Collaborative care models – optometrists and ophthalmologists working together on patient care – are emerging as a way to reduce some of the strain caused by growing patient volume. This could also be the tonic for declining reimbursements and a boon for premium intraocular lens options.
Looking at some of the numbers – 76 million baby boomers needing cataract surgery but only about 431 new ophthalmologists joining the ranks each year – shows collaborative care is the prevailing paradigm for meeting that need. Here’s how some leaders in optometry and ophthalmology imagine this care model.
No Longer an Option
To William Wiley, MD, of the Cleveland Eye Clinic, collaborative care is no longer an option. “In the past, I think it was sort of an option and maybe a unique business model that certain practices were using,” he said. “But going forward I think it truly is key.”
The collaborative care model can consist of optometrists and ophthalmologists co-managing patients either within the walls of the same practice or across separate practices, but Dr. Wiley said the traditional model of an ophthalmologist seeing the patient for every preoperative visit or for primary care for years and then doing cataract surgery won’t save the patient base. Optometry and ophthalmology have to work together to serve patients, he said.
Most of the patients William Trattler, MD, sees who come in for cataract surgery aren’t quite ready for it. He may inform some of these patients that they have a form of pathology – for example, dry eye disease or meibomian gland dysfunction – and that those conditions will need to be treated before the cataract surgery.
Dr. Trattler, director of cornea at the Center For Excellence In Eyecare in Miami, pointed out that he agrees with Dr. Wiley: “I think collaborative care, working together as a team, is the key for being successful.”
No Longer Outliers
Thomas Chester, OD, clinical director at Cleveland Eye Clinic, said he is heartened to hear these opinions from progressive ophthalmologists. Progressive optometrists have been saying this for years, he said.
“Twenty years ago it was that the progressive OD/MD practices were outliers,” he said. “But now I think out of necessity, in order to provide good patient care, we’re going to have to do that.”
A specific area where ODs and MDs can collaborate is on patient education, particularly when it comes to premium intraocular lens (IOL) options. That could help make up for drops in reimbursements, which have declined 15%, said Paul Karpecki, OD, of the UPike College of Optometry/Kentucky Eye Institute.
The opportunity exists. He noted that as premium IOLs have continued to advance, their market share hasn’t; only 6% to 8% of patients look at some of the premium technologies. This isn’t a financial decision. Dr. Karpecki cited a study that showed 24% of patients have the disposable income needed to choose premium IOLs. “Is that just a lack of education in optometry, on these premium IOLs? Is it fear?” he asked. “What could we do in terms of education?”
Overcoming the Cost Issue
Dr. Chester pointed out that for years great effort was put into educating optometrists about co-management of refractive cases, but that not much attention has been paid to educating patients about refractive and cataract options.
But he also brought up a second point. “There is a cost issue,” he said, “but I think it’s not necessarily the patient; it may be the provider. I think we look at it as the cost of a procedure, as opposed to a perceived value, a lifestyle change. I think perceived value is something that we need to address, instead of thinking of it purely from a cost standpoint.”
Added Elise Kramer, OD, of the Miami Contact Lens Institute: “I think we’re afraid to talk about money with our patients, and I think that’s our non-entrepreneur side, our more medical side.” But patients are probably willing to pay, she said. “It’s a onetime surgery; it’s their eyes.”
That education should start in the optometrist’s office, said Dr. Kramer. That’s often where the cataract is first detected, leading to the referral for surgery. “If we tell them this is the highest technology available, the best out there, then they walk into their ophthalmologist’s office with that already in mind,” she said.
How optometrists and ophthalmologists think about collaborative care also needs to change, added Dr. Chester. “I think the big fear is that it’s a pay for referral,” he said. “But I think what we really need to look at is the provider that’s performing the service is being paid for that service. So if there’s perioperative care on the front end, whether it’s managing the ocular surface, postoperatively fine tuning the contact lens refraction, etc., then that provider is being compensated for their time.”
Necessity for that collaboration is going to come from the financial side, Dr. Chester stated, “because they’re being paid for the work that they’re doing.”
These comments were provided by the speakers during a panel discussion at OIS@SECO 2020 in Atlanta.