Ophthalmology practices strive to provide an exceptional patient experience, from the patient’s initial encounter with the website or call to the office, to their time in the waiting room, and throughout the procedure and aftercare. This particularly holds true for patients electing premium procedures like LASIK or SMILE, or premium IOL cataract surgery. Unfortunately, the payment experience for premium procedures can be confusing to patients, an administrative burden for providers, and abjectly frustrating for both. Since payment often is the patient’s last experience with the ophthalmology practice, the effect can be deleterious to the goodwill established up to that point.

MULTIPLE PAYMENT EVENTS

Let’s take a premium IOL cataract procedure as an example. The patient may have as many as five payments related solely to the premium component of the procedure: A payment for the 1st eye at the surgeon’s office and one for that eye at the ASC. A week later, the patient pays for the 2nd eye at the surgeon’s office and again for that eye at the ASC. If they are co-managed and an external optometrist is providing the postoperative care starting at, say, Week 1 after the second eye, they are confronted with another payment at the post-op visit. Along the way there are co-pays and likely a bill for an insurance deductible. Aside from the co-pays, all of these are high-dollar payments. Regardless of how didactically the cost and payment requirements are explained to patients, they can forget or be confused. In the throes of learning about and preparing for surgery, it is understandable that patients might not “lock in” on what’s expected with respect to payment. But the experience can become off-putting: “Another payment?” or “I thought I paid for my surgery already?” These can be uncomfortable collections moments for the staff and administration at each point along the way. As I’ve heard countless times from optometrists, by the time they reach the OD’s office, they’re frustrated.

COMPLIANCE CONSIDERATIONS

To obviate this experience, some surgical practices have collected a single payment from the patient and remitted the amount owed to the ASC and co-managing optometrist. Most ophthalmology practices now understand, however, that this creates compliance issues around how healthcare payments should be made, especially given the referral relationships between the providers. Even though the surgical practice may be looking to provide a convenience to patients and surgical partners, and there may not be any untoward motives, the optics are bad. A foundational pillar of compliance: Doctors should avoid writing checks to referring providers. The patient needs to pay each party for their respective services, a concept sometimes referred to as payment separation. Yet how to make this happen in a streamlined, convenient, and compliant way has been a long-standing challenge. One option is to have the patient pay each party in their offices as they go along, which leads to the frustrating and confusing scenario described earlier. A better option exists: Eye care providers can implement a unique software platform designed specifically for ophthalmology that allows each provider to charge the patient separately, but at one convenient moment in time for the patient. With this tool, administrators can help patients avoid that suboptimal payment experience and also reduce the administrative burden associated with multiple collection events.

KEEPING TRACK OF FEES CHARGED

Another pillar of proper co-management and compliant handling of payments is that the surgeon should not be setting the optometrist’s fee for postoperative services — just like the surgeon doesn’t set the ASC’s fee for a premium lens or the use of the femtosecond laser. In the past, surgeons may have dictated the co-management fee they were willing to pay. To ensure compliance, however, each provider should establish their own fair market value rates for their premium services. Administrators at the surgical practice must be privy to what the ASCs and optometrists charge for their services so that they can be transparent with patients about the cost of their procedure. It is worth noting that for practices working with several optometrists and multiple ASCs, managing the price lists can be unruly and chaotic for the surgical coordinator. The same software tool that streamlines the payment process for all parties involved can also track and organize the various fee schedules of all providers, freeing up valuable resources that are better utilized attending to other tasks. In addition, it is our experience that the vast majority of ophthalmology practices still collecting one sum and remitting payments to the different parties, are not deducting any card processing fees. This in itself creates another compliance concern because the practice incurring those fees is providing something of value to the other parties, whether it be to the optometrist or the ASC. This is even more pronounced when procedures are financed, given the increased costs associated with patient financing — an additional point of risk practice administrators should consider.

ELIMINATE THE STRESSES

Patients are not thrown by the fact that there are multiple providers that are going to bill them when undergoing a surgical procedure — that, after all, is the American healthcare consumer experience. What does not make sense to them, however, is why they can book a flight, a hotel, and rental car from three different companies all at once but cannot make separate payments to various providers in the same fashion when all of the costs associated with the premium procedure are known upfront. By using multiprovider payment software, ophthalmology practices can eliminate the stresses caused by this long-standing pain point that negatively affects their patients’ experiences, while at the same time bringing the patient payment experience in line with the modern consumers’ expectations.