Kind-Hearted Optometrists Increase Medical Legal Exposure

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Have you ever had a patient no-show their scheduled diagnostic test? How about a scheduled follow up appointment for glaucoma, macular degeneration or diabetes? There are many reasons for missed appointments, including insurance plans that result in the patient having co-pays, co-insurance or high deductibles that lead to the patient weighing the cost/benefit of their medical care. In the examples above, the patient is considered non-compliant with the care plan the optometrist has provided.

Unfortunately, many optometrists have been influenced by years of patients asking if the test “is really necessary?” Being told, “I have a high deductible.” Or in the examples above, having patients just not show up. This “back and forth” with the patient has led to many optometrists serving as the patient’s insurance advisor, or worse yet, changing the patient’s care plan based on the patient’s insurance, or lack thereof. In cases where the optometrist feels as though they are doing the patient a favor by deviating from the clinical care guidelines, they are increasing their medical legal exposure.

Optometrists typically haven’t had as much exposure to Professional Negligence or Malpractice risks as other specialties, and due to the very personal relationship many ODs have with their patients, many times patients haven’t moved forward with lawsuits, even when the potential for one exists. In the past year, we have observed what appears to be a change in that area with more lawyers filing suits on behalf of patients for the following:

  1. Mis-diagnosis or missed diagnosis. Unfortunately, disease can present that can lead to substantial or total vision loss if not caught early. In these cases, the doctor has significant exposure in today’s lawsuit happy environment. An example of this would be a patient, fit into an already tight schedule, presenting with red eyes and complaining of pain due to his or her contacts. In this example, if the doctor provided a quick exam with no pressure check and treated based what the patient stated, he or she may miss potential neovascular glaucoma and significant risk to the patient’s vision.
  2. Standard of care. As noted above, deviating from clinical care guidelines due to the optometrist’s perceived patient insurance dilemma, or patient out-of-pocket costs, can lead to unnecessary medical legal exposure. We have seen examples of optometrists who deviate from clinical care guidelines when it comes to disease management for glaucoma, diabetes and macular degeneration, by stretching out appointments and testing to every 6 months or a year, when the guidelines call for treating that patient every 3-4 months. While this works out most of the time when the disease is slow moving, if something unfortunate does happen and vision quickly worsens or is lost, the kind-hearted optometrist is significantly exposed, should a patient/lawyer decide to move forward. Doctor’s charts, documentation and appointment/recall are requested to verify that the doctor followed the appropriate standard of care.

We have seen what appears to be an increase in law-suits move forward against optometrists in the situations presented above.

CS EYE is a Compliant Billing Solutions company that provides optometrists with compliance, credentialing, chart reviews, training and billing services.

References: 2018/2019 OIG Work Plan

Compliance Specialists, LLC, Audit Analysis, 2018