Co-management helps in the continuity of care for patients, improves communication between the surgeon and O.D. and positively differentiates practices from others. Implementing the right related processes can protect patients and optometrists.

Here, I provide tips on how to accomplish this:

1 UNDERSTAND/FOLLOW LAWS

Co-management arrangements can trigger the Stark Law, which prohibits physicians from referring a patient for “designated healthcare services” with which the physician has a financial relationship. This statute, also known as the Physician Self-Referral Law, is based on strict liability, meaning the mere presence of a relationship is enough to violate the statute even if there is no intent to defraud.

Also, co-management arrangements can activate the Anti-Kickback Statute (AKS). AKS prohibits the offer, solicitation or receipt of “remuneration” to induce or reward patient referrals that involve any item or service payable by the Federal health care programs. Remuneration is defined as anything of value. Unlike the Stark Law, the AKS requires the intent to induce referrals. However, even if only one purpose of the arrangement is to induce referrals, it violates the statute. (See oig.hhs.gov/compliance/physician-education/01laws.asp for additional information on Stark and AKS.)

States can have their own laws regarding patient-informed consent and transfer of care that may be stricter than the federal law. As a result, it is also prudent for an O.D. in a co-management arrangement to make sure she is following both the state and federal guidelines. To acquire state guidelines, O.D.s could reach out to their respective state optometric associations.

2 HAVE A PROCESS/PROCEDURES DOCUMENT

This document should include all forms the patient needs to sign, the process for following the patient after surgery and how and when the office staff will send follow-up reports to the surgeon.

This process should be communicated to staff and reviewed regularly to ensure it is current and being followed. In addition, O.D.s should keep a running log of all patients referred out of the office and being co-managed.

3 PROVIDE PATIENT EDUCATION

Optometrists should educate their patients on the co-management, and document the education. For co-management that may not involve surgery (e.g. glaucoma or diabetic patients), the form should include the physician’s name, reason for the co-management, the scheduled appointment time with the other physician and with the O.D.’s office.

Co-management of the surgical patient requires the patient’s written, informed consent to the co-management. This consent should be signed by the patient and scanned into his chart. A copy of the consent should be kept by the surgeon and the O.D.

4 HAVE A TRANSFER OF CARE AGREEMENT

O.D.s must also have a transfer of care agreement from the surgeon. CMS requires the transfer of care document contain: (1) the patient’s name; (2) operative eye; (3) nature of the operation; (4) date of the surgery; (5) clinical findings; (6) discharge instructions and (7) the transfer date.

WELL WORTH IT

Opportunities and demand for co-management relationships will continue to grow. As the demand increases, this will provide an opportunity that is good for the patient and for the practice. The requirements may seem overwhelming. A little research, preparation and training on the front end will help your practice grow and provide comprehensive care for your patients. OM

DR. GILBERT-SPEAR is the founder and director of The Visual Performance Center and is a consultant and speaker with various eye care companies. She recently obtained her juris doctorate degree from the Mitchell Hamline School of Law, with a concentration in Health Law and Compliance.