Article Date: 1/1/2005

Maximizing Your Involvement in Comanagement
Know your licensure boundaries when it comes to co-managing cataract surgery patients.
BY RICHARD S. KATTOUF, O.D., D.O.S., Warren, Ohio

For the past 20 plus years, I've had the great pleasure and opportunity to personally consult with more than one thousand optometrists and ophthalmologists. This experience has provided me with a unique glimpse of the inner workings of my clients' offices. And from surveying the optometrists for whom I've consulted, I've learned that only one in five use their therapeutic prescribing agents (TPA) licensure to its maximum.


In evaluating your state's TPA law, you should know what ocular and systemic drugs the TPA law approves. If your state permits optometrists to prescribe ocular antibiotics, steroids, non-steroidal anti-inflammatory drugs and glaucoma medication, then you're armed with agents that allow you to perform one-day postoperative care. Don't settle for less.

Know your role

After all, whose patient is it? You're the primary carrier who has diagnosed mature cataracts. This is your patient. Therefore, you (the optometrist) must plot the course of pre- and postoperative care -- not the ophthalmologist! A major problem with optometrists is their passive nature. To prove my point, following are the most common responses I hear when I consult with an optometrist who doesn't maximize his licensure:

Medicare classified optometrists as physicians in the mid-1980s. Here we are in 2005, and most optometrists are continuing to play the subservient role to the ophthalmologist.

Leverage the power

As an optometrist, you must understand that you have the power of referral. The ophthalmologist needs your referrals more than ever because of the rise in the number of surgery centers that house all the medical eyecare specialists. These centers develop networks of optometrists to refer directly to their centers. This leaves your local ophthalmologist feeling the strain of competition for the surgical patient.

Don't leave yourself out

Following is a list of must do procedures for optometrists involved in the comanagement of cataract patients, if your state allows:

A-Scan. Optometrists rarely perform this preoperative diagnostic procedure their offices. All cataract referrals must have this vital reading to calculate the power of the intraocular lens. The optometrist or his staff can perform this in all 50 states. Ophthalmologists almost always delegate this procedure to a highly skilled technician. The instrument isn't expensive and the medical reimbursements are terrific. Here are some quotes I hear from optometrists:

► "What if the ophthalmologist won't accept my findings?" This is your patient and your date of service is before the ophthalmologist. If the ophthalmologist wants his own findings, he won't get reimbursed.

► "What if my A-Scan is a different brand than the ophthalmologist?" Evaluate the two instruments to determine if the final outcome is the same.

One-day postoperative examination plus the entire 90-day postoperative period. Why?

► The optometrist's name must appear on all prescribed drugs, not the ophthalmologist's. When the optometrist writes medical prescriptions, patients perceive him as a real doctor.

► Medicare has an allowable amount of payment (approximately $250) for postoperative care. The optometrist should perform all of the care and reap the financial benefits.

The optometrist who allows the surgeon to dictate the care usually gets the patient returned in three weeks for a refraction. Is it any wonder why the patient perceives you as their "glasses doctor"?

Your bargaining chips

Our profession has succeeded in passing diagnostic prescribing agents (DPA) and TPA legislation in all 50 states. Granted, not all of the laws are the same, but in the majority of states, optometrists do have the drug regimen to perform one-day postoperative examinations.

From the ophthalmologist's perspective, the choice is simple. If the optometrist makes the demands that I've outlined, then the ophthalmologist can choose to cooperate and receive the surgical referrals or he can choose to lose referrals. The ophthalmologist needs you more than ever.

Take charge

Optometrists who request consulting services many times complain of low net income. It's the concentration of these types of fee-for-service procedures described in this article that will raise your net income. Many of my clients have followed my instructions and have experienced an improvement in their professional image as a real doctor, in addition to noticing a significant increase in net income.

I challenge you and your colleagues throughout the country to take charge of your patients' care. Stop allowing other professionals to dictate services and procedures that are within your licensure.

Dr. Kattouf is president and founder of two management and consulting companies. For information, call (800) 745-eyes or e-mail him at




Optometric Management, Issue: January 2005