Optometry practice alongside MD clinic?

[PBEA]

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Hey, I'm against stealing patients from anyone, but your description seems flawed. You gripe about the "pittance" you get for co-management, then say that ophthalmologists are stealing your patients for the money? What money? The exam fees? That would be ridiculous. Unless you're in a saturated area where patients are simply hard to come by, most ophthalmologists are going to be looking for patients on whom they can do procedures/surgery. That's where they make their money. Not on exams. Or do the practices in question have optical? If that's the case, maybe you shouldn't refer to them, like KHE says. Fact is, there are crummy, sleazy docs in both our camps. If you go back and read my posts, I was referring specifically to cases of co-management abuse, which I stated are a minority but are more common in metropolitan areas, such as mine. In those cases, it is all about the money . . . on both sides.

I'm sure its regional but its all I know, from what I have come to understand, "exams" pay the bills and "procedures" are the gravy. Saying exams aren't valuable is a non-starter. That argument will never fly.

For the record the only "comanagement" fee I get is from the rare Lasik case. Since I'm not a big fan of corrective eye sx, this is barely worth discussing. You should realize that when you say "comanage", to me that means I saw the 80yo wet amd who finished going through months of avastin from the retina guy I sent them to. I don't get any "fee" or "kickback" from the retina fellow, just an office visit fee from the pt or their insurance.

Point is there is no sense in pointing fingers at optometry when ophthalmology is rife with the SAME problems.

 

[PBEA]

I hear what you are saying PBEA and I think you are right the MDs who get involved with comanagement do so because simply they want more referrals. They know that a large number of ODs only refer to people who do comanagement. The question I have are there people here who send to MDs who don't comanage over others that do or mix it up etc?..I think that answer would speak for itself.

Its my experience that a lot of MDs start comanaging because they feel they are missing out on referrals. Of course they have to approach the OD and say "Hey I comanage too!..(lets try to change your practice pattern)". Of course the OD isn't going to approach the MD and say I want to comanage do you? There are enough OMDs who comanage that they would be happy to garner all the referrals . All you need is one person. Why would an OD approach a MD on that topic when all the MDs are clamoring for the referrals? Its just like me, I am an oculoplastic surgeon and I have to go meet and greet ophthalmologists and optometrists. I can't imagine a situation where they would come to me.

I agree with Visionary it comes down to the money on both sides. MDs hear about other MDs who comanage and now are doing 500-1000 cases when they completely sucked surgically and were doing few cases before and are getting referrals now because of the comanagement and think "Shoot...why don't I do that? I would love to do all those cases...is it better I see my own post ops..probably..well...maybe not..I mean think of all those cases I would get... etc..

I think if comanagement didn't affect the decision making you wouldn't see people's surgical numbers go up after deciding to comanage. If the money didn't matter to ODs why would most (Not ALL) refer to only doctors that comanage? If it is a waste of time and an opportunity cost you would imagine that the ODs would refer to people who didn't comanage so they wouldnt be burdened with it in their clinic..

Something doesn't make sense here..I think both groups are motivated by money..afterall we live in America

An OD has a choice:

1) OMD who will not comanage and OD will never see the pt again because the pt now HAS to see an OMD because of the dangerous blepharitis or dry eye or gasp even glaucoma or has anything that is not myopia or hyperopia

2) OMD who will return pt to ODs care as soon as the post op is stable or satisfies their comfort level. That may be 1 day, 1 week, or 1 month, etc. Point being the pt is returned.

Since cat sx outcomes are basically the same between the two then I wonder which one the OD will choose......hmmmmmmmmmm......let me think 🙄

 

[PBEA]

I hear what you are saying PBEA and I think you are right the MDs who get involved with comanagement do so because simply they want more referrals. They know that a large number of ODs only refer to people who do comanagement. The question I have are there people here who send to MDs who don't comanage over others that do or mix it up etc?..I think that answer would speak for itself.

Its my experience that a lot of MDs start comanaging because they feel they are missing out on referrals. Of course they have to approach the OD and say "Hey I comanage too!..(lets try to change your practice pattern)". Of course the OD isn't going to approach the MD and say I want to comanage do you? There are enough OMDs who comanage that they would be happy to garner all the referrals . All you need is one person. Why would an OD approach a MD on that topic when all the MDs are clamoring for the referrals? Its just like me, I am an oculoplastic surgeon and I have to go meet and greet ophthalmologists and optometrists. I can't imagine a situation where they would come to me.

I agree with Visionary it comes down to the money on both sides. MDs hear about other MDs who comanage and now are doing 500-1000 cases when they completely sucked surgically and were doing few cases before and are getting referrals now because of the comanagement and think "Shoot...why don't I do that? I would love to do all those cases...is it better I see my own post ops..probably..well...maybe not..I mean think of all those cases I would get... etc..

I think if comanagement didn't affect the decision making you wouldn't see people's surgical numbers go up after deciding to comanage. If the money didn't matter to ODs why would most (Not ALL) refer to only doctors that comanage? If it is a waste of time and an opportunity cost you would imagine that the ODs would refer to people who didn't comanage so they wouldnt be burdened with it in their clinic..

Something doesn't make sense here..I think both groups are motivated by money..afterall we live in America

double post

 

[thiaeyemd]

I dont think because someone wont comanage that means they will try to steal all your patients. I think before comanagement there were plenty of Ophthalmologists who would send the patients back to the O.Ds. Once comanagement came on board some of that group decided to comanage, others didn't. The ones who didn't...didn't get any more referrals.

Have you found that those who dont comanage are also the ones who try to steal patients from you?

I thought there are four groups

1. Ones that comanage and don't steal patients
2. Ones that don't comanage and don't steal patients
3. Ones that don't comange and steal patients
4. Ones that comanage and steal patients

Obviously the ones that steal patients are out but if the argument is true that comanagement is somehow a burden or lost opportunity cost of ODs then the non comanaging docs should be preferred which is not the case.

Let me know your thoughts

 

[PBEA]

I dont think because someone wont comanage that means they will try to steal all your patients. I think before comanagement there were plenty of Ophthalmologists who would send the patients back to the O.Ds. Once comanagement came on board some of that group decided to comanage, others didn't. The ones who didn't...didn't get any more referrals.

Have you found that those who dont comanage are also the ones who try to steal patients from you?

I thought there are four groups

1. Ones that comanage and don't steal patients
2. Ones that don't comanage and don't steal patients
3. Ones that don't comange and steal patients
4. Ones that comanage and steal patients

Obviously the ones that steal patients are out but if the argument is true that comanagement is somehow a burden or lost opportunity cost of ODs then the non comanaging docs should be preferred which is not the case.

Let me know your thoughts

I don't think its mutually exclusive. In other words, if you don't "comanage" as an ophthalmologist then you don't send the pt back to the OD. Cut and dried (and pretty straightforward, IMO). By default its stealing/poaching, it's implied by the action to decline to participate in comanagment, "we don't comanage cases with ODs" speaks volumes. Granted some of the cases are hairy and require ophtho, but given the nature of cat sx I think that is a huge minority. As well, some pts will simply prefer to stay with the ophtho to have them provide primary/secondary care level exams, but those aren't the ones we are discussing on this thread. However, I can assure you ophtho is desirous of keeping those primary/secondary exams in house (just like me).

To me it has nothing to do with taking a "cut" of the global fee, its about getting back pts that I've been following for years. Fortunately most of my pts will shrug off the aggressive ophtho recall and return of their own free will.

 

[mclem222]

I have to agree ....there are some OMDs who try to sabotage and steal patients and I don't send patients to them..they also don't comanage. Now there are a few who do comanage and dont steal but not many.

 

[thiaeyemd]

If what you are saying is true then so be it but I know a number of ophtho people who do cataract surgery, feel it is better for the patient for them to see the patient after the surgery (they don't want anyone else seeing them, not an OD, MD, Phd, because that person didn't do the surgery) and have no interest in stealing patients and because they don't comanage don't get sent one patient from ODs. That is the truth about those people. Now it is possible that the large majority of noncomanagers try to steal patients so these people get lumped with themby ODs. I dont do cataract surgery so I don't know. This is just from talking to my friends who are ophtho people out in practice who are young. Do you think they get lumped together then?

 

[PBEA]

If what you are saying is true then so be it but I know a number of ophtho people who do cataract surgery, feel it is better for the patient for them to see the patient after the surgery (they don't want anyone else seeing them, not an OD, MD, Phd, because that person didn't do the surgery) and have no interest in stealing patients and because they don't comanage don't get sent one patient from ODs. That is the truth about those people. Now it is possible that the large majority of noncomanagers try to steal patients so these people get lumped with themby ODs. I dont do cataract surgery so I don't know. This is just from talking to my friends who are ophtho people out in practice who are young. Do you think they get lumped together then?

OK, enough nice talk.

bottomline

This has NOTHING to do with pt care

It has EVERYTHING to do with money, ego , or power

Before I mentioned high road or low road but in reality it should

more money vs less money

what you gonna do bro?

you want to follow your post-ops for the next 20 years under the guise of "pt care"? so be it, don't complain when I totally turn my back to you.

As far as your friends are concerned, I think its a bunch of whiney nonsense. Optometry makes for an easy excuse/target. My guess is they don't have enough internal volume to generate sufficient surgical volume.