LASIK prices: why the gap?

[fedor]

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I just took a loot at JHU's clinic and they charge about $5600 for Lasik on both eyes. Googling around the web I find plenty of places charging $299 per eye. What's the difference? And if you were going to have Lasik done, where would you go?

 

[DOCTORSAIB]

I just took a loot at JHU's clinic and they charge about $5600 for Lasik on both eyes. Googling around the web I find plenty of places charging $299 per eye. What's the difference? And if you were going to have Lasik done, where would you go?

From what I understand, price differences are usually due to hidden costs that aren't mentioned in the advertised $299/eye price. One such hidden cost is additional charges for post-op visits (which can add up very quickly, depending on the surgeon). Another that comes to mind is location. In fact, location probably is one of the biggest reasons for price differences.

Whatever you do, don't have your Lasik done at mall!

 

[fedor]

From what I understand, price differences are usually due to hidden costs that aren't mentioned in the advertised $299/eye price. One such hidden cost is additional charges for post-op visits (which can add up very quickly, depending on the surgeon). Another that comes to mind is location. In fact, location probably is one of the biggest reasons for price differences.

Whatever you do, don't have your Lasik done at mall!

So if not the mall, where would you recommend? A medical school clinic? A private practice OMD?

 

[Andrew_Doan]

From what I understand, price differences are usually due to hidden costs that aren't mentioned in the advertised $299/eye price. One such hidden cost is additional charges for post-op visits (which can add up very quickly, depending on the surgeon). Another that comes to mind is location. In fact, location probably is one of the biggest reasons for price differences.

Whatever you do, don't have your Lasik done at mall!

Another hidden cost is $299 is only for the first 2 Diopters. If you're a -5 diopters, then expect to pay the hidden cost of 3 Diopters.

I recommend finding an experienced surgeon that others have trust and had good experiences.

 

[f_w]

The simple reason for the price differential is: Because the JHU anterior segment division decided that this is what they will charge and the market continues to give them this price (the market in this case is worldwide, the JHU department is very popular around the persian gulf).

Don't go with the $299 discounters. These are the infamous 'lasik mills'. A tech sees you, takes your consent and off you go under the laser. They send you home with some pamphlets but no plan for follow-up. The surgeon who did your procedure might or might not see you for problems, if you need an enhancement procedure you have to pay again. If things go really south, you are on your own.Your health insurance will politely decline to cover follow-up care for a surgical procedure that wasn't medically indicated. You end up paying out of pocket for the care of an expert trying to salvage your eye.

It doesn't have to be JHU (that said, if you have the money to spring you might as well). But go with a fellowship trained cornea and refractive surgery specialist who treats lasik as what it is: surgery ! Before you go under the laser, there should be an in-depth exam to pick up the few contraindications for lasik. There should be a discussion of the risks and benefits and time for you to think about it. Yes, these people will typically charge more, maybe $1500 per eye, but your follow up care and necessary enhancements are typically included in this charge. Be weary of 'surgeons' (and especially optometrists) who offer a 'free' pre-lasik consultation, they are salespeople, not physicians.

 

[file014]

There are respectable surgeons that offer free consults. You should definitely check for a good referral before going to a consult.

 

[f_w]

> Its kinda tough to get someone to pay $100 to tell them they can't
> have surgery.

Actually, it is not. This patient will be thankful for the in-depth discussion you provided him in which you explained why he can't have LASIK and what other refractive surgical alternatives you (or someone else) can offer him. If the patient paid for the service he/she is less likely to walk into the next lasik salesmans office until he finds someone less scrupulous.
It is the difference between providing a professional service (for which you can expect payment) and a sales meeting (for which you can't expect to get paid if the deal doesn't come through).

Note:
I have yet to meet a refractive surgeon whose staff isn't convinced that he 'developed lasik as we know it' or 'invented much of the equipment' or 'has plenty of patents on lasik'......

 

[VA Hopeful Dr]

Actually, it is not. This patient will be thankful for the in-depth discussion you provided him in which you explained why he can't have LASIK and what other refractive surgical alternatives you (or someone else) can offer him. If the patient paid for the service he/she is less likely to walk into the next lasik salesmans office until he finds someone less scrupulous.
It is the difference between providing a professional service (for which you can expect payment) and a sales meeting (for which you can't expect to get paid if the deal doesn't come through).

I don't really think there's anything wrong with offering "free consultation/pre-op" for lasik. Whether or not you offer this has absolutely no impact on the MDs skill.

You are right, people won't mind paying for the pre-op most of the time. But I guarantee that, if you charge, you will have some very unhappy lasik-rejection patients that then have to pay your professional fee out of pocket since, at best, insurance only offers a discount.

Be weary of 'surgeons' (and especially optometrists) who offer a 'free' pre-lasik consultation, they are salespeople, not physicians.

It seems to me that optometrists are ideal in getting patients to consider lasik. Think about how many patients that ODs have that only come in once a year to make sure their glasses are still strong enough. Sounds like a great time to suggest lasik, doesn't it?

Simply put, since lasik is entirely a voluntary procedure, you need an aspect of salesmanship.

 

[f_w]

> I don't really think there's anything wrong with offering
> "free consultation/pre-op" for lasik. Whether or not you
> offer this has absolutely no impact on the MDs skill.

It is the difference between being a professional funeral director vs a coffin salesman.

> But I guarantee that, if you charge, you will have some very
> unhappy lasik-rejection patients that then have to pay your
> professional fee out of pocket since,

And if you give away your professional services for free and try to recoup the cost by talking people into marginally indicated procedures, you will have unhappy patients who didn't get the benefit they expected.

> It seems to me that optometrists are ideal in getting patients
> to consider lasik. ............ Sounds like a great time to suggest
> lasik, doesn't it?

Sure, the optometrists are great in roping patients into getting lasik done. But mainly because they are looking for the kickbacks from 'their' lasik surgeon (the official name for this scheme is 'co-management', kickbacks and bribes sounded like it is something bad.)

> Simply put, since lasik is entirely a voluntary procedure, you
> need an aspect of salesmanship.

If that is what you want to be, a salesman, then yes.

 

[pathstudent]

I hope optometrists will soon be allowed to "push the button" on the Lasik machine so opthalmologists can get back to real medicine.

 

[f_w]

> I hope optometrists will soon be allowed to "push the button"
> on the Lasik machine so opthalmologists can get back to
> real medicine.

The issue with training for lasik is not so much how to 'push the button' but rather the question of 'when' and 'when not'.


Well, in Oklahoma they apparently now can do surgery if they feel up to it. And from some of the stuff ophthalmologists in the surrounding states are seeing lately, the results are mixed.

 

[fedor]

> I hope optometrists will soon be allowed to "push the button"
> on the Lasik machine so opthalmologists can get back to
> real medicine.

The issue with training for lasik is not so much how to 'push the button' but rather the question of 'when' and 'when not'.


Well, in Oklahoma they apparently now can do surgery if they feel up to it. And from some of the stuff ophthalmologists in the surrounding states are seeing lately, the results are mixed.

f_w, I tried to send you a PM but your PM box was full.

 

[sco1styear]

> I don't really think there's anything wrong with offering
> "free consultation/pre-op" for lasik. Whether or not you
> offer this has absolutely no impact on the MDs skill.

It is the difference between being a professional funeral director vs a coffin salesman.

> But I guarantee that, if you charge, you will have some very
> unhappy lasik-rejection patients that then have to pay your
> professional fee out of pocket since,

And if you give away your professional services for free and try to recoup the cost by talking people into marginally indicated procedures, you will have unhappy patients who didn't get the benefit they expected.

> It seems to me that optometrists are ideal in getting patients
> to consider lasik. ............ Sounds like a great time to suggest
> lasik, doesn't it?

Sure, the optometrists are great in roping patients into getting lasik done. But mainly because they are looking for the kickbacks from 'their' lasik surgeon (the official name for this scheme is 'co-management', kickbacks and bribes sounded like it is something bad.)

> Simply put, since lasik is entirely a voluntary procedure, you
> need an aspect of salesmanship.

If that is what you want to be, a salesman, then yes.

The optometrists that I worked for don't push lasik to get "kickbacks" but are extremely professional in helping patients understand if they qualify and the cost/benefit of having such a procedure performed.
I think it is unfair to assume optometrists are trying to "rope" patients into having procedures done. Most tend to want the best for their patients.
But just like any profession, including ophthalmology, there are "bad" ones out there.

 

[NDirish]

Many of the most respected LASIK practices in the country do free LASIK evaluations. It is a much more respectable way to increase your volume than advertising on billboards and the comics.

 

[NDirish]

I hope optometrists will soon be allowed to "push the button" on the Lasik machine so opthalmologists can get back to real medicine.

You have obviously never pushed "the button" as evidence by your ignorance and complete lack of knowledge of what LASIK surgery is and involves. If done the right way by trained ophthalmologists (i.e. cornea/refractive fellowships), then it is a valued service in one's repetoire.

 

[VA Hopeful Dr]

It is the difference between being a professional funeral director vs a coffin salesman.

Please explain to me exactly how this works. How does offering free pre-op affect a surgeon's skill?

And if you give away your professional services for free and try to recoup the cost by talking people into marginally indicated procedures, you will have unhappy patients who didn't get the benefit they expected.

Offering free pre-ops doesn't mean that you are in immoral surgeon. No doctor in his/her right mind will try to do lasik on someone who isn't suitable. I'm no lawyer, but even I could win the case where an MD did lasik on someone who wasn't a good candidate.

Sure, the optometrists are great in roping patients into getting lasik done. But mainly because they are looking for the kickbacks from 'their' lasik surgeon (the official name for this scheme is 'co-management', kickbacks and bribes sounded like it is something bad.)

Don't be foolish, no OD is going to try and "rope" patients into lasik. Here's a dirty little secret: the co-managing fee for lasik is NOTHING compared to glasses and contact profit for ODs. ODs aren't out trying to have all their patients get lasik, it wouldn't make any kind of sense for them.
As for co-management, we've all been through this about a thousand times so far. Its not about the immediate money! Co-management fees are nothing compared to the time spent. Co-management only exists to make sure that ODs get their patients back after surgery. Simple as that.

 

[f_w]

> Please explain to me exactly how this works. How does offering
> free pre-op affect a surgeon's skill?

I never said that it affects the surgeons skill, I just consider it unprofessional. Because many surgeons will do it, there is sort of a pressure to go along with the herd, it doesn't make it right.

> No doctor in his/her right mind will try to do lasik on someone who
> isn't suitable.

Every day, refractive surgery is done on patients who are only marginally suitable. (The rate for the laser has to be paid, the practice overhead is looming and after all 'the guy next door will do him if I don't do it'.) The refractive surgery malpractice industry is just now picking up steam. In a few years, the avalanche of malpractice suits kicked off by unscrupulous lasik providers will drive the price of the equipment into a range making it economically unsustainable even for the patients it can genuinely benefit.

> Don't be foolish, no OD is going to try and "rope" patients into lasik.
> Here's a dirty little secret: the co-managing fee for lasik is
> NOTHING compared to glasses and contact profit for ODs.

Of course, for you as an OD it is nothing unusual to bundle your professional services with a sales pitch. 'free eye exam with purchase of glasses' has been outlawed in some states, but around here it seems to be the rule, not the exception.

> Co-management only exists to make sure that ODs get their
> patients back after surgery. Simple as that

Co-management exists to fatten the wallet of optometrists who are in a market position to demand it. No ophthalmologist I know of wants to keep post-op patients for the type of services an optometrist could provide. Don't worry, you'll get your patients back, no fee needed for that.

 

[KHE]

>

I never said that it affects the surgeons skill, I just consider it unprofessional. Because many surgeons will do it, there is sort of a pressure to go along with the herd, it doesn't make it right.


Co-management exists to fatten the wallet of optometrists who are in a market position to demand it. No ophthalmologist I know of wants to keep post-op patients for the type of services an optometrist could provide. Don't worry, you'll get your patients back, no fee needed for that.

I disagree on both counts.

1: Cosmetic surgeons all do free consultations. At least they do around here in Connecticut. That's pretty much the standard for any elective and/or cosmetic procudure.

2: Co management does not exist to fatten OD wallets. Considering how low comanagement fees are, I could make much more money simply filling those time slots with other patients. Even on the high end of LASIK surgery fees of $4000, where the comanagement fee is $800. This is especially true since a significant number of LASIK patients need numerous follow up visits to deal with their enhancements, fluctuating vision in the early stages of recovery, and chronic dry eyes. LASIK is definately not a money maker for the comanaging OD.

I had to have an extensive abdominal surgery three years ago. Did the surgeon do the post op care? No. My PCP did. Are these guys "fee splitting?"

 

[sco1styear]

> Of course, for you as an OD it is nothing unusual to bundle your professional services with a sales pitch. 'free eye exam with purchase of glasses' has been outlawed in some states, but around here it seems to be the rule, not the exception.

Co-management exists to fatten the wallet of optometrists who are in a market position to demand it. No ophthalmologist I know of wants to keep post-op patients for the type of services an optometrist could provide. Don't worry, you'll get your patients back, no fee needed for that.

Obviously you know different optometrists and ophthalmologists than I do.

 

[f_w]

> 1: Cosmetic surgeons all do free consultations. At least they do
> around here in Connecticut.
> That's pretty much the standard for any elective and/or
> cosmetic procudure.

As I said, the herd moves one direction, but does it make it right ?

I venture to guess that these are truly 'cosmetic surgeons'. Plastic and reconstructive surgeons (you know, the ones who actually trained to do these procedures) are not dependent on selling their services like time-shares in Orlando.

> 2: Co management does not exist to fatten OD wallets.

Then why are you so bent on doing it ? (oh yeah right, because they are 'your patients' and you want to take care of them. You do this out of pure altruism...)

> Considering how low comanagement fees are, I could make
> much more money simply filling those time slots with other
> patients.

Go right ahead !

> I had to have an extensive abdominal surgery three
> years ago. Did the surgeon do the post op care? No.
> My PCP did. Are these guys "fee splitting?"

But your PCP didn't squeeze a 'fee' out of the surgeon to see you for pain meds and prescription refills. He billed you for the services he provided and your insurance co picked up the tab. It is not the same.

 

[sco1styear]

Wow, aren't you filled with attitude?
I think you need to try meditation...maybe that will help.

 

[fedor]

I asked the question of how OD's are dealing with Lasik in the Optometry forum a while back and the concensus was that it was actually lucrative for optometrists to "comanage" Lasiks patients. To claim now that this fee has no incentive for OD's to send patients to OMD's for Lasik is a bit unrealistic. The $800-$1000 the OD gets per patient is actually quite substantial.

 

[KHE]

I asked the question of how OD's are dealing with Lasik in the Optometry forum a while back and the concensus was that it was actually lucrative for optometrists to "comanage" Lasiks patients. To claim now that this fee has no incentive for OD's to send patients to OMD's for Lasik is a bit unrealistic. The $800-$1000 the OD gets per patient is actually quite substantial.

On the surface, it does seem that way.

But when you consider the number of office visits needed to manage many of these patients, it's just not worth it. Most follow up protocol is 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year. Some doctors eliminate the 3 month visit. Some eliminate the 6 month visit. At least the ones that I have worked with.

But those are only the patients where everything goes perfectly smooth. All it takes is a couple of enhancements and/or dry eye patients to have the number of non paying office visits go up exponentially. And the $800-$1000 comanagement fee is only coming from surgeons who charge $4000-$5000 for the surgery. And that is definately becoming a rarity these days, even for custom lasik, or intralase or any of the other newer technologies.

Again, I maintain that I can make more money by filling up my appointment book doing things other than LASIK comanagment.

And for cataract surgery, it's way worse.

 

[VA Hopeful Dr]

Of course, for you as an OD it is nothing unusual to bundle your professional services with a sales pitch. 'free eye exam with purchase of glasses' has been outlawed in some states, but around here it seems to be the rule, not the exception.

First, I'm not an OD nor in school to be one... just a little ole M-1 who is growing weary of all the unfounded OD bashing. That said, the "free exam with glasses" thing isn't something respectable ODs will do. It happens, but most ODs tend to be fairly unhappy about it.

Co-management exists to fatten the wallet of optometrists who are in a market position to demand it. No ophthalmologist I know of wants to keep post-op patients for the type of services an optometrist could provide. Don't worry, you'll get your patients back, no fee needed for that.

No, no, no, this is just not true. As has been stated countless times, co-management isn't about the money. Let's take cataract surgery. Co-management fee for that runs about $120-$150 depending. This covers somewhere on the order of 3-4 office visits in the 90 day period (1 week, 1 month, 3 month) with more visits being needed if something goes wrong. Those three visits could be filled with regular patients that would be charged around $90-$100 for an exam. $300 is much more than $150, so its obviously not about the money for the post-op care. It is about getting the patient back. There are many MDs that get along fine with ODs by just promising to send the patient back once they have a stable glasses Rx (Dr. Doan, to name one we all know). As long as they get the patient back, ODs are happy.
This idea isn't limited to MD/OD relations either. As sco1styear said, often your PCP will do post-op care of surgery. If internists and family practice guys don't ever see the patients they send off, they will stop referring to that particular surgeon.

 

[f_w]

> just a little ole M-1 who is growing weary of all the unfounded OD bashing.

Well, I am a bit further along in my medical career, and my reservations about the trade of optometry are what I believe well founded.

> No, no, no, this is just not true. As has been stated
> countless times, co-management isn't about the money.

By re-stating something over and over again, it doesn't rise to truth (although the current goverment seems to believe that).

> Let's take cataract surgery. Co-management fee for that runs
> about $120-$150 depending.

Are you aware of how minimal reimbursement for cataract surgery is these days ? ($120-150 is a big chunk out of the typical medicare/hmo rate for an uncomplicated phaco)

> It is about getting the patient back. There are many MDs that
> get along fine with ODs by just promising to send the patient back
> once they have a stable glasses Rx

If you were happy with the patient alone, why are you trying to leech off the surgeons reimbursement ?

> As sco1styear said, often your PCP will do post-op care of surgery.

And as I pointed out, this doesn't involve the exchange of money between the providers. (You might invite some of your referrers to a round of golf or a fancy dinner with their wife once in a while, but they don't typically squeeze you for cash.)

 

[VA Hopeful Dr]

Are you aware of how minimal reimbursement for cataract surgery is these days ? ($120-150 is a big chunk out of the typical medicare/hmo rate for an uncomplicated phaco). If you were happy with the patient alone, why are you trying to leech off the surgeons reimbursement ?

Yes, its 20%. But an experienced surgeon can do an uncomplicated phaco in about 10-12 minutes. $450-$500 for 10 minutes of time (80% leftover after co-management fee) is not too shabby.
If MDs hadn't been stealing surgical patients, there would have been no need for co-management. This is a unique situation in healthcare. An orthopedic surgeon isn't going to continue to treat a patient's diabetes after surgery. Ophthalmologists, on the other hand, can take over complete eye care for a patient after surgery. This lead to many ODs never seeing patients after surgery, ever. Co-management was enacted as a way to make sure that the patients came back to the referring OD. If ALL ophthalmologists agreed to send patients back after the post op period for glasses and continuation of care, this wouldn't be a problem.

 

[f_w]

Yes, its 20%. But an experienced surgeon can do an uncomplicated phaco in about 10-12 minutes. $450-$500 for 10 minutes of time (80% leftover after co-management fee) is not too shabby.

Oh yeah right, and the OR turns itself around. There are indeed surgeons who run 3 ORs at a time and plow through large numbers of cases in a single morning. In the more typical hospital OR or ASC setting, the fee has to cover far more than the 10 minutes you imply. And in general, it is payment for a professional service including the financial and legal responsibility for the outcome. It is not payment for 10 minutes of your time.

The issue with ophthalmologists 'keeping' optometry patients after the immediate post-op care is imho seriously overblown by the optometry lobby. I rather see the opposite. Ophthalmologists looking for ways to reduce the number of simple 'glasses and contacts' patients in order to keep space in the schedule for the stuff they trained for (One factor you might not be aware of are the patients. Often enough, they prefer the care of a physician and opt to stay in the ophthalmologists care by their own volition. Discharging a post-op patient from your care against his will is very very difficult and requires careful legal maneuvering )

 

[Tom_Stickel]

The issue with ophthalmologists 'keeping' optometry patients after the immediate post-op care is imho seriously overblown by the optometry lobby. I rather see the opposite. Ophthalmologists looking for ways to reduce the number of simple 'glasses and contacts' patients in order to keep space in the schedule for the stuff they trained for (One factor you might not be aware of are the patients. Often enough, they prefer the care of a physician and opt to stay in the ophthalmologists care by their own volition. Discharging a post-op patient from your care against his will is very very difficult and requires careful legal maneuvering )

If they don't want patients simple glasses and contacts exams, why are so many ophthalmologists opening dispensaries?

On another note, I'm on both sides of the fence as an OD working in a 3 ophtho/1 OD practice in which I handle the routine cataract post-ops. Many patients aren't willing to go back to their OD, no matter how insistent or hard I push.

See it from the patients point of view. For years, the OD has been saying "I can't really help you. I'll sell you some new glasses, which will make you see just a little better. But other than that, you just have to get worse." This goes on for a few years and the patient's VA and visual satisfaction decrease. Then, after 1 15 minute outpatient procedure, their vision is miraculously restored, and hey, they don't even need their glasses to drive. It's no wonder that some patients are very attached to their cataract surgeon. Ours gets flowers about twice a month from happy patients. Any ODs getting that kind of love?

I think we all just need to step back and try to see it from the other side for a minute.

Tom Stickel, OD

 

[Ben Chudner]

Oh yeah right, and the OR turns itself around. There are indeed surgeons who run 3 ORs at a time and plow through large numbers of cases in a single morning. In the more typical hospital OR or ASC setting, the fee has to cover far more than the 10 minutes you imply. And in general, it is payment for a professional service including the financial and legal responsibility for the outcome. It is not payment for 10 minutes of your time.

Actually, there is a separate fee that covers the OR time and another one that covers anesthesia which is above and beyond what the surgeon gets so I am not sure what you mean by this.

 

[f_w]

> so I am not sure what you mean by this

The $450 of the professional fee (after separation of the post-op charges) are not for the 10-15 minutes you actually spend scrubbed at the microscope. There are OR turnaround times, pre-op assessment and other issues consuming additional time that are part of the service you are getting paid for. (to say 'cataract surgery only takes 10 minutes so you can do 6 cases and make $2250 per hour just demonstrates an utter lack of understanding of how surgical practice works).

 

[sco1styear]

>
Well, I am a bit further along in my medical career, and my reservations about the trade of optometry are what I believe well founded.

Maybe you need to get out more

 

[f_w]

> Maybe you need to get out more

Except for this type of dull personal attack you haven't contributed much substance to this thread, have you ?

 

[sco1styear]

It's pretty apparent there will be no changing your mind so I decided not to waste my time trying.
So I thought I would put in comments that contained absolutely no substance. 🙂 (seriously)
In all honesty, I'm trying to get you to loosen up a little. You seem pretty tightly wound.

 

[VA Hopeful Dr]

The $450 of the professional fee (after separation of the post-op charges) are not for the 10-15 minutes you actually spend scrubbed at the microscope. There are OR turnaround times, pre-op assessment and other issues consuming additional time that are part of the service you are getting paid for. (to say 'cataract surgery only takes 10 minutes so you can do 6 cases and make $2250 per hour just demonstrates an utter lack of understanding of how surgical practice works).

If we assume only 2 phacos per hour (to allow for OR turnaround), it comes to $900. Even if half of that goes to overhead (which I suspect it a bit high, but if anyone can prove me wrong I'll gladly accept that), that still gives the surgeon $450 an hour. We'll even round that down to $400. Doesn't seem to shabby to me.

The issue with ophthalmologists 'keeping' optometry patients after the immediate post-op care is imho seriously overblown by the optometry lobby. I rather see the opposite

This is getting better every year. Back in the 80s (and earlier, but I don't remember those days), ODs knew that if they sent a patient out, they would not see that patient again unless the patient went out of the way to come back. I would suggest that you think it is overblown by the optometry lobby for exactly this reason: the OD lobby is lots of older (35+ years old) who remember when MDs had absolutely no respect for ODs as anything other than refraction technicians. Today's MDs are, overall, better about this and will send patients back. So you have ODs who remember who bad things used to be compared with a fairly friendly atmosphere currently, that can make it seem like things are being blown out of proportion.

 

[fedor]

This is a unique situation in healthcare. An orthopedic surgeon isn't going to continue to treat a patient's diabetes after surgery. Ophthalmologists, on the other hand, can take over complete eye care for a patient after surgery. This lead to many ODs never seeing patients after surgery, ever. Co-management was enacted as a way to make sure that the patients came back to the referring OD. If ALL ophthalmologists agreed to send patients back after the post op period for glasses and continuation of care, this wouldn't be a problem.

It's not unique. Family practitioners or internists will often send their uncontrolled type-II diabetes patients to an endocrinologist knowing that the endocrinologist will often become the primary doctor for this type of patient.

If a family practitioner or internist demanded some sort of commission for sending this patient to the endocrinologist, the medical community would rightly be up in arms.

What we're seeing in optometry is that this comanagement fee is an incentive for OD's to send their patients for Lasik. I'm not going to harp on those OD's and OMD's who perform Lasik on marginal patients, because that type of money grubbing isn't the norm and also isn't relegated to OD's and OMD's.

What I am going to harp about is that this comanagement fee is often no more than a kickback to the OD for sending the patient his way. If a patient would benefit from Lasik and is interested in the procedure, send the patient to the OMD. Don't just say that OD's need to be compensated because they're going to lose the patient because of Lasik. Imagine a FP doctor telling a specialist that he needs some sort of comanagement fee because he is going to lose 6 patient visits a year. The comanagement fee is shady.

 

[fedor]

Maybe you need to get out more

These type of ad hominem attacks do nothing but detract from your cause.

 

[VA Hopeful Dr]

It's not unique. Family practitioners or internists will often send their uncontrolled type-II diabetes patients to an endocrinologist knowing that the endocrinologist will often become the primary doctor for this type of patient.

If a family practitioner or internist demanded some sort of commission for sending this patient to the endocrinologist, the medical community would rightly be up in arms.

That is a different situation. If an OD sends a patient to an MD for an ongoing condition (macular degeneration, perhaps), then the OD also realizes that he probably won't see that patient again. However, this is surgery we're talking about. Consider it this way: an FP sends a patient to a GI guy for a colonoscopy. The GI specialist, who is still an internist, then keeps that patient. Can the FP get angry then?

What we're seeing in optometry is that this comanagement fee is an incentive for OD's to send their patients for Lasik. I'm not going to harp on those OD's and OMD's who perform Lasik on marginal patients, because that type of money grubbing isn't the norm and also isn't relegated to OD's and OMD's.

What I am going to harp about is that this comanagement fee is often no more than a kickback to the OD for sending the patient his way. If a patient would benefit from Lasik and is interested in the procedure, send the patient to the OMD. Don't just say that OD's need to be compensated because they're going to lose the patient because of Lasik. Imagine a FP doctor telling a specialist that he needs some sort of comanagement fee because he is going to lose 6 patient visits a year. The comanagement fee is shady.

The co-management fee, in my understanding, covers post-op visits for lasik. If the referring OD doesn't take over post-op, then the co-management fee probably is a bit odd. But, the OD sees the patients so the OD should get compensated for it somehow.

 

[sco1styear]

These type of ad hominem attacks do nothing but detract from your cause.

I guess you didn't read my next post....
Sorry for detracting from the conversation at hand. I'll refrain from further posts without substance (at least in this thread 🙂)

 

[Ben Chudner]

What I am going to harp about is that this comanagement fee is often no more than a kickback to the OD for sending the patient his way. If a patient would benefit from Lasik and is interested in the procedure, send the patient to the OMD. Don't just say that OD's need to be compensated because they're going to lose the patient because of Lasik. Imagine a FP doctor telling a specialist that he needs some sort of comanagement fee because he is going to lose 6 patient visits a year. The comanagement fee is shady.

This is factually incorrect. If the LASIK surgeon wants to take on the follow-up care then there is no need for the co-management fee. Since the OD is taking on the follow-up care in most cases and therefore a percentage of the liability, he should be compensated. I don't know about other states, but in mine fee splitting is illegal. I do not get any money from the surgeon. He charges a fee for the LASIK and does not typically see post-ops past the one-day visit (because he would rather spend his time operating). I see the patients for the rest of the scheduled and non-scheduled follow-ups for up to a year and for that the patient pays me a fee. I may be a little different than other OD's, but I also charge for the pre-op eval. If the patient is a good candidate and elects to have the procedure, that pre-op fee is credited towards the post-op fee.

As for cataract surgery, there is no kick-back either. The surgeon charges the insurance company for the procedure, and the co-managing doc charges for the post-op. It is true that the OMD would keep all of the reimbursement if he followed the patient for the 90 days, but in my experience, the really good surgeons are so busy that they do not want to follow these patients. Therefore, they send them back to the referring doc. Since that referring doc is doing the work and assuming a percentage of the liability, he should be compensated.

 

[Ben Chudner]

One more point, because I can already hear the responses. Yes, the OD can choose to send cataracts only to those OMD's that send them back at 1 week and this may seem shady. My answer to that is that each of us has to live with our referral choices. If an OD refers to someone only because he will get that patient back I would question his ethics. Just as I would an OMD that performs cataract surgery on a 20/20 eye or LASIK on an unacceptable candidate. Once again in my experience, the really good surgeons are so busy that they do not want to see uncomplicated post-ops. This way I can take comfort in the knowledge that I referred a patient to a very qualified surgeon.