Co-managed care rife with success stories for patients, doctors

At over $300 a trip, flights from Kodiak Island to Anchorage, Alaska, can start to add up quickly, especially when those visits are a pre- and post-operative necessity.

“Patients are much more apt to miss appointments or drop out of care entirely if the burden to access care becomes too great,” says Paul M. Barney, O.D. “We see that here in Alaska, where we’re talking about plane trips to appointments; they don’t have the financial wherewithal to do that, and they simply miss care.”

As director of the Pacific Cataract and Laser Institute’s (PCLI) co-management and surgical center in Anchorage for the past two decades, Dr. Barney, an AOA trustee, knows firsthand how such barriers to care can negatively affect patient outcomes. Alaska, at nearly two and a half times as large as Texas, is by far the largest state in the U.S., yet it’s among the least populous. Understandably, Alaskans’ first resort for health care are the primary care providers within their immediate communities. Secondary or tertiary care often requires considerable travel and coordination. 

Given this environment, PCLI, a high-volume surgical center, approaches co-management not just as a nicety but an imperative. In the case of cataract surgery, Dr. Barney will remain in frequent contact with a patient’s local primary eye care provider on how to best manage that case.

“The reality is that when you’re doing a significant volume of surgeries, as that volume of patients increases, then you have more demand from those patients in terms of communicating with them, too,” Dr. Barney says. “If optometry isn’t providing co-management, then ophthalmology wouldn’t be able to do it all.” 

Health care trends point to optometry’s critical involvement

Despite a desire to paint this level of patient care and collaboration as “rare” among optometry’s opponents, co-management among optometry and ophthalmology has long been commonplace. For years, doctors of optometry have referred patients to ophthalmology, educated patients about the surgeries performed by ophthalmologists and managed these procedures both pre- and post-operatively. Far from outliers, these arrangements provide great benefit to patients and alleviate barriers to care identified by emerging health industry data.

 Demand for medical eye care services is expected to balloon with the share of the U.S. population over 65-years-of-age expected to increase from 15% in 2016 to 21% by 2030 and 23% by 2060. Likewise, demand for medical eye exams alone will increase by about 15 million more exams between 2020 and 2030 at a time when ophthalmology, as a profession, remains relatively flat in growth. 

While about 4.2 million cataract surgeries were provided in 2020 with an estimated 16,042 full-time equivalent ophthalmologists available, by 2023 those figures increased to 5.6 million procedures with a net addition of only about 500 ophthalmologists.

“The average ophthalmologist performs 400 cataracts a year, so that would mean we need 3,500 additional ophthalmologists just for cataract surgery—forget everything else—and we’re only going to have 500,” notes Richard Edlow, O.D., the Eyeconomist author and industry lecturer, reflecting on his annual Economic Overview of the Ophthalmic Industry report. “So, ophthalmologists will be spending more and more time in their surgical facilities and less and less time providing all that medical, chronic eye care.”

Optometric co-management a win-win for patients, providers

For those eager to say co-management is well and good in rural areas but not urban or suburban settings, Dr. Barney is quick with a rebuttal: even in metropolitan areas, there are additional indirect and direct costs to patients when they must utilize the ophthalmologist for all their care. Think of the senior on a fixed income coordinating public transportation or driving to an unfamiliar part of town. Or in the case of some of the U.S.’s metropolitan melting pots, think of the patient who isn’t as fluent in English and has a developed rapport with their local optometrist from a similar background.

“We see very similar difficulties among patients in urban versus rural areas,” Dr. Barney says. “It comes back to: if we’re doing co-management with their optometrist who practices in their community or near their home, it’s much easer for that patient to get care.”

Co-management of ophthalmic surgery is one of the most successful models of collaborative inter-professional care that exists, says Christopher Quinn, O.D., founder and president of Omni Eye Services of New Jersey and CEO of Omni Ophthalmic Management Consultants, as well as an AOA past president. Omni Eye is a co-management-based practice that emphasizes collaboration among optometry and ophthalmology to deliver high-quality patient care.

“Over the past 40 years, patients undergoing eye surgery have benefited from the expertise of experienced ophthalmic surgeons who work collaboratively with primary care optometrists,” Dr. Quinn says.

“Patients benefit from the continuity of care, convenience and improved access provided by their local optometrist who is most familiar with their visual needs. High-quality ophthalmic postoperative care provided by optometrists is a common and proven model that benefits patients,” he adds.

Considerations for co-managed care success

Thinking about co-managed care? Paul Ajamian, O.D., and Randall Reichle, O.D., experts in co-management, offer these tips and considerations for doctors exploring this model of care. 

1. Make contact. Identify potential co-managing ophthalmologists by turning to your best resource: local optometric colleagues. These doctors of optometry already know the local surgeons with the best rapport and approach to co-managed care. Once you’re ready, schedule meetings over lunch or simply arrange a visit to their practice.
   
   
2. Determine the division of labor. When visiting the surgeon’s practice, use this as an opportunity to discuss their stance on co-managed care and optometry’s scope. Ask to observe a procedure to see the “bedside manner” of the doctor and staff with patients. Discuss clinical issues and assessing the level of care offered in the practice; does the surgeon offer state-of-the-art care with premium lens options, advanced technology or even dropless surgery for patient convenience? See if the surgeon is doing everything possible to maximize favorable patient outcomes.
   
   
3. Maintain lines of communication. Co-management requires strong communication, so it’s vital that the primary care doctor of optometry and surgeon are on the same page from the start about how this partnership is to be approached. Put expectations on the table, and that includes the frequency and form of communication regarding the patient. Use written documentation of pre-op requirements, medications, post-op visit schedules and conditions under which the surgeon would need to see the patient to avoid a breakdown in communication.

Keep reading about successful co-management tips and strategies in AOA Focus.