For many eye care providers, telemedicine and telehealth may seem like a foreign concept that might take years to be integrated into the healthcare space. However, it is a concept that has been championed for over 50 years in areas of psychiatry, radiology and telemetry. What all practitioners should realize is that the driving forces for telemedicine start and continue from the outside that force the paradigm shift in the way we provide care and meet the demands of patients. More importantly, the generational shift pushed millennials to be the largest segment of the workforce, which are the biggest proponents of technology and telemedicine. At 75 million strong, millennials grew up in a technology-based environment that demands efficiency and transparency while being very conscientious of costs and convenience.1 This includes their healthcare delivery.
However, there are many other drivers to this emerging technology. Financial drivers have forced payers and providers to deliver care to patients in urban and rural areas. In 2018, the number of ambulatory visits was approximately measured at 1.25 billion where one third of those patients could have had treatment from the use of telemedicine.2 The rising costs of healthcare have shifted the way employers offer healthcare to their employees. According to the Large Employers’ 2018 Heath Care Strategy and Plan Design Survey, 96% of employers have made telemedicine services available with 55% covering behavioral health.3
With the increasing prevalence of chronic disease, especially in rural areas, telemedicine has been adopted by the Centers of Medicare and Medicaid and the Veterans Administration. In 2017, CMS payments for telemedicine payments increased by 28% and telemedicine claims increased 33% from the previous year.4 The amount of physicians graduating is not able to meet the demands of patients and payers, especially in the area of primary care causing "primary care deserts" to 65 million Americans.5
What about eye care?
Optometry and ophthalmology share this challenge together and it does not matter if it is called tele-ophthalmology or tele-optometry. Screenings for retinopathy in diabetics, ocular consultative services, triage and overall supervision have been studied in recent years and have demonstrated to be a viable model to eye care.6 Tele-retinal exams have been increasing in both the VA system and in private health systems. With the combination of electronic health records and digital imaging equipment, a hospital system like Grady Memorial Hospital in Atlanta, Georgia was able to reduce the backlog of 14,000 diabetic patients to 3,000 within 1 year and reduced emergency room visits from cases from vitreous hemorrhages, neovascular glaucoma and retinal detachments.7 While some eye care professionals may not consider this the standard of care, optometrists and ophthalmologists must acknowledge that there are deficiencies in access to care and the need for retinal screenings is outpacing provider care. Early adopters can work with healthcare teams to mitigate the public health need of eye care and to lower costs.
Bryan M. Rogoff, OD, MBA, CPHM has a unique background in areas of holistic eye care, business management and healthcare reform. He specializes in LEAN clinical management and operations, technology implementation, healthcare strategy, and strategic partnerships. Currently, he serves as a consultant for for the FDA, Immediate Past-President & Education Chairperson for the Maryland Optometric Association, Federal Keyperson and Meetings Committee Member for the American Optometric Association, reviewer for the Council on Optometric Practitioner Education and is the Founder of Eye-Exec Consulting, LLC. To contact Bryan, visit www.eye-exec.com or email email@example.com. He can also be found on LinkedIn, Facebook, Twitter and Instagram.