Article

Eye Care During the COVID-19 Pandemic

How optometrists are navigating uncharted waters

Beginning in March, it became clear that optometry was in uncharted waters. In addressing the COVID-19 pandemic, the AOA released patient care guidance (bit.ly/2XWuQ22 ), which included delaying all routine eye care visits. To discover how optometrists were guiding their practices during the crisis, in mid-March Optometric Management emailed several leading O.D.s from different areas of the country, asking: “What is working for you?” In their replies, this expert panel explained steps their practices are taking to cope with the pandemic:

ANDY GURWOOD, O.D., F.A.A.O.

Eye care is essential, so it’s reasonable for an individual eye care practitioner to stay open during the coronavirus pandemic. My private practice in Philadelphia area is open and we continue to see a trickle of emergency patients and those who need essential care, with the following precautions in place.

  • Screening patients based on their needs. This way, only the most important cases are seen, and high-risk individuals are not scheduled. That said, there are some patients who feel it is absolutely necessary to keep an appointment because, in some cases, it just took so long to get it. After disinfection protocols are completed and screening questions for risk factors and symptoms are asked, while properly masked, patients with no symptoms and no history of exposure can be evaluated safely and examined with low risk. It’s an individual practitioner’s decision to participate or maintain quarantine.
  • Keeping regular hours. Even if direct patient care is not happening, this will facilitate appointment making, permit updating clerical duties, allow needed maintenance of equipment and the updating of documents and policies.
  • Limiting staff. Doing so minimizes exposure risks. Additionally, the staff work schedule should be rotated, so that everyone has a fair chance at earning hours. Along with this, I should add that it is my opinion that no practitioner or staff member should ever be forced into service. If they have a strong conviction that the social distance initiative be carried out, they should be granted this privilege in this circumstance; in the United States a National Emergency has been declared.
  • Using telemedicine. This has been permitted by Medicare, and there is a waiver issued by the Department of Health and Human Services regarding good faith use of telemedicine during this pandemic. (Read CMS guidelines on this https://go.cms.gov/34eusxb and the HHS waiver https://bit.ly/2wmpRfS ). I have found that video portals can allow the optometrist to view the anterior segment and superficial and adnexal issues with reasonable detail, to form a hypothesis, diagnosis and plan, which could then be reevaluated using the same system, while limiting traffic to your office. Yesterday, one of my patients got a piece of metal in his eye. I had him come to the office to remove it and receive proper cycloplegia and front-to-back evaluation of all tissues, however, I will be able to complete the care, so long as it stays uncomplicated, using a telemedicine platform.

SHELDON KREDA, O.D., F.A.A.O.

Today is a new ballgame with new rules in which the safety of our staffs and patients take priority. At Kreda Eye Center, in Laurelhill, Fla., here are two steps I’ve taken to protect them.

  • I’ve designated our drive-up window as a point of contact. We are fortunate to have a drive-up window that we use for drop-offs and pick-ups of eyeglasses, contact lenses and solutions. Since the advent of the coronavirus pandemic, when materials are ready for pickup, patients must use drive-up, as opposed to it being an option before.
  • My staff and I have made sure to keep waiting areas as desolate as possible. Patients are encouraged to wait in their vehicles until we call them to communicate that an exam room is ready. Only the patient is allowed in the exam room, unless there are extenuating circumstances, such as in the case of the patient being a very young child or in need of a translator, and family members are told to wait in the car. Thus far, patients have been understanding and respectful of these procedures. They understand that these are difficult times, and are grateful we’re open and providing much needed services.

PAMELA J. MILLER, O.D., F.A.A.O., J.D., F.N.A.P.

At my practice, in Highland, Calif., we are helping patients by email, phone and in person and taking a wealth of precautions, such as spaced out appointments. We have posted notices both outside the office, as well as at the front desk, reminding patients that if they have been sick, traveled, or otherwise come in contact with COVID-19, we will reschedule them. They are asked the same questions when they call to make an appointment or are contacted to confirm their appointment.

Here are some other steps we are taking in the office to minimize exposure risk among our patients:

  • We allow only the patient into the office. If the patient is a minor, with her parent or guardian.
  • We have removed all magazines, the children’s table and books, and set all chairs in the waiting room six feet apart. All other seats have been temporally removed to allow for “personal distancing.”
  • After each patient leaves, we wipe down the office, including counters, pens, chairs, door knobs, all frames that were removed from the frame boards, the front desk area, and anything the patient may have touched.
  • Our testing and optometric equipment are cleaned prior to every patient encounter.
  • Staff members wear a mask when they are in contact with someone else in the office. They wear gloves for all patient interactions.
  • Hand washing, of course, is an ongoing policy to minimize any contamination of patients or staff.

We are continuing to provide a bit of normalcy for our community and patients, as well as our staff. We will continue to do so, until or unless it becomes necessary to close our office. Our patients have been very understanding and appreciative of our efforts and our continuing commitment to serving our community. We continue to monitor the news and make adjustments as needed.

The Path Ahead

APRIL JASPER, O.D., F.A.A.O., chief optometric editor, shares her thinking on what obstacles optometrists will continue to face once the pandemic has subsided. In an online article, available at bit.ly/2xVCWNJ , she shared these with readers. Among the things she considered, that the virus would still be a virus, that patient-friendly hours would be important and that many patients would continue to work from home. And from there she started to sketch out a plan. Dr. Jasper is encouraging all readers to reach out with steps they’ve begun to take.

In addition, she’s also answering common questions related to the pandemic via video at bit.ly/2z7IFR4 .

SCOT MORRIS, O.D., F.A.A.O.

At Eye Consultants of Colorado, located in Conifer, Col., we have taken several steps during the crisis, both for the long- and short-term:

  • Call all lenders, suppliers, labs, credit cards, leases, etc. Ask for a forbearance or partial payments during this time. They are most likely going to accept some payment versus no payment, as they are running a business too and are most likely affected by this crisis as well.
  • Get your taxes in order (especially if you are expecting a refund). Though the deadlines have been moved from April 15 to July 15 (penalties and interest are waived as well), if you are expecting a refund, get those taxes in now and get that refund under way. If you are expecting to pay taxes, then have your accountant hold on to the submission for now.
  • Apply for an SBA loan, if needed. As a result of the crisis, you can now apply for a small business loan through the Small Business Administration’s Economic Injury Disaster Loan program (disasterloan.sba.gov ). It has a maximum interest rate of 4%. The application takes about 30 minutes to complete and may be just the little line of credit or loan that you need to get through this.
  • Maintain basic operations. Be sure you have someone answering the telephone daily, setting or moving appointments and receiving mail (and collections).
  • Tackle that long-term to-do list. Review office protocols and job descriptions, do online training, take a look and document current inventory and any other tasks that you may have previously been too busy to accomplish. One that can be particularly helpful: Look into your insurance accounts receivable; spend some time recovering those monies and refiling claims.

Remember: The world will go on. We will all recover. Pandemic and financial downturn have happened before and will happen again. With every challenge comes opportunity for those who are willing to look for it.

MATT OERDING, CO-FOUNDER OF TREEHOUSE EYES

As we all deal with the unprecedented impact of COVID-19 on our practices, communication becomes more critical than ever among our team members.

Implement video communications for productivity and to keep the team engaged. At Treehouse Eyes, we have two centers in greater D.C. metro area and licensee partners all around the country. We were well prepared for remote work; however this situation has made us realize the unique benefits of video communication. Our D.C. centers are scaled back to urgent care only, so some staff are not at the office and more isolated than usual.

Since the outbreak has started, we replaced our weekly all-team conference call with a video conference. The impact was dramatic. Team members joined via their computers or smartphones from wherever they were at the moment. The agenda was the same, but the quality of the discussion was markedly better — simply because we could all see each other.

Everyone is dealing with anxiety and, rather than just hearing voices on the phone, being able to see people had a power to it and created an empathy that is much needed at this time. This is an easy change you can make now to connect with your team and keep them engaged.

Some video conferencing services offer a free version or are offering the service for free during this time, including Zoom, GoToMeeting and Google Hangouts Meet, making it an inexpensive tool to try out and implement in this challenging time.

GINA M. WESLEY, O.D., F.A.A.O.

As business owners, we have an incredible amount of responsibility at this time. Responsibility to our patients, our staffs, our businesses and ourselves.

Here are the key steps I’m taking to stay ahead, so my practice can survive:

  • Watching the news and keeping up-to-date on legislation and state rulings. This is literally changing sometimes by the hour. It can be draining to have the news on all the time, but periodic check-ins allow us to keep a pulse on what is happening across the nation and in our regions, so we can make informed patient care and business decisions. Secondly, we owe it to our staff to keep up on the relief and loan packages available to our businesses and employees. My goal is to keep them paid by whatever means that employs.
  • Critically evaluating my expenses and spending. I’m looking into what bills are a priority to pay and which ones could possibly be deferred. I highly recommend we call our vendors and negotiate or, allow our doctor alliance to do this leg work for us and stay ahead on which will benefit us the most. My goal is to use my savings in my practice as long as I can, but to be prepared for having to utilize SBA loans or lines of credit, if needed.
  • Continually communicating with my staff. They deserve to know what’s going on, as much of the economic relief and/or unemployment changes are foreign to so many of them (including us). However, I think it’s our responsibility to help them navigate these systems, so they can support themselves and their families. I’m letting them know we are here for them for the long-run, and our team will come together once again.

SHARE THE WEALTH

If you have found a process or tip that is working really well for you at your practice, consider sharing it with us. Send an email to Shannon.simcox@pentavisionmedia.com. On the flip side, if you have a question you need answered, reach out to us as well. If we don’t have the answer, we’ll do our best to find one or find someone who can answer it. OM is here for you during this time — we’re all in this together. OM

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In between editions, you can find all of OM’s pandemic-related content, along with resources from around industry compiled in one place for you at bit.ly/OMcoronavirus .