What Does Co-Managed Care Mean?
In LASIK, “co-management” is the term commonly used to describe a situation when an optometrist provides pre-op and post-op care with an ophthalmologist providing surgery. For example, an optometrist will provide the initial LASIK, All-Laser Lasik, PRK, LASEK or any other refractive surgery evaluation, and then care for the patient after the surgery. The ophthalmologist will merely provide the surgical component. In other words, you won’t be seeing the doctor before or after the surgery.

Proponents of co-management argue that it provides a check and balance between the patient and the surgeon with an optometrist assessing the patient’s questions and concerns. But what patients should understand is that co-management is not about care. It is about economics. It’s mostly about the money. Though they cannot legally perform surgery, optometrists are teaming up with ophthalmologists who can do those surgeries by referring patients for the procedure. Then, they handle the patients’ post-operative and sometimes pre-operative care in exchange for a cut of the fee.

Ophthalmologist or Optometrist: What’s the Difference?
Many people may not realize who they are going to see when they go visit the “eye doctor.” The big difference is that one (ophthalmologist) is a medical doctor whereas the other (optometrist) is not. An ophthalmologist is a medical doctor or surgeon who deals with the structure, function and diseases of the eye. An optometrist is a specialist in the measurement of the range, and power of vision, and in the prescribing of corrective lenses. Once again, an optometrist is NOT a medical doctor.

Who Benefits from Co-Managed Care?
Co-management is still a very controversial area of LASIK. That’s because there are serious ethical issues involved here. The most important issue is that optometrists may in fact be performing the role of a physician – a role they are not qualified to perform. Also, co-management can be hard to distinguish from the illegal practice of “fee splitting.” Optometrists have a choice of ophthalmologist to whom they refer patients, and that decision can be influenced by whether the ophthalmologist is willing to co-manage patients. Overall, co-management is just another way for money to change hands.

One of the largest laser surgery centers in the country, TLC, admits that its co-managed care model may be illegal. In its Annual Report to Stockholders, filed with the United States Securities and Exchange Commission, it states:

Many states prohibit a physician from sharing or “splitting” fees with persons or entities not authorized to practice medicine. The Company’s co-management model for refractive procedures presumes that a patient will make a single global payment to the laser center, which is a management entity acting on behalf of the ophthalmologist and optometrist to collect fees on their behalf. In turn, the ophthalmologist and optometrist pay facility and management fees to the laser center out of the patient fees collected. While the Company believes that these arrangements do not violate any of the prohibitions in any material respects, one or more states may interpret this structure as non-compliant with the state fee-splitting prohibition, thereby requiring the Company to change its procedures in connection with billing and collecting for services. Violation of state fee-splitting prohibitions may subject the ophthalmologists and optometrists to sanctions, and may result in the Company incurring legal fees, as well as being subjected to fines or other costs, and this could have a material adverse effect on the Company’s business, financial condition and operations.

Co-management arrangements can also promote an “assembly line” mentality when it comes to LASIK procedures. By scheduling multiple procedures in the same day, these business models can maximize profits, but at what cost to the patients? It goes without saying that physicians who perform so many procedures in one day can suffer from fatigue, which can result in lack of focus or attention to detail during these complicated procedures, the end result being a botched surgery.

It is up to each patient to decide what type of care he or she wants to receive. However, remember that in LASIK, pre-operative screenings are very important. It could make the difference between you having perfect or near-perfect vision or losing your vision altogether. That may sound dramatic, but it is certainly not exaggerated. LASIK is not for everyone; a medical doctor – and not a technician must make the decision.

If you or a loved one has suffered devastating consequence or loss of vision as a result of co-managed care, please contact the Law Office of Todd J. Krouner, P.C. to find out more information about your legal rights and options. Call us today at (914) 238-5800 or email info@krounerlaw.com to schedule your free consultation and claim evaluation.