Significant policy change in post-op co-management

An updated ophthalmology position paper finds postoperative, co-managed care an "appropriate" course of action in a substantial policy shift likely reflecting optometry's effectiveness in delivering this quality service.

The joint position paper from the American Academy of Ophthalmology (AAO) and American Society of Cataract and Refractive Surgery (ASCRS), released Sept. 9, 2015, revises original guidance issued in 2000 to reflect a standards-driven approach that emphasizes patient choice in the decision to co-manage or transfer postsurgical ophthalmic care to "non-operating practitioners," consistent with their scope of practice.

The guidance encourages ophthalmologists exercise "professional judgement" when deciding on co-management or transfer of care, as well as:

• Acknowledges that co-management can be appropriate and serve legitimate patient interests.
• Lists clinical categories that justify co-management, including barriers to patient travel, unavailability of operating .ophthalmologist and patient prerogatives.
• Lists criteria for co-management or transfer of care arrangements.
• Eliminates most references to legal and ethical perils.

Christopher J. Quinn, O.D., AOA vice president, says these revisions are a complete reversal from the previous AAO/ASCRS guidance, and likely stem from the cooperative, co-managed care already provided by doctors of optometry and ophthalmology, stretching back for years.

"This is a very positive acknowledgement of what has become standard practice," Dr. Quinn says. "It's a reflection of the many years of successful patient care and good work that our members provide."

Momentous reversal of long-held policy

Although co-management of postoperative patients is often preferred today—especially when the doctor of optometry was the primary care provider to identify and refer the patient for surgical care—the subject has been hotly debated for several decades.

The federal government has long recognized the role of doctors of optometry in co-managing patients with ophthalmic surgeons, dating back to 1980 when Congress amended the Medicare statute to allow payment to doctors of optometry for postoperative care. But even the AAO/ASCRS guidance issued in 2000 emphasized ethical concerns for co-management, concluding such situations should be an exceptional occurrence, and prompting the Federal Trade Commission to proclaim that "serious antitrust concerns would, of course, be raised by an ethical rule" should doctors of optometry be prevented "from providing services they are legally and professionally qualified to provide."

The AOA believes that referrals for specialty services should be based on achieving the best possible outcome for the patient. All health care professionals have an ethical obligation to patients to ensure that medical and surgical conditions are appropriately evaluated and treated.

"This is something that we've been working toward for many years, and something that will serve patients very well going forward," Dr. Quinn says.