Ophthalmologists & Optometrists: A Winning Formula to Manage Changes in Reimbursement

by Jessie Wilson / 28 April 2013 / No Comments

By Jessie Wilson, Director of Business Operations at Brighter Bay LLC

Private physician practices are increasingly caught between the rising costs of providing quality health care and decreasing reimbursements from Medicare and private insurers. One strategy that’s proven successful in combating both these challenges is practice integration. When physicians work hand in hand with ancillary professionals such as nurse practitioners and physicians’ assistants, they see both the quality of care they deliver and their own profits increase.

Integration promises particularly big rewards in the field of eye care, which is a volume-driven specialty. Right now, the average profit per case in surgical eye centers is relatively low. The limiting profit factors are the number of surgeries ophthalmologists can perform when they are dealing with so many other care-related responsibilities. Integrated ophthalmologist/optometrist practice models offer the ideal approach to
providing effective and efficient patient care.
female medical professional

Ophthalmologists and Optometrists: A Winning Formula

The optometric scope of practice varies from state to state. In many states, however, optometrists can diagnose and treat glaucoma, refractive errors and common diseases such as dry eye, as well as prescribe oral and topical medications. In contrast, an ophthalmologist’s scope of practice is much broader. Ophthalmologists typically will see many of the same types of cases that optometrists treat routinely. To a large extent, this overlap may not constitute the most efficient use of an ophthalmologist’s specialized training. When optometrists and ophthalmologists work together, ophthalmologists are able to spend more time in surgery and delivering other types of specialized care, and less time doing duplicative care.

Integrated Ophthalmologist/Optometrist Practice Models: How Do They Work?
Presently, integrated eye care practices use two models. In one, both an optometrist and an ophthalmologist see every patient who walks in the door. In the other, one professional — typically the optometrist — functions as the primary care physician. He or she is the first line of contact, and benefits from being able to refer the patient for secondary or tertiary care without having to go outside the practice.
The patient benefits as well from this arrangement. All patient records are in the same place, and the patients do not have to travel to an unfamiliar office to consult with a specialist. Any unusual problems patients are experiencing that may require surgery are far more likely to be treated. It’s much easier to perform quality assurance on different interventions that take place under the same roof.
Optometrists collaborate as equal partners with the specialists they work beside. Ophthalmologists can focus surgical procedures or other specialized interventions.

It seems likely that one consequence of the sweeping health care reforms of the last few years is that it is going to become more and more difficult for single practitioners to survive. Multi-practitioner practices that utilize an integrated practice model are best situated to be able to continue delivering high quality patient care in a time of constrained resources.

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