Biography: Hovanesian is a faculty member at the UCLA Jules Stein Eye Institute and in private practice at Harvard Eye Associates in Laguna Hills, California.
April 29, 2020
3 min read

BLOG: Climbing out of COVID-19

Biography: Hovanesian is a faculty member at the UCLA Jules Stein Eye Institute and in private practice at Harvard Eye Associates in Laguna Hills, California.
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At this writing, nearly half the world’s population is under lockdown to contain the spread of the novel coronavirus. Virtually all medical practices across the country are open to only emergency and urgent patient visits, if that. And it’s completely unclear how long the shutdown will last. But there are options our practices can explore even now to help our patients and support our employees. Here are three steps you can take.

1. Stay in touch. Your patients would love to know what level of services you are offering and how to access them. You might choose to send a blanket email to your patients announcing your availability for emergencies. If you do, consider sending it out in batches over time to reduce an overload of calls for whomever is covering your phones. Our practice in southern California is using MDbackline software to contact all active patients individually by email and SMS to ask if they feel a need to be seen. Responding patients can then designate if their need is urgent or more routine and to describe the reason. This generates a task in our EHR system for the staff to call the most urgent cases first, possibly for an in-person office visit, and to triage the others for telemedicine services. However you choose to reach out to patients, you might publish an email address for patients to correspond with. This is permissible in this time of relaxed HIPAA regulations, and using email might reduce an overload of calls for whomever is covering your phones.

2. Organize your staff. Most practices I know are applying for SBA loans to allow continued pay for employees. Whether it’s your full staff or some subset, you can put these employees to work responding to patient emails and calls. Besides taking a history and determining the type of visit that’s needed (in person vs. telemedicine), your staff can also coach patients on how to prepare technically for a telemedicine call, perhaps having a younger relative or friend help the patient at the designated time. The staff can collect this information in the EHR system, even from home.

Once the stage is set, you can perform the telemedicine visit, where you can do just as you would in the office, refining the history and recommending treatment. Naturally, without an in-person visit, our examination is limited, but most of us can do fairly well for many conditions, even under these limited circumstances, and many patients are happy just to make contact with their doctor.

What platform should you use for telemedicine? Choose a simple method, whether you follow the clever advice of my colleague, Rich Davidson, who came up with a way to use FaceTime (iPhone only) without giving a patient your cell phone number or personal email address, or use a system like Google Meet, which is free and HIPAA compliant and has been nearly ideal for our practice. Remember that all telemedicine visits require a doctor’s involvement to be billable, according to webinars offered by practice management consultant Kevin Corcoran, and the level of billing generally depends on the amount of time spent.

3. Get creative! Some wonderful ideas have emerged out of this pandemic. Raleigh Ophthalmology in North Carolina has already started conducting a drive-in IOP check clinic with patients remaining in their cars and a hand-held tonometer used to check pressures, according to an employee’s social media post. We’ve had similar thoughts for the large numbers of patients whose pressure checks should not wait a few more weeks.

Another idea is to contact patients with impending need for cataract surgery. During telemedicine visits, you can counsel them on risks and benefits of surgery and spend the time you usually don’t have to talk about premium options. Then, your staff can schedule a biometry visit the same week you return to regular work, followed quickly by surgery, ramping up your revenue quickly and working through the pent-up demand of cataract patients with an even higher rate of premium conversions.

You may need to alter your physical office environment for live visits. To promote social distancing, consider having staff test visual acuities in a hallway with a 20-foot chart rather than sitting in close quarters in an exam room. During the peak of the crisis, in our office, where we have limited N95 masks just for physicians, those physicians are the only ones to get close enough to emergency patients to administer eye drops, check pressures and perform exams.

No event during our professional careers has tested our ethics and our creativity as much as this crisis. Never have we had a better reason to remember why we became doctors — to help patients. Long will we share stories about the clever methods we tried to do our best when conditions were at their worst. Good luck, dear colleagues!

Disclosure: Hovanesian reports he has a financial interest in MDbackline and Alphabet Inc.