treat others with respect, and treat your patients with dignity and respect, you'll get it back. If some arrogant ophthalmologist gives you sh|t, it reflects badly on him/her, not you.

You can only control those things within your sphere of influence, right? So, why get all upset when some arrogant MD pisses in your pot? I'm a psychiatrist and I often see my colleagues act superior to doctorally-prepared psychologists (PhD or PsyD). Why? We're on the same team, right? You'd think so, but to many psychiatrists (both MD and DO), it's often an US-THEM type of interaction/attitude. This leads many psychologists to always be on the defensive -- even to the chagrin of psychiatrists like me who view as partners in mental health care, not competitors or <gasp> professional subordinates.

If you are a competent and friendly optometrist, you should foster great relationships with any professional. If an MD gives you that superior attitude, simply ignore it and continue to model professional behaviour. Eventually, things should change for the better. If they don't, consider ending the professional relationship if possible. You don't need negative working relationships with other professionals, nor should you or your patients want such defective "partnerships" in their tx.

 

[posner]

Listen, it's all a matter of personality, isn't it? I mean, if you, as an OD, conduct yourself in a professional manner and exude confidence, you'll get respect. If you know your stuff, treat others with respect, and treat your patients with dignity and respect, you'll get it back. If some arrogant ophthalmologist gives you sh|t, it reflects badly on him/her, not you.

You can only control those things within your sphere of influence, right? So, why get all upset when some arrogant MD pisses in your pot? I'm a psychiatrist and I often see my colleagues act superior to doctorally-prepared psychologists (PhD or PsyD). Why? We're on the same team, right? You'd think so, but to many psychiatrists (both MD and DO), it's often an US-THEM type of interaction/attitude. This leads many psychologists to always be on the defensive -- even to the chagrin of psychiatrists like me who view as partners in mental health care, not competitors or <gasp> professional subordinates.

If you are a competent and friendly optometrist, you should foster great relationships with any professional. If an MD gives you that superior attitude, simply ignore it and continue to model professional behaviour. Eventually, things should change for the better. If they don't, consider ending the professional relationship if possible. You don't need negative working relationships with other professionals, nor should you or your patients want such defective "partnerships" in their tx.

Very well put. I was hoping to add to my original post, but felt I was becoming too inflammatory initially so I stopped. Your point about personality is one I have tried to make before. This is one of the big problems in many areas of healthcare(seemingly more so in optometry however). Schools are so focused on academics, they turn out graduates that not only lack interpersonal skills, but self confidence. If one exudes confidence and professionalism(this is why working at Doc-in-the Box is so counter productive) respect from others follows naturally. Look at graduating classes these days at optometry schools. There are always a few that have the personality(and they are generally the ones that do well) but the vast majority of new graduates are Nerds with marginal self confidence/esteem(these are the people that run to the local Wal Mart and spin dials for $29 per patient).

Your last paragraph summarizes quite succintly the necessary ingredients for good/healthy professional relationships.

Posner

 

[Olddog1]

If you refer a patient that can be comanaged be sure to ALWAYS comanage the patient(dont be greedy here; you could technically comanage YAG patients and get a small reimbursement) and dont let them waste all the comanagement time with BS about how they feel the patient is not really ready for the OD to see them until 60 days post op.

POsner

Just curious, what does "can be comanged" and "don't be greedy" mean? I have come to understand from your prior post you have a pretty low opinion of MDs in general, and most OMD. I know you can't understand that after one does potentially blinding surgery on a patient that some of us really want to see how it turns out, and manage the complications that occur. My labrador retreiver can manange uncomplicated cataract surgery follow up (except for the refraction part, he doesn't understand the autorefractor 🙂). However, do you think it is appropiate for an OD to manage post-op bleb leak, overfiltration, hypotony, choroidals, encapsulated bleb, malignant glaucoma, underfiltration, etc...? Most OMDs who at least had a hand in managing this during their residency would not touch them with a ten foot pole. Does "don't be greedy" mean only manage what will give you the biggest bang for the $, regardless if you have propper training, or manage only what you have been trained to manage?

 

[POJO]

Just curious, what does "can be comanged" and "don't be greedy" mean? I have come to understand from your prior post you have a pretty low opinion of MDs in general, and most OMD. I know you can't understand that after one does potentially blinding surgery on a patient that some of us really want to see how it turns out, and manage the complications that occur. My labrador retreiver can manange uncomplicated cataract surgery follow up (except for the refraction part, he doesn't understand the autorefractor 🙂). However, do you think it is appropiate for an OD to manage post-op bleb leak, overfiltration, hypotony, choroidals, encapsulated bleb, malignant glaucoma, underfiltration, etc...? Most OMDs who at least had a hand in managing this during their residency would not touch them with a ten foot pole. Does "don't be greedy" mean only manage what will give you the biggest bang for the $, regardless if you have propper training, or manage only what you have been trained to manage?

Olddog1
I'm not sure what your background or your intention is but this response is off topic and is inflammatory in this forum. Please reply in your own fashion on one of those other threads. On this, we are trying to be constructive about building good relationships.

 

[Ben Chudner]

Just curious, what does "can be comanged" and "don't be greedy" mean? I have come to understand from your prior post you have a pretty low opinion of MDs in general, and most OMD. I know you can't understand that after one does potentially blinding surgery on a patient that some of us really want to see how it turns out, and manage the complications that occur. My labrador retreiver can manange uncomplicated cataract surgery follow up (except for the refraction part, he doesn't understand the autorefractor 🙂). However, do you think it is appropiate for an OD to manage post-op bleb leak, overfiltration, hypotony, choroidals, encapsulated bleb, malignant glaucoma, underfiltration, etc...? Most OMDs who at least had a hand in managing this during their residency would not touch them with a ten foot pole. Does "don't be greedy" mean only manage what will give you the biggest bang for the $, regardless if you have propper training, or manage only what you have been trained to manage?

I think we all understand what "can be co-managed". We are talking about cataracts, yag's, LPI's, and LASIK. I don't know any OD's that have even the slightest desire to co-manage glaucoma, retina, neuro, or plastics procedures. And I think that most OD's do understand your feeling about seeing how your surgery turns out and managing the complications that occur but the problem is that ophthalmology has a reputation of stealing patients, both intentially and unintentially. Since even you admit that your dog can manage uncomplicated cataract surgery follow-up, why do you not understand that OD's want to see their patients back when the surgery goes well? We are obviously qualified, and doing so helps build a stronger relationship with our patients. I think the OD's that work well with ophthalmology have no problem when the surgeon tells us that the patient had some complication at the one-day visit and therefore they will be sent back when it is appropriate rather than at one week.

 

[DrEyeBall]

Interesting topic.

I would suggest that you discuss cases with the local MDs. Show an interest other than "co-management". The issue of co-management is certainly controversial. It is hard to see this as much more than a financial issue in many cases. In my subspecialty practice, I feel very strongly that the patient I operate on is my responsibility until the results of that surgery and the medical care following it are complete. I have an excellent working relationship with many ODs but will not send surgical patients back to them until my care is finished. However, I am often called to discuss cases with them and am always happy to help them help a patient. While we can all talk about the ODs and MDs who are only bottom-line oriented, those are hopefully in the minority.

You may feel that you should be handling certain types of patients. If you work with an MD that you respect, respect their opinion about which patients they feel should not be treated by you as well. If someone is not willing to share patients of a certain type, is that the only criteria to no longer use their services? Hopefully not.

 

[PBEA]

Just curious, what does "can be comanged" and "don't be greedy" mean? I have come to understand from your prior post you have a pretty low opinion of MDs in general, and most OMD. I know you can't understand that after one does potentially blinding surgery on a patient that some of us really want to see how it turns out, and manage the complications that occur. My labrador retreiver can manange uncomplicated cataract surgery follow up (except for the refraction part, he doesn't understand the autorefractor 🙂). However, do you think it is appropiate for an OD to manage post-op bleb leak, overfiltration, hypotony, choroidals, encapsulated bleb, malignant glaucoma, underfiltration, etc...? Most OMDs who at least had a hand in managing this during their residency would not touch them with a ten foot pole. Does "don't be greedy" mean only manage what will give you the biggest bang for the $, regardless if you have propper training, or manage only what you have been trained to manage?

Your answer is the last bit you posted "..manage only what you have been trained to manage." And no, what you list is not within an OD's ability. I know you are responding in kind to posner (and you are right), but I think posner is only referring to uncomplicated followup, and while your lab may be able to "handle" these relatively simple cases, I think posner is pointing out that some OMD's take exception to ANY and ALL medical eyecare delivered by ODs, and will disparage an ODs ability merely to retain the patient for uncomplicated followup, years and years after the surgery. Posner actually highlights a point that is never mentioned (and I think has some merit), that is that many surgeries are simply "overdone". Ophthalmology often claims that knowing when to to do surgery is as big a deal as how to do surgery. I know this is true, yet I have seen many surgeries that clearly were not needed and resulted in far worse outcomes. Its anectodotal but I believe that I serve as a "gatekeeper" for many pts, and prevent some unecessary surgeries from taking place. Furthermore, I would add that I think fellowship should be required of ALL ophthalmologists (while limiting much of general ophthalmology), and leave the bread and butter stuff to the ODs.

 

[POJO]

Interesting topic.

I would suggest that you discuss cases with the local MDs. Show an interest other than "co-management". The issue of co-management is certainly controversial. It is hard to see this as much more than a financial issue in many cases. In my subspecialty practice, I feel very strongly that the patient I operate on is my responsibility until the results of that surgery and the medical care following it are complete. I have an excellent working relationship with many ODs but will not send surgical patients back to them until my care is finished. However, I am often called to discuss cases with them and am always happy to help them help a patient. While we can all talk about the ODs and MDs who are only bottom-line oriented, those are hopefully in the minority.

You may feel that you should be handling certain types of patients. If you work with an MD that you respect, respect their opinion about which patients they feel should not be treated by you as well. If someone is not willing to share patients of a certain type, is that the only criteria to no longer use their services? Hopefully not.

I think if you portray the scope of your working relationship in the context of 'wanting to retain control of your patients' and leave it like that, I don't I or anyone in the optometric community would have any arguements. However, it is better that you never explain yourself. It is the feeble excuses that most surgeons use to defend their actions. So dont' tell me that you're doing it because you cannot trust us, th at you don't think we know what we're doing or that we're not skilled enough to do it. Just don't say anything.

And the worse thing that can befall a surgeon and will experience an informal 'black list' is bad mouthing ODs in general while playing golf or in some parties.

I've heard many say publicly how well they work with OD's and yet 12hours later hear them tell their peers what fools we are. OK we may be fools for working with that surgeon but if it comes out, I'm sure there will be some kind of action. So, keep your own counsel and don't wear your anti-optometry feelings widely.

I, for one, feel that there are a lot of surgeons in town and if one doesn't want my referrals, I know 2-5 who will.

 

[posner]

Interesting topic.

I would suggest that you discuss cases with the local MDs. Show an interest other than "co-management". The issue of co-management is certainly controversial. It is hard to see this as much more than a financial issue in many cases. In my subspecialty practice, I feel very strongly that the patient I operate on is my responsibility until the results of that surgery and the medical care following it are complete. I have an excellent working relationship with many ODs but will not send surgical patients back to them until my care is finished. However, I am often called to discuss cases with them and am always happy to help them help a patient. While we can all talk about the ODs and MDs who are only bottom-line oriented, those are hopefully in the minority.

You may feel that you should be handling certain types of patients. If you work with an MD that you respect, respect their opinion about which patients they feel should not be treated by you as well. If someone is not willing to share patients of a certain type, is that the only criteria to no longer use their services? Hopefully not.

YOur point is well taken. I do happen to work with a couple MDs that I respect. But I have endeavored to foster this relationship and it goes both ways(I saw a patient today 1 day post op from our OMD because he was out of the office). I am encouraged by your willingness to discuss patients with you local ODs and to help them help patients. This is exactly my point. We should be more focused on what is truly best for the patient rather than flexing our egos.

Posner

 

[DrEyeBall]

I am not sure I understand that post POJO.

I refer patients to other subspecialists all the time. Who gets these referrals is easy. I send them to the person who would see them if it was my own relative. I also will not treat patients in such a manner as to only generate more business. That may not be popular with some people who want to "co-manage" but at least I hope they will respect my opinion. I feel the same way about other MDs who send me patients.

Having said that, there are many patients that can be helped by both MDs and ODs.

 

[POJO]

I am not sure I understand that post POJO."...

Simply said, what will foster good relationships is a minimal amount of any public display of dissatisfaction of optometry. What I have heard from ODs across the country is their dismay and disappointment at surgeons who publicly flay optometry in front of other surgeons, the general public or other optometrists.

In the spirit of this thread, my recommendation to any surgeon who doesn't want to have an optometrist co-manage any part of the post operative period, then great. But keep it to yourself. Say that it is your personal preference! But don't stand up and say that you don't want to do comanage because optometrists are "this or that". I"m just relaying what the optometrists will say back at the coffee shop. That is a relative truth.

Optometrists know that the only remedy for a misbehaving surgeon is their pocket book by withhold referrals or redirecting them to someone who is perceived as slightly better.

 

[DrEyeBall]

I agree with that POJO. My decision not to co-manage my patients is based upon my belief that as the operating surgeon, I am responsibile for them. It has nothing to do with the qualifications (good or bad) of the person sending them to me.

I have good relationships with our local ODs. I have helped to train some. I am not worried that they are going to take business away from me. I figure that patients will make their way into an ODs office and I am happy to help them handle those patients. I do not need to treat every patient in my city, there are plenty to go around for everyone.

 

[POJO]

I agree with that POJO. My decision not to co-manage my patients is based upon my belief that as the operating surgeon, I am responsibile for them. It has nothing to do with the qualifications (good or bad) of the person sending them to me.
...

I think the axiom of good relationships is most often lost by all parties involved. Thanks for your explanation.

 

[POJO]

What are the obstacles of a good working relationship? Let's check on one of them?

Should the ophthalmologist compete with the optometrist by dispensing?

 

[posner]

Just curious, what does "can be comanged" and "don't be greedy" mean? I have come to understand from your prior post you have a pretty low opinion of MDs in general, and most OMD. I know you can't understand that after one does potentially blinding surgery on a patient that some of us really want to see how it turns out, and manage the complications that occur. My labrador retreiver can manange uncomplicated cataract surgery follow up (except for the refraction part, he doesn't understand the autorefractor 🙂). However, do you think it is appropiate for an OD to manage post-op bleb leak, overfiltration, hypotony, choroidals, encapsulated bleb, malignant glaucoma, underfiltration, etc...? Most OMDs who at least had a hand in managing this during their residency would not touch them with a ten foot pole. Does "don't be greedy" mean only manage what will give you the biggest bang for the $, regardless if you have propper training, or manage only what you have been trained to manage?

Damn it dog, I was actually starting to respect your opinions and look what you went and did. Again you have oversimplified the issue and insulted ODs at large by suggesting we want to comanage complicated procedures that most general OMDs wouldnt want to touch. I dont have a low opinion of MDs in general, in fact my best friend is a family physician. Nevertheless, he also feels as though many specialists look down on the family physician and his or her role. As far as OMDs go, I actually have a great relationship with just about every OMD in my entire county(or they are great pretenders because I have a high volume practice). It is the radical minority of MDs(which seem to be everpresent on this forum) that I have a low opinion of; Those that try to suggest what they do is so much more important and vital than what I do.

As far as comanaging goes, of course I do not advocate the comanagement of patients for which the OD does not have adequate training. I am talking largely about cataract and post refractive surgery patients. I can understand a surgeon wanting to see a patient one day post CE/IOL and I can even accept a one week post op visit for an uncomplicated patient. After that, I assume care for the patient. Hanging on to patients for 60 days post op for CE/IOL is bull**** and you know it.

Another thing, how many ODs in this forum have seen patients that have been to their local OMD for ARMD, longstanding stargardts, RP, etc that have been told, "I'm sorry, but there is nothing that can be done for your condition except for us to monitor you periodically to be sure nothing is changing". They see these patients q 4-6 months ad infinitum. Finally, a friend of the patient sends them into your office and you are able to dramatically improve their quality of life with low vision aids. I dont do much low vision, but my associate sees this daily. The point is, the OMD(and not all of them are like this) decides that because nothing can be done from a surgical standpoint for the patient, there is nothing more that can be done. Is this what is best for patients? I think that most ODs accept the role of the OMD in the complete care of patients, but the reverse is not true. It was said in an earlier post by an OMD in response to one of my posts, "you dont know what you dont know". I would argue that there are vastly more ODs than OMDs that do know what they dont know and refer appropriately.

The bottom line is that if the OMDs are busy in the OR, the rest of us can utilize our primary care skills to the fullest, and everybody wins(most importantly the patient).

Posner

 

[DrEyeBall]

I do not dispense but that is an interesting statement.

Why is having an optical shop seen as competing with optometrists? Why can't an MD have an optical shop in his office to provide that service to his patients without it being a threat to someone else? If I did dispense, I would make every effort that patients sent to me from an OD made it back to that office for their glasses when needed. If we are all ok that certain diseases that have historically been treated by MDs are appropriate to be treated by ODs as well, then why can't the historical notion of only ODs dispensing be changed as well?

If the person that you had been sending all of your cataract patients to suddenly starting dispensing would you stop sending him patients? Even if you were certain they would come back to you for that service? How would you explain that decision to a patient if they asked you why you sent them to have one eye operated by one surgeon but to another for the next eye?

 

[POJO]

I do not dispense but that is an interesting statement.

Why is having an optical shop seen as competing with optometrists? Why can't an MD have an optical shop in his office to provide that service to his patients without it being a threat to someone else? If I did dispense, I would make every effort that patients sent to me from an OD made it back to that office for their glasses when needed. If we are all ok that certain diseases that have historically been treated by MDs are appropriate to be treated by ODs as well, then why can't the historical notion of only ODs dispensing be changed as well?

If the person that you had been sending all of your cataract patients to suddenly starting dispensing would you stop sending him patients? Even if you were certain they would come back to you for that service? How would you explain that decision to a patient if they asked you why you sent them to have one eye operated by one surgeon but to another for the next eye?

DrEyeBall,

This topic is about good working relationships, right? Do you want to know what riles up optometrists?

#1, a dispensing ophthalmolgist!!!!!

I see it mainly as a "greed" issue! Simple as that! Look, you know that you're not making enough on surgery, and they're certainly not enough sick eyes, so the dispensing ophthalmologist has to "cloak" the dispensing as part of medical care". I just hate the statement that you just made about your justification for dispensing!

This is what gets many ODs upset. It may not be reasonable, but the OD world as a whole is waiting for any alternative to the dispensing Ophthlamologist. Heck, they'll send them across town if they could get away with it.

 

[posner]

I do not dispense but that is an interesting statement.

Why is having an optical shop seen as competing with optometrists? Why can't an MD have an optical shop in his office to provide that service to his patients without it being a threat to someone else? If I did dispense, I would make every effort that patients sent to me from an OD made it back to that office for their glasses when needed. If we are all ok that certain diseases that have historically been treated by MDs are appropriate to be treated by ODs as well, then why can't the historical notion of only ODs dispensing be changed as well?

If the person that you had been sending all of your cataract patients to suddenly starting dispensing would you stop sending him patients? Even if you were certain they would come back to you for that service? How would you explain that decision to a patient if they asked you why you sent them to have one eye operated by one surgeon but to another for the next eye?

I dont have a problem with a dispensing OMD. I earn 60% or more of my income from services to patients; while I dont ignore the optical part of our practice, I make sure to let each and every patient I see know that I am more than a glasses peddler.

POsner

 

[DrEyeBall]

Well, at least you have hit the nail on the head. It is all about greed. Dispensing is a business, no more or less for MDs than ODs. I do not care to get into the business of dispensing. If I did, I sure would not let someone try to "bully" me with referrals about it. I will take less vacations, live in a smaller home or drive a less expensive car. I won't sell out my patients or my principles or let someone control me by pulling at my wallet. Maybe if everyone felt the same way, we could all get along better.

 

[DrEyeBall]

Good point Posner. Optometry is trying to demonstrate that it is a professiont hat does more than refract and sell eyeglasses. However, some ODs feel that only they should be selling glasses. Hard to argue that you should be able to have it both ways. Again, I would ask the OD that steers his patients away from any MD that sells glasses how they would explain their referral patterns to a patient when asked? Would you really tell them that you are sending them to another person because the guy who does the best surgery started sellign glasses and you want to teach him a lesson or are afraid of losing a sale to him? Would you be upset if you found out your mother's eye care was determined the same way?

 

[Northerner]

Well folks, after many of my posts have been hijacked by OMDs on this board that pretend to be truly "concerned" for patients that receive anything more than glasses or contacts from ODs, I thought I would try to contribute what I feel has allowed me to develop a great relationship with local OMDs.

First of all, dont be intimidated by these folks. If they choose to call you by first name, be sure to return the favor even if it is in front of patients. If you get wind of an OMD that has seen one of your patients and perhaps said less than flattering things about the care the patient received while under your care(unless you really screwed up bad), be sure to call them and discuss it. While it is true that OMDs are intelligent(they have to be pretty sharp to match come residency time) they are not infalliable. Not only do they make mistakes, thier mistakes often result in far more serious consequences for patients(woops...sorry Mrs. Smith I didnt mean to blast your macula with my laser, sorry for the detached retina after cataract surgery but my partner the retina guy can hopefully restore some vision, etc). Demand your patients back from these guys, dont let them absorb them into their practice following surgery(they like to do this in some cases, because when they are not in the OR many times they can make money on these folks doing the same things you would otherwise be doing). I used to keep a log on patinets we sent out. If I didnt get them back, I would have my staff on the phone finding out why. I never hesitate to call and talk to the OMD about these kinds of things...If you dont call them on it they will often choose the passive aggressive route and just take the patients.

If you refer a patient that can be comanaged be sure to ALWAYS comanage the patient(dont be greedy here; you could technically comanage YAG patients and get a small reimbursement) and dont let them waste all the comanagement time with BS about how they feel the patient is not really ready for the OD to see them until 60 days post op. If the OMD doesnt want to dance to your tune for referrals, find another one, there are plenty. Call these guys and take them to lunch to discuss business. Let them know what you can do for their practice and what you are able to do for your mutual patients.

When you refer a patient, be sure to send over a referral that doesnt appear to have been written by a 6 year old. List differentials, describe in detail what you have done, what you found, and what exactly you want the OMD to due for the patient. Be sure to ask for a copy of his or her findings. If you dont get them, call their office and have them sent. Pick one or two OMDs that can handle the vast majority of your referrals. This will make it easier to develop a relationship, and will make your referrals of greater value since you will not be diluting them over multiple OMDs.

I will have more to say on this shortly. I hope this is of some help.

POsner

...wow, you're pretty malignant.

 

[Ben Chudner]

DrEyeBall,

This topic is about good working relationships, right? Do you want to know what riles up optometrists?

#1, a dispensing ophthalmolgist!!!!!

I see it mainly as a "greed" issue! Simple as that! Look, you know that you're not making enough on surgery, and they're certainly not enough sick eyes, so the dispensing ophthalmologist has to "cloak" the dispensing as part of medical care". I just hate the statement that you just made about your justification for dispensing!

This is what gets many ODs upset. It may not be reasonable, but the OD world as a whole is waiting for any alternative to the dispensing Ophthlamologist. Heck, they'll send them across town if they could get away with it.

I disagree with this. Maybe if we are talking about a glaucoma specialist that decides to start dispensing you could make the argument that it is a greed issue, but how can you say that about a cataract surgeon? They see primary care patients just as we do unless they are in referral center. I think they are very justified in offering that service to their primary care patients. Why should their patients be expected to go elsewhere to get glasses and not ours? Posner has the right idea about where our revenue should come from, although I would make the argument that the majority of OD's have problems making the shift from materials to services either due to insurance issues or personal ones. POJO, if you are that dependent on revenue from materials, I would suggest you have bigger problems than your working relationship with OMD's.

 

[posner]

I disagree with this. Maybe if we are talking about a glaucoma specialist that decides to start dispensing you could make the argument that it is a greed issue, but how can you say that about a cataract surgeon? They see primary care patients just as we do unless they are in referral center. I think they are very justified in offering that service to their primary care patients. Why should their patients be expected to go elsewhere to get glasses and not ours? Posner has the right idea about where our revenue should come from, although I would make the argument that the majority of OD's have problems making the shift from materials to services either due to insurance issues or personal ones. POJO, if you are that dependent on revenue from materials, I would suggest you have bigger problems than your working relationship with OMD's.

I have said all along optometry needs to focus more on the service end of the business. I hear countless ODs complain about scope constriction yet most of them generate the bulk of thier income from the dispensary. The excuses are endless as to why ODs cant develop a service/procedure based practice. The bottom line is that most ODs dont choose to embrace this model of practice and live in servitude to the dispensary. You think that when an OMD finishes a residency he or she has a steady stream of patients lined up at the door? Nope. They build a practice the same way that you would-one patient at a time. Eyeball is right when he(or she) says that we cant have it both ways.

We had a Walmart vision center open about 6 years ago near our busy office and a Costco vision center open 1.5 years ago near a satellite office(and as you might imagine, there were plenty of ODs eager to twist some dials for $29...thanks for helping out the profession guys/gals! But I digress....) I will say that I was concerned about the impact it could have on our practice, however, we have continued to grow every year by 8-11%. As I said, you cant ignore the dispensary but we must focus more on the services we can and should provide. Any jackass can put a pair of glasses on a patient- In fact many of your colleagues do this daily for the low low price of $29(see Walmart/Costco)! While I would agree that insurance panel issues are definitely a major governing force, I would bet that if ODs were allowed on every panel in the USA tomorrow, you wouldnt see many things change for most practices. The issues run deeper for ODs....much deeper.

Posner

 

[posner]

deleted

 

[Olddog1]

Olddog1
I'm not sure what your background or your intention is but this response is off topic and is inflammatory in this forum. Please reply in your own fashion on one of those other threads. On this, we are trying to be constructive about building good relationships.

Easy there POJO, take a deep breath. I was not trying to be inflammatory, I really don't know the overall feelings ODs have for managing "advanced", for lack of better word, procedures. On another thread Posner stated he was trained in some procedures so I was wondering how far this went in managing other procedures.

Posner and others have made some excellent points. In the first post Posner alluded to getting feedback. If you don't get any it is likely fraud because I bet the MD billed for a consult or referral, hence part of that fee is for a dictated letter. I would recommend in your consult you explicitly say you don't want the patient back, if indeed you do not. Posner stated to refer to the same individuals, and this is also a good idea, so they know what to keep and what to return. If you build a relationship and the docs know to return everybody unless otherwise stated it saves time for everybody. Also, if the problem is chronic and you want the patient back and were looking for other ideas on management write that in the consult. My letters have my findings and then how I would treat A if B, C if D, etc..., obviously some people don't do that. It saves a few trips for the patient, and gives some guidance, since that is why the consult was generated in the first place. I do disagree with Posner about dispensing. I think the referring OD should always fill, or have the opportunity to fill, the Rx. While reportedly 60% of your business is not dispensing, that is 40% that is, which could really add up over time with a high volume cataract person with their own dispensory. Also, if you are "specializing" in low vision, or have an interest, make sure the OMDs in the area know this, you will likely see your referrals increase.

A few other thoughts on Posners original post. I really believe you are paranoid about what is said about ODs by MDs, I just don't see OMD saying how bad ODs are. It makes even less sense if you are sending the patient back to the referring OD for further care. That being said, I can see why you are a little paranoid because it sounds like your practice environment is very competitive where everybody is holding onto every patient like grim death.

 

[posner]

Easy there POJO, take a deep breath. I was not trying to be inflammatory, I really don't know the overall feelings ODs have for managing "advanced", for lack of better word, procedures. On another thread Posner stated he was trained in some procedures so I was wondering how far this went in managing other procedures.

Posner and others have made some excellent points. In the first post Posner alluded to getting feedback. If you don't get any it is likely fraud because I bet the MD billed for a consult or referral, hence part of that fee is for a dictated letter. I would recommend in your consult you explicitly say you don't want the patient back, if indeed you do not. Posner stated to refer to the same individuals, and this is also a good idea, so they know what to keep and what to return. If you build a relationship and the docs know to return everybody unless otherwise stated it saves time for everybody. Also, if the problem is chronic and you want the patient back and were looking for other ideas on management write that in the consult. My letters have my findings and then how I would treat A if B, C if D, etc..., obviously some people don't do that. It saves a few trips for the patient, and gives some guidance, since that is why the consult was generated in the first place. I do disagree with Posner about dispensing. I think the referring OD should always fill, or have the opportunity to fill, the Rx. While reportedly 60% of your business is not dispensing, that is 40% that is, which could really add up over time with a high volume cataract person with their own dispensory. Also, if you are "specializing" in low vision, or have an interest, make sure the OMDs in the area know this, you will likely see your referrals increase.

A few other thoughts on Posners original post. I really believe you are paranoid about what is said about ODs by MDs, I just don't see OMD saying how bad ODs are. It makes even less sense if you are sending the patient back to the referring OD for further care. That being said, I can see why you are a little paranoid because it sounds like your practice environment is very competitive where everybody is holding onto every patient like grim death.

I can see how it would seem from my posts that I am paranoid about OMD vs OD. However, I have stated many times that I believe I have an excellent OMD relationship in my area(in fact I would maintain that my situation is more the exception rather than the rule). Our OMDs dont hold onto patients, are dilligent to send correspondece on consults, and are always more than willing to discuss patients/cases. I speak with colleagues all over the US and sadly, this is not the case for many of them. Whether it is a relflection of their own lack of self confidence or not is a different story. However, I do see on this board comments from OMDs that would seem to indicate this whole OMD/OD phenomenon is alive and well.

As far as dispensing goes, I dont believe it should be exclusively the realm of the OD. I agree that the OD should have the opportunity to fill spectacle Rxs of referred patients but I dont believe that the patient should be obligated any moreso than they would otherwise be to fill the rx at the ODs office. It is just my opinion; we have a local OMD that has a dispensary and to whom I refer an occasional patient. I have never given it much thought as to whether he fills my patient's rxs. I suppose if I saw the optical part of my business really dropping off I would be more concerned, but this has just not been the case.

Posner

 

[POJO]

The original push for optometric scope expansion was the gradual progression of ophthalmologic dispensing or perceived loss of dispensing income.

I also believe that posters on this forum are not your "average" optometrist. The average optometrist still uses paper charts for the most part and may have computer assisted billing but not much more than that. They will have a field unit and a topographer, but no retinal camera or other imaging device. They'll see an average of 10/patients a day and hope to capture 90% of those as their Rx. The average OD will see 1 diabetic a day or less. Forget about cataract co-management. Their average patient age is far below the 60's or 70's. Again this is the average.

So you can see that the average OD is upset at any "threats" to dispensing income

To further clarify, I'm a non-dispensing optometrist and see almost all glaucoma, diabetic or AMD patients. I don't practice within an ophthalmologic group. But as a writer and journalist, it is also my task to interview across the country optometrists of all flavors to check their sentiments.

 

[drgregory]

I agree with that POJO. My decision not to co-manage my patients is based upon my belief that as the operating surgeon, I am responsibile for them. It has nothing to do with the qualifications (good or bad) of the person sending them to me.

i see most of the one-day post ops from our surgeons. but, i think it shoud be totally up to the surgeon. ive worked with these surgeons for some time now (we share office space). we bounce many things off each other. im also not afraid to call them and ask for assistance, nor are they afraid to let me know of surgical complications that may result in post-operative complications. they rely on me for lens calcs and targets. i think the key is communication. i wouldnt get mad if suddenly the surgeons said "i want to do my own post-ops from now on". maybe its because theyd be doing the post ops in my office anyways, i dont know. i guess my only question would be "why are you, when you are three months booked out in surgery, wasting your time doing uncomplicated post-operative care?" if they want to spend three or four visits with a patient holding their hand for the $140 post operative fee, so be it. they seem to be phobic of any general eye care, which is fine by me. i guess id be the same if i were a fellowship trained ophthalmologist - why in the world, with over 12 years of formal education, would i be doing a comprehensive eye exam and deciding on Acuvue or Ciba contact lenses? why would i be wasting energy throwing drops on conjunctivitis? id be sleeves-up in surgery, out of VSP's grasp, doing battle with Medicare, and have the drones (ODs like me) wading through the primary eye care sorting out the surgical cases.
but thats just my setup - a magical little dream world where ODs and OMDs not only get along, but are symbiotic. neither is too proud to ask for assistance from the other. leaves me time to focus on my real enemy = corporate optometry.

 

[DrEyeBall]

As a fellowship trained subspecialist, and from a purely "financial" side, I would love to operate a patient, then send them to someone for follow-up. However, I also enjoy seeing my postops and learn from them. I also view postop care as part of my obligation to the patient. I think it is wrong for me to delegate that to someone else just so I can get into the OR to do more cases. Having a close working relationship with some ODs and knowing them well, I do send some patients back earlier than I may for others. This of course takes time to develop these relationships. In order to develop these relationships, and the trust that is needed between parties, I would recommend phone calls, discussions, etc.

Personally, if I was called by an OD who wanted to be more involved in the care of patients they send to me, I would be very open to this if it seemed that the issue was patient care, interest in the diseases being treated, etc. If I feel like it was just another way to earn money, I would rather not see those patients from that person. I am busy enough.

I often get calls about managing a problem that I see each day. I am happy, and feel honored to get that call and help someone learn something or better treat a patient. I am not worried about the loss of that patient from my office. Many of my patients travel far distances. If I can help them avoid an extra trip, I am happy to do so.

 

[POJO]

.... I really believe you are paranoid about what is said about ODs by MDs, I just don't see OMD saying how bad ODs are. It makes even less sense if you are sending the patient back to the referring OD for further care. That being said, I can see why you are a little paranoid because it sounds like your practice environment is very competitive where everybody is holding onto every patient like grim death.

Olddog1,

Your post about being paranoid may be far fetched in your circle but not so in CA. I've had some physicians wonder why I'm practicing in their midst and made all kinds of generalizations both in front of me and behind my back. Yes, it's possible I have generalized, but that is only through the school of hard knocks.

 

[PBEA]

As a fellowship trained subspecialist, and from a purely "financial" side, I would love to operate a patient, then send them to someone for follow-up. However, I also enjoy seeing my postops and learn from them. I also view postop care as part of my obligation to the patient. I think it is wrong for me to delegate that to someone else just so I can get into the OR to do more cases. Having a close working relationship with some ODs and knowing them well, I do send some patients back earlier than I may for others. This of course takes time to develop these relationships. In order to develop these relationships, and the trust that is needed between parties, I would recommend phone calls, discussions, etc.

Personally, if I was called by an OD who wanted to be more involved in the care of patients they send to me, I would be very open to this if it seemed that the issue was patient care, interest in the diseases being treated, etc. If I feel like it was just another way to earn money, I would rather not see those patients from that person. I am busy enough.

I often get calls about managing a problem that I see each day. I am happy, and feel honored to get that call and help someone learn something or better treat a patient. I am not worried about the loss of that patient from my office. Many of my patients travel far distances. If I can help them avoid an extra trip, I am happy to do so.

Well what can I say, but that you seem to embody the very concept of being a "true" doctor. You would seem to be the exact type of surgeon I would want to refer to. Please feel free to refer back any of our pts that we share (when they are ready), for the sake of objectivity, and logic, please refer those patients BACK into the primary care realm (ASAP, of course). I hate to admit it, but I get a little nervous when some surgical remedies come off as more self serving then patient serving.