Ultimately, the referral of an ophthalmologist to a surgeon (and vice versa) should not depend on the patient`s return to post-operative care or economic reflection, but on what is best for the patient. Although there are no final decisions yet declaring co-management illegal, practitioners involved in co-management take a regulatory risk, unless such co-management is consistent with the patient`s convenience, as defined by the patient, even if the fees paid at the co-manager`s transfer source are commensurable to the patient`s services. The AAO and ASCRS also believe that the patient should approve in writing all pre-approved postoperative management plans, and the consent form for the ASCRS model is available at www.ASCRS.org/advocacy/comanagmentconsent2.doc. These guidelines are intended solely for information purposes and are intended to provide practitioners with voluntary and unenforceable co-management policies. Practitioners should apply their personal and professional judgment when interpreting these guidelines and applying them to the particular circumstances of their individual practical regulations. This document is not intended for legal assistance and should not be used as such. Practitioners are encouraged to consult an experienced health lawyer when they have questions about the adequacy of their co-management agreements under existing laws and regulations. Health care providers considering a co-management agreement should review existing professional guidelines and legislation before entering into such agreements. 1. The final decision on co-management must be made by the patient, subject to the agreement of the operator so that it does not compromise the best medical interest of the patient. If the patient chooses postoperative management by an ophthalmologist other than surgeons, the patient must sign a statement confirming this decision. With respect to the proposed financial relationship, it is essential to decide to comply with Medicare rules for Medicare patients. Medicare imposes strict requirements regarding the value of co-management services that can charge for the services provided and the amount to be paid for each service.
There is virtually no other way. However, with respect to referral services, the proposal raises several questions. If the ophthalmologist recovers the full costs and pays the ophthalmologist for co-management services, this could raise questions as part of the government`s royalty-sharing prohibitions. But, more importantly, as suggested, it appears that the patient does not have a basis for knowing the amount paid to ophthalmoptic for postoperative care. While it is always preferable to have the optometrist bill for the services of the ophthalmologist and the ophthalmologist`s bill for the services of the ophthalmologist, the patient must, when a decision is made to charge a total fee, receive a broken statement reflecting the payment to each provider, i.e. the ophthalmologist and the ophthalmologist. If a fee on facilities is included in this payment, this section should also be delineated.