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Soapbox

10905 – Why don’t we work together?

27/03/2018
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As optometrists we have a duty to our patients to provide the highest quality of primary eyecare possible. That’s why when visual conditions are outside where we feel comfortable practicing, we understand and utilise referrals to GPs and ophthalmologists.

But, rarely do we consider referrals to colleagues who have different skill sets to ours as there tends to be confusion over how, where and importantly, to whom do we refer on. That’s despite the fact that there is a Medicare Item Number – 10905 – specifically dedicated to this practice, which in theory should help streamline the process.

Last financial year only 9,694 10905 Medicare Item Numbers were recorded. Yet, there were a total of 5,173,247 consultations of professional attendance of more than 15 minutes duration.

Simple arithmetic reveals that referrals between optometrists only represent 0.19% of all consultations. This presents the most underutilised Medicare Item Number in this category. By far.

Why?

A possible explanation is that it’s a result of the optometric balancing act between the commercial and health elements, and therefore of no surprise that some clinicians feel pressured to retain their patients rather than refer on.

However, this raises the issue of principle. There are many optometrists who are more experienced in certain fields, and therefore is it not more ideal to refer on? Patients appreciate the extra care and effort that goes into a referral.

"Referrals between optometrists only represent 0.19% of all consultations. This presents the most underutilised medicare item number in this category. By far."

I am yet to come across a patient who hasn’t been happy when I referred to another optometrist. I simply tell them “there is someone who knows a lot more about this than me, and I’m going to refer you for their opinion and assessment” – it’s blunt, but honest, and if the patient ultimately benefits, then we do too; as a profession, and as practitioners.

Like with almost everything, we are stronger when we work together. That means the optometrist receiving the referral also has an important role to play for the system to really work as it should.

For example, although optional, optometrists receiving the referral should strongly consider writing a report back to the referring optometrist. Points to consider include findings, management, review period and when the patient should return back to the referring optometrist.

As I alluded to earlier, optometrists often feel pressured to retain their patients, and such reports may encourage optometrists to appreciate the benefits in referring to colleagues rather than viewing it as a threat to business.

GLAUKOS
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Personally, I make it clear to these patients that I will happily address their reason for referral (e.g. foreign body, behavioural optometry, specialty contact lenses) but their primary eyecare provider is the referring optometrist. Therefore goods not pertaining to the referral, for example glasses, should be purchased from the referring optometrist.

Put simply, the 10905 item exists to enable a smooth billing pathway for referrals between optometrists, intended for consultations that are at least 15 minutes in duration.

We as a profession should take advantage of this as it means we can quite easily refer to optometrists who may have different interests, equipment or even greater confidence when dealing with certain ocular conditions – and vice-versa – while still maintaining, if not enhancing, the relationship with our patients.

In saying this, the referrals process between optometrists should be streamlined. When referring our patients on to GPs and ophthalmologists we often take the time out to construct a well-formed letter – and a similar level of care should be put into Item 10905.

Clearly the item number is still very much underutilised. But, as it exists to provide a streamlined pathway that ultimately may benefit patients and the profession alike, why not consider referring to another optometrist next time, especially to optometrists who may have special interests? It could be behavioural optometry, ortho-keratology, myopia control or even low vision – just to name a few.

GPs and ophthalmologists have such a wealth of knowledge, in no way am I trying to undermine them – I’m simply asking you to consider your colleagues as well!


Name: Rose Huang
Qualifications: Bachelor of Optometry and Vision Science (Hons, UNSW)
Organisation: Malinda Halley Optometry
Position: Optometrist
Location: Dapto
Years in the profession: Three

 

George & Matilda Eyecare
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