I’ve had one eye corrected with PRK with excellent results and am now
about to have the second eye done. My MD has suggested that I may want
the second eye to be mildly undercorrected because it may delay my need
for reading glasses later on.
Before I decide, I would apreciate any comments on the advisability of
this.
Most optometrists get fees of up to $1700 for referring a patient to an
opthamologist for laser eye surgery. Ostensibly they are sharing in the
pre and post-op care of the patient, but obviously the laser eye centers
are desperate for patients. Does anyone here think this is in any way an
improper practice? Fees for referrals are of course illegal.
Brad
In article <5li1rk$…@panix.com>, bst…@panix.com (Brad Stone) wrote:
> Most optometrists get fees of up to $1700 for referring a patient to an
> opthamologist for laser eye surgery. Ostensibly they are sharing in the
> pre and post-op care of the patient, but obviously the laser eye centers
> are desperate for patients. Does anyone here think this is in any way an
> improper practice? Fees for referrals are of course illegal.
> Brad
Any fees ODs receive for pre and post op care (comanagement) of refractive
surgery patients by law must be a reasonable reflection of the work done.
It is hard to justify the $1700 you quote, and it may well be illegal.
Cataract surgery has been "legitimized" regarding comanagement by Medicare
having a special code for this with billing. 20% of the surgical fee is
allocated to the postoperative care.
Most ethical refractive surgeons have adopted this 20% as a reasonable
refractive surgery comanagement fee. That is what I do; I reduce my
global fee by 20% (roughly $400 per eye) if the followup care is to be
done by an optometrist. It is up to the optometrist to collect this fee
from the patient, I do not pay the OD anything. And finally, ALL
patients are given the choice of whom they prefer to see for the followup,
me or their regular OD (if they have a good longstanding relationship with
their OD, they generally stick with the OD).
It is concerning to me when I see large corporate refractive surgery
outfits trying to "outbid" others by offering unjustifiably large
comanagement fees to ODs. Ultimately, quality of care will suffer, and
the patient may not be referred to the best surgeon, but simply to the
surgeon who reduces his or her fee the most to allow the OD to maximize
revenues. Unfortunate.
Moral of the story is, regardless of who your OD recommends, do your own
homework and check out the surgeon extremely carefully….
Gary M. Kawesch, MD
–
Gary M. Kawesch, MD
RK & Laser Eye Institute of California
http://www.2020eyesite.com
Brad Stone wrote:
> Most optometrists get fees of up to $1700 for referring a patient to an
> opthamologist for laser eye surgery. Ostensibly they are sharing in the
> pre and post-op care of the patient, but obviously the laser eye centers
> are desperate for patients. Does anyone here think this is in any way an
> improper practice? Fees for referrals are of course illegal.
> Brad
I’ve worked with optometrists for years and can tell you that no O.D.
receives such a fee. And, the fees are for co-management, which means
that the MD does the surgery and immediate followup, but the progress of
the eye after that is followed by the optometrist. The usual fee for
such co-management is about 20 percent of the total fee for the eye
surgery.
You are right that the laser centers are pretty desperate to get their
hands on patients. Several practice management articles have been
written in the past year or two which projected the costs of such a
center, and each writer found that the profit margins for laser centers
were extremely thin. In fact, the authors said that if the center
relied on advertising as the source of patients, it was practically
impossible for a profit to be made.
The positive side of this is that most optometrists today have taken
considerable course work in providing such monitoring and care and
probably check post-surgical progress more thoroughly than MDs because
they have more time per exam to do so.
Of course, if an O.D. takes a fee and does NOT provide the post surgical
care, the fee is probably a kickback (payment for a referral), which is
illegal in most parts of the world. I have found this situation to be
extremely rare.
Thomas Lecoq