Fee Splitting

The ability of an optometrist to co-manage surgical patients with a licensed physician or professional corporation as defined in the Ohio law has been enhanced by the adoption of this rule. The law now permits payment to an optometrist from a licensed physician or professional corporation when a global fee is paid to the surgeon or professional corporation. In this circumstance an optometrist may accept payment for post-operative services from the surgeon or professional corporation who received the original global fee. Post-operative fees should be commensurate with the professional care that is documented in the patient's record.

There has been no change in the law prohibiting acceptance of money or anything of value on the part of the optometrist for the act of referring a patient to any medical doctor or professional corporation. An optometrist cannot accept these type of payments.

When recommending that a patient consult a surgical specialist, the best visual or systemic outcome for the patient should be the foremost priority. The referral, by an optometrist, to a surgeon should not be contingent on the return of the patient for post-operative services.

When a co-management relationship exists between patient, optometrist and physician the following conditions must be met:

Co-management schedule, guidelines and visits will be determined by consultation between the surgeon and referring optometrist. The patient will be advised of the schedule of return visits and any guidelines to be followed.
The operating surgeon and co-managing optometrist should communicate during the post operative period to assure the best possible outcomes for the patient.
The optometrist cannot accept payment from the referral entity, either a licensed physician or a corporation, for the pre-surgical visits or consultations. This helps to assure the neutrality of the consultation and any subsequent referral recommendations.
The only exchange of value permitted between the optometrist and the surgeon would be payment for services actually performed. Payment must come from third-party payers, self-paid from the patient, or from a pre-existing agreement between the optometrist and physician that allows for break out fees for services provided when global compensation is involved. The optometrist must document sufficient information to describe the post-operative care rendered.

Arrangements must not be made that would circumvent these procedures. Such action would be a violation of Optometry Board Laws and Rules.

The purpose of this policy, which is merely a further interpretation of the rule, is to protect the public and to clarify the specific conditions when an optometrist may accept payment from a surgeon or a professional corporation. It provides benefit to the patient in that it allows easier access to post-operative care in many cases. It in no way prohibits or restricts the providing of post operative care by either the optometrist or the surgeon that would be considered in the best interest of the individual patient.