Co-management, in the context of laser vision correction,
is a term used to describe a relationship between a surgeon and a non-surgeon. Typically,
the non-surgeon sends the patient to a surgeon who performs the laser procedure. The
patient then returns to the care of the non-surgeon for continued care. Sometimes the
referral back to the non-surgeon is after the postoperative care has been completed. Other
times the postoperative care is performed totally by the non-surgeon.
Most commonly, the non-surgeon is an OPTOMETRIST, an eye doctor not licensed to
perform surgery in most states. OPHTHALMOLOGISTS not trained in laser vision
correction can also function as the non-surgeon in a laser vision correction co-management
arrangement.
Surgeons performing Laser Vision Correction via LASIK are OPHTHALMOLOGISTS, MDs or
DOs who have completed specialized training.
Co-management almost always involves a FEE-
SPLITTING arrangement. The surgeon either gives part
of his fee to the non-surgeon, or in the case of some corporate laser centers, both the
surgeon and non-surgeon are paid by the laser center. The fee split is supposed to be
based upon the amount of work done by each individual. The problem is that the non-surgeon
often has to do little or nothing to get his split.
Thus the term ECONOMIC CO-MANAGEMENT has been coined. This refers to the payment for the referral of
the patient with little or no further obligation by the referring doctor.
FEE-SPLITTING
HAS LONG BEEN CONSIDERED AN UNETHICAL PRACTICE IN MEDICINE.
While co-management is not an illegal practice, fee-splitting is illegal in certain circumstances. For example,
it is a violation of MEDICARE'S fraud and abuse policies for a provider to pay another
provider, either directly or indirectly, for the referral of a Medicare patient.
See Related Articles on the
Legality of Co-Management and Fee-Splitting
Since most laser vision correction patients are not Medicare age, and since there is
presently not many third parties paying for these procedures, fee-splitting is not illegal. That is
not to say that it is ethical. The splitting of fees introduces a conflict of interest between
the referring doctor and his/her patient.
The American Medical Association and the American Academy of Ophthalmology are in the
process of introducing guidelines against co-management of patients, unless it is in the
patients best interest. You see, there is no good reason why a patient who has had LASIK
or PRK should receive his or her preop examination and postop care from anyone other than
his or her surgeon. This is particularly true when the surgeon is readily accessible to
the potential patient. It does not make sense, unless you see the real reason behind
co-management arrangements.....FEE- SPLITTING.
FEE-SPLITTING
IS NO MORE THAN AN INDIRECT (OR SOMETIMES DIRECT) PAYMENT FOR A PATIENT REFERRAL.
See Related Article:
See legal opinion as to Standards of Post-operative care as
it Related to Co-management
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EVER WONDER
WHY OPTOMETRISTS ADVERTISE LASIK?
OPTOMETRISTS ARE NOT LICENSED TO PERFORM LASIK SURGERY. SO WHY DO
THEY SEEK OUT PATIENTS WANTING LASIK SURGERY?
THE ANSWER:
Optometrists advertise because LASIK patients are a valuable commodity ($$$). Co-management arrangements with LASIK
surgeons have become a significant source of revenue to optometrists. Frequently there
maybe little in the way of preoperative or postoperative work for the optometrist to
perform.
In order to be fair, we must point out that
some ophthalmologists who do not perform laser vision correction also refer
patients for $$$, the same as optometrists!
Unfortunately, patients are often referred to the surgeon who will pay the highest
co-management fees.
PATIENTS ARE BEING SOLD TO THE HIGHEST BIDDER!
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It is becoming all to common that optometrists are taking their
patients to laser centers run by large public corporations.
The surgery is being performed by surgeons who have never seen the patient before and will
likely never see the patient again. The surgeon (AND PATIENT!) relies on the optometrist
to do the correct preoperative evaluation and postoperative care.
THE PROBLEM: OFTEN THE SURGEON DOESN'T EVEN LIVE IN THE CITY WHERE HE PERFORMS THE
SURGERY!
Who is going to take care of you in the event of a problem when your surgeon lives
hundreds of miles away? The local surgeon, whom you bypassed to have your surgery, is
certainly NOT going to care for you in this scenario.
WOULD YOU EVER CONSIDER HAVING
YOUR GALL BLADDER REMOVED OR YOUR HERNIA REPAIRED BY SOMEONE WHO FLIES INTO YOUR HOSPITAL
ONCE A WEEK?
Obviously, for someone living in a remote setting, this might be necessary. In the case of
laser vision correction, we are usually talking about areas served by local doctors
trained to perform the surgery.
REMEMBER: PUBLIC
CORPORATIONS ARE FIRST RESPONSIBLE TO PROVIDE PROFITS TO THEIR SHAREHOLDERS.
See Related Article on
the Coprorate practice of Refractive Surgery |
NEWS
FLASH! 
