Covid-19: Unchartered Optometric Territory

By: Paul M. Karpecki, OD, FAAO Clinical Director – PECAA

There was little else that I could write about for this months’ column to my PECAA colleagues. Finding optimism in situations like this can be difficult but we must try because we will look back on this time as a true time of change but a small blip in the spectrum of  time. This is in no way meant to lighten things for those who have lost of suffering family, friends or acquaintances but to help us put things in perspective. It’s tough and it’s going to get tougher for most of us before we see the light again. As I write this, the CDC recommended the discontinuation of routine examinations (not mandated but a recommendation), which affects most of our profession and optometry practices aren’t truly set up for a situation like this. Most of us can’t afford to close the door for 3-4 weeks and not feel a significant impact. For many optometric practices its survival mode and the hope that this pandemic doesn’t last too long.

What Do We Know About COVID-19?

The first cases of COVID-19 in China were diagnosed via a conjunctivitis presentation, but little information was provided to the world at that point. Based on what we’ve seen in China, Italy and other countries affected prior to us, we know it will have an exacting toll on lives (2-3.5% who contract the virus) and the economy, which includes our practices. Even small percentages (0.0056% penetration in China) can lead to major consequences. And countries like Italy with a predominantly elderly population can experience significant morbidity and mortality rates. On the other hand with taking precautions now, as we are doing in North America, and warmer weather coming, which usually ends or greatly diminishes the flu season, we can expect a significant rebound in the second half of the year.  But unfortunately so much is unknown. Could this virus continue or relapse beyond the normal flu season? With limited testing capabilities and limited knowledge of this virus’ long-term effects, we naturally default to fear of the unknown.

Remaining Absent May Not Be the Best Answer

The government is promoting Telehealth for practitioners seeing routine examinations and for patients concerned about an infection (including conjunctivitis). We’re seeing large companies like Amwell, TelaDoc and CVS promoting their telemedicine platforms at this time. I’m sorry but a PA, which is used for many of these outfits, is not likely to have the ophthalmic knowledge necessary to field these ocular related consults. That being said, there is something to the need for telemedicine. Medical professions such as radiology have had great success in telemedicine for many years. One thing this pandemic is teaching us is that optometry must utilize more than just our offices to be successful and help patients. Telehealth is one key option and fortunately in eye care we have a well-developed platform from a company called EyeCare Live, which was started by optometry with help from some of the top programmers and technology experts in Silicone Valley. Another is online contact lens sales.  Reading through Walmart’s annual report gave key insight into their success in contact lens sales. It showed numbers for sales from optometric offices associated with Walmart and sales from shoppers who only use Walmart’s online system to order contact lenses and found that neither was close to the combination. Meaning more than 2 times the sales came from patients who saw an optometrist at a Walmart office and then ordered online! It’s that initial office experience that leads patients to trust us but the convenience of online ordering they want in today’s society and especially in unknown times as we face now and likely in the future. We will need an omni-channel web ordering system associated with our practices. This combination is worth more than the office visit and simple online ordering combined. It’s a way to combat 1-800 that lacks the brick and mortar stores and has clearly shown contempt toward optometry. It will also allow patients the best of both experiences. TelaSight is another online Telehealth opportunity where experts in the field in areas of glaucoma, retina, neuro, cornea, OSD to name a few that are available to answer consultative questions from colleagues based on patient cases. Started by an optometrist this platform becomes the perfect tandem to those serving patients with medical eye care needs in the office or online via telemedicine.

Why and Where Does Telemedicine Fit In?

The most obvious answer currently is the ability to see and care for patients without the risk of COVID transmission to them, others or us. But there are specific areas where it will always be valuable including future patients with conjunctivitis that you don’t necessarily want to see in office and who usually see a primary care provider or pediatrician. Other areas include simple follow-up examinations, prescription refills, contact lens follow-up exams and prescription renewals. Another big advantage is that medicare and 3rd party insurers provide reimbursement for telemedicine exams as being the same as if the service had been furnished in-person. The practice simply has to add the modifier code 02 (Telehealth) to the proper examination code (e.g. 02-99212 or whatever level the exam meets).

Limitations of Telehealth

Current limitations include image quality, band-width, reliance on patient cooperation with examination, lack of sophisticated equipment to confirm diagnosis— meaning that telemedicine is not a replacement for in-office examinations. It is an adjunct to improve patient care and provide services during times such as this. Some watch-outs include making sure you are using a platform for safe and secure communication that is HIPAA compliant. For example, FaceTime is not a HIPAA compliant platform (although Medicare is allowing the temporary use of this and lifting HIPAA regulations temporarily, these systems still don’t provide the level of sophistication needed like a true Telehealth platform). The system must allow for asynchronous as well as synchronous interactions. Meaning sending pictures (asynchronous) may not be reimbursed in your state but is valuable to the diagnosis but being able to talk to the patient live via video (synchronous) allows you to be reimbursed. Again these requirements vary from state to state.

What of the Future?

It is unlikely we will fully return to pre-pandemic norms. For example, companies that previously had no work from home policies are now asking employees to work from home/remotely and expect to keep some level of this in place. These changes will prompt us to find solutions in the interim that will remain in place for the future. It seems like people are accepting these changes such as less travel, more online meetings, online sales, telemedicine and although it won’t replace face to face meetings and conferences, it will likely compliment them. I can see the future being a hybrid among in-office practice, which is essential, with an online sales option for contact lenses and OTC products. Likewise telemedicine will replace many of the follow-up exams, infectious conjunctivitis cases and prescription refills even when we return to normal clinic schedules.

I believe that once we survive this pandemic, that optometry will be best positioned for the future. We see 88% of all comprehensive examinations and that won’t change, we have the premier practices for clinical examinations, which we’ve shown is essential and necessary but now we can combine this with telehealth initiative like EyeCare Live and TelaSight, as well as online contact lenses, solutions and OTC products we financially benefit from and most importantly provide patients with the avenues they will come to expect following this current COVID-19 crisis.

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