One eye care practice increases telehealth, staff rewards to thrive during COVID-19
As the COVID-19 pandemic and necessary quarantine procedures remain at the forefront of health care concerns, eye care providers continue to implement best practices for seeing patients and chronic and emergent conditions.
Primary Care Optometry News spoke with Scott Han, OD, a practitioner at The Eye Associates in Bradenton, Fla., regarding changes to patient management in his practice in light of COVID-19 as well as his internal focus on staff.
PCON: How are you practicing differently now than you were prior to the pandemic?
Han: After the mandatory closure of our clinic to routine care patients, we ramped up slowly and are currently at about 90% of our pre-COVID patient volume, which allows us to reduce the number of people in the office at any one time. In addition to the normal standard of care, we have implemented extra cleaning and sanitation protocols. Of course, everyone — patients, staff and doctors — must wear a mask while in the clinic, and we screen everyone with a temperature reading and health questionnaire. We allow only the patient and one caregiver, if necessary, to enter and have rearranged the waiting room to maintain social distancing.
Additionally, we adjusted patient flow. Patients complete an online intake to speed up the check-in process, and we make a conscientious effort to keep our patients from spending too much time in the office. We also offer the option of telehealth appointments for at-risk patients and those with routine follow-up visits. Overall, we are working harder and faster to process patients, get them taken care of and seen by a doctor, and then out of the clinic.
Staff appreciation is something we have always done, but now we are actively doing extra because they are doing extra. Our employees accomplish more with fewer coworkers and have stepped up to implement procedural changes, clean and sanitize, and take on additional responsibilities. We are thankful for our great staff, and we want to reward them and encourage them.
PCON: Please talk more about how you have implemented telehealth.
Han: During the closure, we took all appointments via telehealth, which we used primarily as a triaging tool to assess and diagnose. In rare cases, we requested patients to come to the clinic if we determined that the risk for vision loss was greater than the risk for contracting COVID-19. My practice adopted Luma Health, a browser-based platform that is compatible with any operating system and does not require patients to download an app. This is an important feature because many patients prefer not to deal with an extra app. Prior to the appointment, patients receive an electronic communication with instructions to take a vision assessment on our website. At exam time, they follow a unique link to a HIPAA-compliant virtual examination room where we review their vision test results, update their case history and perform an external examination. With newer smartphones and good bandwidth, we can see amazing detail.
Telehealth appointments will be a permanent change. Not only does this format help reduce crowding and volume in the office, it is proving an excellent option for patients receiving follow-up care. For symptomatic disease, like dry eye, patients benefit from encouragement and guidance, and these appointments are easily conducted virtually.
We also offer hybrid exams to our patients who cannot wear a face mask for long periods but are able to keep one on for a few minutes. We ask them to wait in the car until called in, perform the needed ancillary tests and send them home. Then we confer with the patient via telehealth.
The hybrid model also works well for interim visits. For example, we see dry eye patients twice a year, once for a full dilated checkup and 6 months later for an assessment. At the assessment, we perform symptom checks over the phone and have them come in for diagnostic testing only if objective measures are needed.
PCON: How has dry eye sustained your practice?
Han: We are a high-volume practice, and during the COVID-19 closure we performed 680 telehealth visits; most of those were dry eye related. The tendency is to focus on our patients with more severe disease, but it was our symptomatic dry eye patients who were reaching out to us and asking for help and guidance. Mask wearing, more time indoors and the proportionate rise in screen time are exacerbating dry eye. I see an increase in the number of patients complaining of visual fluctuations and eye discomfort, and I expect this trend to continue.
Dry eye patients are ideal for telehealth appointments because it is an anterior segment disease with symptoms they can describe and at least some signs that we can see and diagnose on camera. Treatment plans are doable from home, and follow-up visits can be scheduled with less time between visits online than in the office. Patients like this option because we can address their questions and encourage compliance.
Patients have also been receptive to our recommendation to use a clinically tested supplement such as gamma-linolenic acid and eicosapentaenoic acid (Hydroeye, ScienceBased Health), in addition to eyedrops, and artificial tears to maintain their treatment plan. We offer payment over the phone and curbside pickup. The combination of revenue from online dry eye patient exams and related product sales enabled us to be ready to open back up again.
PCON: What do you see for your practice 6 months down the road?
Han: I do not think things will ever be like they were before COVID-19. In medical settings, we will probably continue to wear masks and take the same precautionary measures. Some of these things are good, like extra sanitation, online check-in and streamlined office visits. Patients have embraced minimized waiting experiences and quick visits, and I believe they will expect that going forward. Telehealth will continue to play a large role, which I view as an opportunity to supplement office visits and potentially compensate for any reduction in patient volume.
For more information:
Scott B. Han, OD, practices at The Eye Associates in Bradenton, Fla. He is a specialist in ocular disease and has participated in numerous research teams conducting FDA clinical studies on dry eye syndrome and glaucoma. He can be reached at: SHan@theeyeassociates.com.