Comanaging with ophthalmology: Building relationships that benefit patients and your practice

Comanaging with ophthalmology is invaluable and can be a rewarding experience for the optometrist, the ophthalmologist, and the patients by enhancing the care provided. As optometrists, we are often the first to evaluate and diagnose ocular pathology. Although much is within our scope to manage, the practice modality, state laws, indications for advanced management or surgery, and patient preferences will determine what we manage and what needs to be referred. Using the correct terminology and clear communication are key to a successful comanagement relationship.

The medical community easily interchanges referral and consultation, but their definitions are different, and correct usage is important in ensuring you are getting the type of care you request. A referral means you are sending your patient to another provider for care of a condition that is beyond your expertise or management capabilities until, if ever, that condition resolves. For example, if your patient has cataracts, is interested in surgery, and has indications for surgery, you refer them for a surgical cataract evaluation. A consultation, on the other hand, is more of a request for another provider’s opinion but does not result in that provider assuming care of the patient. For example, reviewing optical coherence tomography with another provider for their opinion without that provider assuming care of the patient is a consultation.

Prior to establishing comanagement care with an ophthalmologist, you should research practices and ophthalmologists in your area and talk with colleagues about their experiences with them. You need to decide whom you will refer to for an array of ocular conditions, such as eyelid lesions, eyelid anomalies, conjunctival disorders, corneal disease and disorders, cataracts, optic nerve disorders, retinal pathology, refractive surgery, and strabismic surgery. Because ophthalmologists typically don’t treat every condition and can have a subspecialty within their area of expertise, you need to know what conditions the ophthalmologist manages and their surgical and therapeutic approach and outcomes. You need to understand how the ophthalmologist’s management aligns with your professional management, as this can influence whom you establish a relationship with. Although knowing that allows you to better prepare your patients for what to expect, you can and should request time to meet the ophthalmologists and observe them in practice. You can request to observe their preoperative examinations, surgeries, and postoperative examinations, which will greatly enhance your understanding of the process and expected outcomes. Discuss the timeline of your referrals, how to best schedule patients, their philosophy on the costs of therapy, the office hours and days of operation, and whether a particular staff member can best assist your needs. Inquire about what methods (phone, fax, email, and/or text) are best for communicating routine cases, urgent cases, postoperative complications, and after-hours care for established and new patients. Discuss whether your examination notes, a formal letter, or a specific referral form with your examination data is preferred. When applicable, send your imaging, preferably in color; additional testing; and previous treatments with responses. State clear expectations of the care you need and when or whether the patient is to return to your care.

Although establishing communication for the ophthalmologist is important, you should also specify how you would like to receive information from the ophthalmologist. You should expect to receive timely communication for the care your patient receives. Both of you should respect one another and be able to properly communicate to provide the best care for your patient. At a minimum, you should receive a letter or copy of the examination notes of the initial evaluation, and if surgery was indicated, you should receive communication once the surgery is completed and, additionally, whether/when the patient is being released to your care.

In addition to communicating clearly with an ophthalmologist, you also need to clearly communicate with your patients. By knowing your referring ophthalmologists and their management outcomes, you can honestly provide recommendations to your patients. Whether you decide to refer a patient for additional care or your patient desires a second opinion, help them navigate the system, properly set expectations for them, and don’t overpromise therapy and results. Discuss whether transportation modifications are needed for such appointments. Although that may seem obvious to us, it could be a common concern with patients and could affect how they proceed. Except for an emergency retinal detachment, generally, no surgery will be done the same day as the initial evaluation with the ophthalmologist. Stating this will minimize frustration for the patient and ophthalmologist. For elective surgeries specifically, such as cataract surgery, if your patient does not want surgery, do not send them for a surgical evaluation. You are wasting time and resources by sending them for an evaluation that does not end in surgery. Your referring ophthalmologists will greatly appreciate the effort you have put forward to only send those who are interested in surgery. Lastly, specify to the patient when you want the patient to return to your care. In some situations, a patient may prefer to stay with the ophthalmologist, and although that is their right, a trend of patients not returning to you should trigger a conversation with the ophthalmologist and may justify ceasing your referral and comanagement relationship if it continues.

Aside from referring and resuming care with patients you have referred to an ophthalmologist, optometrists have an opportunity for practice growth. You should share your areas of expertise, interests, and hours of operation with ophthalmologists, who may send you patients in return. For example, if your office is open on a Saturday and a patient calls with an urgent concern for their ophthalmologist who is either closed or out of town, that ophthalmologist may request the patient see you in the interim. This enhances the care for the patient by allowing them to be promptly evaluated, boosts your revenue, and creates another comanagement relationship.

Comanaging with ophthalmology enhances patient care and can provide an opportunity for practice growth. Although establishing new relationships with ophthalmology can be time-consuming, it is necessary to enhance patient care. Good communication is key to efficient and thorough care.