In modern healthcare, co-management of patients after surgery is becoming more common. In this approach, two or more doctors share responsibilities for a patient’s post-operative care. One doctor performs the surgery, while another assists with follow-up visits, medication adjustments, and recovery monitoring. This article explains how co-managing doctors are compensated for their role in post-op care, with simple examples to help readers understand.
What is Co-Management in Post-Operative Care?
Co-management happens when different doctors work together to provide patient care. In surgery, a surgeon may handle the operation, but a different doctor, often a primary care physician or specialist, takes over the patient’s post-surgery recovery. This teamwork is especially beneficial for patients who need extended follow-up or for patients living far from the surgical facility.
In a co-management setup, patients receive continuous care without having to frequently visit the surgeon. Doctors share the responsibility, which ensures that patients get comprehensive care without delays. The co-managing doctors coordinate and communicate frequently about the patient’s progress.
Why Do Doctors Co-Manage Patients?
Doctors may choose to co-manage for several reasons:
- Efficiency: Surgeons are often busy with surgeries. Co-management allows other doctors to handle follow-up, so the surgeon can focus on new cases.
- Expertise: Some aspects of post-op care, like pain management, may benefit from a specialist’s knowledge. An anesthesiologist or pain specialist may join the team.
- Accessibility: Patients who live far from the surgeon’s office can see a local doctor for follow-up, making it easier for them to access care.
How are Co-Managing Doctors Paid?
In a co-management model, doctors receive payment for their specific role in post-operative care. Payment methods can vary, but here are the main ways co-managing doctors might be compensated:
1. Fee-for-Service
In a fee-for-service model, doctors are paid for each follow-up visit or procedure. Each time a patient sees the co-managing doctor for a check-up or wound care, the doctor receives a set fee.
Example: Suppose a patient had knee surgery and needs to see a co-managing doctor twice a month. The co-managing doctor may charge $100 per visit, so they would earn $200 monthly for these follow-ups.
2. Global Surgical Payment Split
Some health systems use a “global surgical package.” This package covers all care from the day of surgery until a fixed recovery period, typically 90 days. When co-management is involved, the global payment is divided among the doctors.
Example: If the global fee is $3,000, and the co-managing doctor handles 30% of the care, they would receive $900. The surgeon would get the remaining $2,100 for their surgical and immediate post-op care.
3. Capitation Payment
In capitated payment, a doctor receives a set amount per patient per month, regardless of how many times they see the patient. This model is less common in post-op care but may be used in certain healthcare systems.
Example: A co-managing doctor might be paid $150 per month for each post-op patient they see, regardless of whether they see the patient once or multiple times.
4. Shared Savings Model
Some healthcare systems encourage cost-saving practices. In a shared savings model, co-managing doctors are rewarded if they help reduce overall patient costs. This could include fewer hospital readmissions or fewer complications.
Example: If the average post-op cost is $5,000 but a co-managing doctor’s approach reduces costs to $4,000, the doctor may receive a bonus of $500 for contributing to cost-saving.
Challenges in Payment for Co-Managing Doctors
Although co-management is beneficial, payment systems can be complex. There are challenges like:
- Billing Confusion: Deciding who bills for what service can be confusing, especially when both the surgeon and co-managing doctor see the patient. Clear billing guidelines help avoid duplication.
- Medicare and Insurance Rules: Many insurance companies, including Medicare, have specific rules. Sometimes, insurance only covers post-op care from the surgeon, making it hard for co-managing doctors to get paid.
- Payment Delays: Co-managing doctors may wait for payment due to processing delays, especially if payments are based on shared savings or performance.
Example Scenario: Co-Managed Cataract Surgery
To help understand how co-management works in real life, consider this example:
Patient Case: Sarah, a 67-year-old woman, had cataract surgery. She lives far from the city, where her surgeon is based. For follow-up care, Sarah sees a local ophthalmologist.
Co-Management Plan: Sarah’s local ophthalmologist handles her post-op check-ups, checks her vision, and monitors healing. The surgeon and ophthalmologist agree to a co-management arrangement.
Payment Method: They decide on a split of the global fee. The total fee for Sarah’s cataract surgery is $1,500, which includes post-op care. The ophthalmologist takes on 40% of post-op care, so they receive $600, while the surgeon keeps $900.
In this example, Sarah benefits from local follow-up, and both doctors are compensated fairly for their roles.
Benefits of Paying Co-Managing Doctors
Paying co-managing doctors fairly ensures high-quality patient care. When doctors know they will be compensated for their time and expertise, they are more likely to participate in co-management. Benefits include:
- Continuity of Care: Patients experience smoother transitions and don’t need to travel far for check-ups.
- Better Health Outcomes: With regular follow-ups, complications can be caught early. This improves recovery and reduces hospital readmission.
- Cost Savings: Co-management reduces healthcare costs by allowing follow-ups in a less intensive setting than a hospital.
Future of Co-Management Payments
The healthcare system is constantly evolving. Some believe that more standardized payments are needed to make co-management smoother. A clear framework could help doctors avoid disputes over fees and reduce administrative issues.
Insurance companies are also considering new payment models that will support co-management. For example, bundled payments or performance-based incentives are being discussed. These changes could encourage more doctors to co-manage without worrying about delayed or reduced payment.
Final Thoughts
Co-managing doctors play an essential role in post-operative care. They provide valuable support, especially for patients who need regular monitoring or live far from their surgeons. Payment for co-managing doctors should reflect their contribution to a patient’s recovery.
With transparent and fair payment structures, co-management can improve patient outcomes and make healthcare more accessible. In the future, as healthcare adapts to new models, co-managing doctors may see even more efficient ways to be compensated for their vital role in post-op care.
