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Comanagement
is the term used to describe situations
where someone other than the surgeon
provides the preop and postoperative care.
Usually, this other provider is an optometrist,
but it can be an ophthalmologist. The comanaging
provider will receive a portion of the global
surgical fee for providing these services.
Comanagement is a very controversial practice,
since money is changing hands-arguments
are frequently made that optometrists refer
not to the best surgeon, but to the highest
bidder-a situation which is not only unethical
but also illegal.
Comanagement has its place, but patients
need to understand several things. First,
the patient must be given the option
of seeing whomever they want for the pre
and postop care-they must not be forced
to have aftercare at a clinic other than
the clinic they had surgery with. Unfortunately,
this is rarely done since a patient who
chooses the aftercare with the surgeon will
cause the referring practitioner to not
receive any money. Also, comanaging doctors
need to be upfront about what fees they
receive from the surgeon for doing this
work.
An optometrist who steers a patient strongly
toward a certain surgeon may be letting
financial gain cloud his or her judgment.
A prudent patient would do their own research
to find out who the "best" surgeons
and clinics are.
Comanagement works best when the surgeon
is located far from the patient, and it
would be inconvenient for the postop visits
to be done in the surgeon's office.
How
Surgeons manage Comanagement
Survey
of Surgeons on the issue of Comanagement
Physicians
and Legal experts discuss Comanagement
Information
from the American Academy of Ophthalmology
on comanagement
Article
from the Sacramento Bee, 4-29-2000, on comanagement
Opinion
article on comanagement from EyeNet Magazine
Position
Paper on Comanagement from the American
Society of Cataract and Refractive Surgery
and the American Academy of Ophthalmology
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