NEW YORK—The COVID-19 pandemic has forced a change in all of our lives, both on a business and personal level. Although everyone is experiencing this change and uncertainty together, navigating this new situation can still feel scary and uncertain. It might feel like no one knows for sure what the best thing to do right now actually is—but it’s always helpful to hear from those in similar situations. As many practices decide to temporarily close, move online or only take emergency patients, knowing what steps to take and what situation everyone else is in can be overwhelming. 

To help mitigate this anxiety, VMAIL reached out to seven of CooperVision’s 2020 Best Practices Honorees, which VM first profiled in March after they were announced. Below, David Anderson, OD, of Miamisburg Vision Care in Miamisburg, Ohio (19 employees); Amanda Barker-Assell, OD, of Advanced Family Eye Care in Denver, North Carolina (33 employees); Brittani Carver-Schemper, OD, of Better Vision Optometric Center in Fayetteville, North Carolina (17 employees); Arthur Epstein, OD, of Phoenix Eye Care in Phoenix, Arizona (7 employees); Lee Ann Hoven, OD, of Advanced Eyecare in Durango, Colorado (18 employees); Paul Lin, OD, of Valencia Eyecare Optometry in Valencia, California (12 employees); and Jennifer Zolman, OD, of Draisin Vision Group in Charleston, South Carolina (21 employees) discuss what has changed due to the pandemic, what they expect from the future, how they’re adapting, and more.

Q: What is the current status of your practice due to COVID-19?


David Anderson, OD

David Anderson, OD: My office is currently operating under reduced hours. We are keeping busy with phone calls, a handful of emergency patients each day, and orders for contact lenses and glasses that can be done without the patients coming into the office. We plan to continue this way for another month, but will assess the needs based on the amount of phone calls and patient needs.

Lee Ann Hoven, OD: We are open from 11 a.m. to 3 p.m. Monday through Friday for urgent care only. We are offering telemedicine if necessary, but we do have a doctor in the office to provide care.

Amanda Barker-Assell, OD: Our practice is operating under reduced hours daily, seeing emergency patients as needed and via telemedicine.

Arthur Epstein, OD: We continue to remain flexible as the situation evolves, with the primary focus on caring for our patients, as well as providing emergency eye care for our community. We postponed all routine care and reduced office hours, but we are keeping the office minimally staffed to respond to phone calls and manage patients with urgent problems and emergencies.

Brittani Carver-Schemper, OD: We are open for emergency and essential care with reduced hours from 10 a.m. to 2 p.m., Monday through Friday. We are using our Weave app from home to check messages regularly and triage patient calls.

Pal Lin, OD: We have reduced our operations from six days a week to two days a week.

Jennifer Zolman, OD: We are operating under reduced hours for urgent medical needs and emergencies, and to enable curbside glasses pickups, shipping contact lenses, answering phones and fielding questions, and additional work at the practice.

Q: What measures (if any) have you taken to sustain patient care or customer service during this time?


Brittani Carver-Schemper, OD

Dr. Carver-Schemper: We are maintaining patient communication through Weave and social media, and returning calls, texts, and messages in a timely manner to reassure patients we are here for them. We are offering curbside glasses and contact lens pickup, glasses adjustments and repairs. We are also providing free direct shipping to patients on all contact lens orders.

We are following all recommendations from the CDC, AOA, and the North Carolina Board of Optometry to continue to provide emergency and essential care during this time. It’s more important than ever to educate our patients that we are the primary source of treatment for eye emergencies and injuries. These patients should not be visiting the emergency room.

Dr. Barker-Assell: We have several employees operating from home to answer calls, texts, and emails. We are scheduling telemedicine visits and ordering contact lenses as needed. We are able to combine various technologies to work from home, including UPrise, CLx, and Weave.

Dr. Epstein: When appropriate, we are reappointing patients beginning in May and are telling them that if the situation improves, we will get them in sooner. All contact lens needs are being addressed remotely and prescriptions are extended for six additional months.

Dr. Lin: We are utilizing our after-hours phone number, and have started to offer virtual telemedicine. For patients who are visiting our practice, Weave distributes a pre-visit questionnaire asking about any high-risk travel or symptoms prior to arrival. We are taking contact lens orders over the phone with free direct-to-patient delivery, and are offering virtual frame try-on with Eyeconic.

Dr. Anderson: I have a clear message on our Facebook page, website, and phone system addressing how we are dealing with this. Further, we have sent numerous email blasts to our entire patient database informing patients how we are handling emergency care and basic things like glasses repairs and contact lens orders, as well as our compliance with CDC guidelines.

Dr. Hoven: We have been putting a lot of energy into emailing and texting our patients, as well as increasing our social media presence, to let them know how we can help during these difficult times. We are also trying to continue scheduling appointments for the distant future to ensure that our books will be busy when this crisis has passed.

We have an in-office lab so we have been able to fabricate spectacle lenses using a previous prescription for patients who find themselves without eyewear. When we do this, we are also making spectacle appointments for six to eight weeks in the future and assuring these patients that they have 90 days for a remake, if necessary. This is to encourage patients to return for their exams, and not just settle for a new pair of glasses that may not be in their optimal prescription.

This situation has been a great chance for us to reinforce the message to our patients that we can help them—they don’t have to go to online retailers. We are also contacting all of our patients who are due for medication refills or medical visits to let them know how we can best handle their situation. My main objective is to reach out to patients before they feel a need to contact us. We’re reinforcing that we have their best interests at heart, and we’re here for them.

Q: How are you handling the business side of the equation?


Jennifer Zolman, OD

Dr. Zolman: We have taken advantage of the Small Business Administration loan options, and are preparing to apply for the Payroll Protection Loan as well. We are also asking for deferments and extensions for any payments due.

Dr. Hoven: I have watched many webinars and read articles to try to navigate the options available to us for loans and grants to help us hang in there for the next several weeks. There is so much information to access and it takes time to digest it all. About two thirds of our employees have been temporarily furloughed, and others are presently doing some job sharing. We want to get all of our employees back to the office as soon as possible. With the new CARES Act, we are hoping that will be possible in the next two to three weeks.

We are continuing to cover insurance costs for employees, and trying to reduce their financial stress as much as possible. We’re keeping them all updated throughout this process. In addition to the Paycheck Protection loan, we have also applied for the disaster grant and are working to obtain a line of credit. I’ve reviewed my expenses to determine what is mandatory, what can be delayed, and what needs to be stopped for a period of time. For instance, paying my employees is mandatory, but water delivery and patient recall cards can be put on hold.

Dr. Anderson: I have asked for and gained deferment on all loan payments, and have contacted all non-essential vendors—such as the cleaning crew, window washers, and trash collectors—to stop service until we need them again. I reached out to my bank for an additional line of credit. I took all payments that were automatically charged on credit card or debited from the bank account and asked that they begin sending invoices. I redeemed our credit card and vendor rewards. I contacted all utilities—electric, gas, water, etc.—and asked for delayed payment options. I also applied for an Economic Injury Disaster Loan, and have been monitoring all other loan options so I can bring my staff back as soon as possible. I spoke with my insurance agent about the business interruption insurance we have, and he is monitoring to see if any legislation around this should lead to a payout.

Dr. Epstein: We furloughed employees who had child care conflicts, since that was the best option for them—but we have continued insurance and other benefits. We are pursuing various practice support programs recently announced by the federal government.

Dr. Lin: For our staff, we have made sure to educate them on universal safety precautions and proper handwashing practices, and have transitioned to time clock entry via individual keyboards instead of a central clock. We are reassuring them that every one of them is important to our practice despite the reduced schedule right now; once we are able to return to full operating capacity, we’ll get back to normal schedules.

Dr. Carver-Schemper: First and for most, we are trying not to worry. This is a difficult time for many of us in optometry, but we are doing our best to stay positive. We have taken advantage of webinars on the CARES Act and the Family First Act so that we can understand what they mean for us. We will definitely leverage the benefits available for our business. It is important that business owners keep in close contact with accountants and bankers as we navigate the process of maintaining cash flow and reducing expenses. To that end, we have been in contact with our vendors and lenders to make sure that we are aware of all available deferment options. We are also implementing telehealth capabilities to lower risk to our patients while also reducing risk of exposure to our staff.
   
Dr. Barker-Assell: We are working with vendors and through programs offered to small businesses to maintain a healthy practice. We continue to stay in regular contact with our employees through social media, email blasts, and more.

Q: If you could share advice with peers who are struggling, what would you tell them?


Pal Lin, OD

Dr. Barker-Assell: These are difficult times, and we need to think outside of the box. This is a great opportunity to work on projects and staff training so we are super prepared when we get through the pandemic. It’s a time to incorporate technology and learn more things like telemedicine, as the face of our profession is changing daily. We need to remain relevant and be able to adapt with what is happening. As an independent practice, we have the ability to change quickly—but that still takes work and careful planning.

Dr. Lin: Make sure you apply for a Small Business Administration loan, and keep ready cash available for use down the line. Also make sure to utilize unemployment insurance—including for yourself, if you are employed under a corporation or LLC. There are also various webinars available with valuable information to help get us through this.

Dr. Zolman: We are all in this together. Have your moment to cry, scream into a pillow, punch the wall—but get back up, dust yourself off and find a way to thrive in this environment and when this is all over. Educate yourself and take action. Take advantage of the webinars and online resources available, as there is a lot of free information out there to help you get through this. Many optometric organizations and companies are hosting webinars and have information available on their websites and blogs.

Dr. Hoven: Talk to as many people as you can. First it helps to know that we are all in this together and secondly, I learn from every person I speak with. Whether it be a payroll administrator, accountant or a medical biller, each person has a different insight. I’ve spoken with a dentist, a manager for an ENT office and a medical biller to find out how other medical fields are being impacted and how they are adapting and changing to handle these challenges. Everyone has given me a pearl of wisdom to work with, which is helpful as I’m making decisions.

Dr. Carver-Schemper: It is important during this time to take care of ourselves. It is easy to slip into bad habits, but keep up your spirits by making time for self-improvement. Take this time to focus on new and creative ideas for your business. A feeling of accomplishment is a great mood lifter. Also, be sure to stay connected with your staff during this time, even if they have been laid off or furloughed. With resources like WhatsApp, Zoom, and FaceTime, you can maintain good relationships and keep spirts high. We have been scheduling team Zoom meetings with fun themes, such as crazy hat day or favorite sports team shirt day.

Dr. Epstein: On 9/11, I was in St. Louis for an AOA CLCS board meeting. I woke shortly before the first plane hit the World Trade Center. I watched in disbelief and shock as I had been in the towers dozens of times and could see them as I drove home from my Roslyn, N.Y. office every evening. I drove home from Missouri two days later to an office that had very few patients, and all of my lectures and meetings had been cancelled.

I was angry and sad beyond description. Rather than sitting and moping, I taught myself Microsoft FrontPage and put together a website for our practice. I learned SEO and, as a result, not only did our practice recover, but it actually grew as a result. To my colleagues, I’ll share that this will be a difficult and uncertain time, but also a time to take control as best you can and reinvent yourself and your practice. Learn new things and mobilize your staff to reach out to patients. Consider adding telemedicine or a new niche specialty and use this time to expand your horizons. I realize that some will not come through this OK. Do everything you can to not be that person or that practice.

Dr. Anderson: Focus on things you can control. Right now, we cannot control our situation, the virus or any timing. Frankly, with so much unknown, it is easy to focus on what is out of our hands—because so much is out of our hands. Look at the good things in your office and focus your time and energy there. Put together a marketing plan that includes really developing your brand, who you are and what you want your office to be. Use that to provide consistent messaging both now and into the future. I have prepared Facebook posts and scheduled them far into the future.

Q: What suggestions would you offer other ODs on how best to use this “time away” from the practice for both professional advancement and/or personal wellbeing?


Arthur Epstein, OD

Dr. Epstein: Recognize that this will come to an end soon. Hold on to that as an essential truth, and it will help get you through this. The isolation and lack of routine can is depressing and stressing for all of us. Identify and utilize all available resources for your practice. You and the practice will be okay as long as you stay engaged. The AOA has been especially helpful in taking a leadership role in watching out for optometric interests. Use your membership benefits if you are an AOA member. Don't allow down time to get you down. Use the time to take CE courses, attend to outstanding business issues, plan new aspects of your practice that can generate additional income, and strategize for how you will come back and handle the incredible pent-up demand. Also reconnecting with hobbies, catch up on reading or movies that you missed. Taking a break from reality is more important now than ever.

Dr. Hoven: Now is the time to evaluate systems to determine if there are areas for improvement. For example, we are currently working through inventory analysis for frames and collaborating with Demand Force and CLx on better methods for tracking patient orders associated with exam dates. On a personal note, this is a great time for more exercise and thinking about the big picture as well as smaller details.

Dr. Anderson: Consider taking 1-2 hours of CE that is often available free or low cost—either related to a new interest in a specialty area, or an area that you consider a weak spot in your knowledge. As an example, I have watched several videos (without gaining CE) about neuro-rehab and the eye to help me better understand this part of eye care. For your personal wellbeing, I recommend having a schedule or a checklist for your days. We are all creatures of habit and are used to having a very scheduled and structured day; for all of that to fall far away, we can feel overwhelmed and incomplete at the end of each day. But having a checklist allows you to feel you have accomplished something.

Dr. Barker-Assell: First and foremost, this is time to take care of our families, employees, patients and ourselves. I hope to spend more time with my children and my husband and perhaps read a few books that have been placed aside for far too long. From the business perspective, I think it is a good time to attack the "to do" list—finish projects that seem to never get proper attention, plan for future goals, complete training for doctors and team members, and re-evaluate protocols.

Dr. Zolman: Concentrate on all the things you “never have time to do,” like self-education. Advance yourselves with all the free online resources out there while you are at home and work on certifications you have been putting off. Use the time to do inventory and deep cleaning of the office, or work on projects like starting your dry eye center or training on myopia control. Focus on cleaning up all outstanding insurance balances and collection. Start that workout plan and drink your water to stay healthy, take that nap you never have time for. Enjoy the calm, write your goals down for the rest of the year in detail, and map out how you are going to achieve them. Start your plan to get back to normal in your office. Spend time with your spouse and kids—make it fun and a time for them to remember.

Dr. Carver-Schemper: In every season of our lives, good or bad, it is important to find the joy. This is a very stressful time for our profession, but we have to strive to thrive so that we will excel when the time comes for us to reopen our doors to full-time patient care. What can you do now that will make your practice stronger when you reopen? What can you get caught up on now, so you can focus on patient care when you reopen? Do you need to update your website? Do you need to update your EHR or training manuals? When was the last time that you read your employee manual? Do you have staff training planned? Do you need to plan your social media/marketing calendar for the year?

It is a great time to go through your P&L statements and find what is or is not making you money and make adjustments accordingly. We didn’t ask for or anticipate the situation we’re in, but we were given time that we can use to benefit our businesses in the future. It is also very important to take care of our personal wellbeing. With all the changes that surround us, it can be easy to fall into bad and lazy habits. Headspace, which is a meditation/stress relief app, is offering free access to their pro subscription through the end of 2020 for all healthcare providers.

Q: Are you currently doing anything at the office to prepare for reopening? Or catching up on anything that you had been putting off or didn’t have time for previously?

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Lee Ann Hoven, OD
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Dr. Hoven: While I am helping answer phones with our skeleton crew, I am seeing a lot of patients in the system that are significantly overdue for their eye exams and have been getting their contact lenses online. I see this as an opportunity; we need to do a better job of keeping up with these patients!

Dr. Carver-Schemper: We are utilizing our reduced staff to make sure all insurance claims are up to date, recalls are ready when we return to routine patient care, and any necessary training has been completed. We are in the process of deep cleaning and organizing throughout our practice. We are also preparing our marketing calendar for the year.

Dr. Barker-Assell: We have created what we call "Area Rocks" for each department. These are tasks or projects to accomplish, ranging from cleaning out drawers to professional training. Our goal is to work through these lists to catch up and be prepared for re-opening. We are also working on new safety protocols to put in place for re-opening to protect our team and our patients. Additionally, we are hoping to implement some new technology that was difficult to install while operational.

Dr. Lin: I am currently leaning about introducing telemedicine into the practice, and fine-tuning our sterilization protocol.

Dr. Epstein: I'm working on our websites and other patient-facing initiatives. We're having more frequent staff meetings virtually, and I'm working on ideas for expanding the practice.

Dr. Anderson: I am currently looking at frame lines and frame turn very carefully, evaluating which lines will be sold down. I am reviewing a complete inventory of all items that we sell, and analyzing the monthly purchase rate to ensure we have a better ordering system once we open. The rest of the time I am spending on marketing, both on social media and to our community to build better referrals around our specialty service. I am also putting together a brochure and call list for offices that need to better know our services once we are back open. This includes neurologists, pain management clinics, and primary care physicians, as well as pediatricians, ophthalmologists, and hospitals.

Q: Are you doing any outreach or support efforts related to COVID-19 within your local community?


Amanda Barker-Assell, OD
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Dr. Barker-Assell: We wrote an article for our local newspaper to help educate the public about COVID-19 and the eyes.

Dr. Anderson: On Facebook, I am posting frequently in support of other small businesses and what they are doing to help people during the pandemic. I have also reached out to our mayor to see how our practice might be able to provide guidance on the pandemic, and we are working to figure out a way to make this happen.

Dr. Zolman: We are supporting the community by seeing emergency eye care patients to keep them out of the hospitals and emergency rooms, which can instead concentrate on the COVID-19 patients and concerns.

Dr. Carver-Schemper: We are purchasing gift cards from locally owned restaurants and giving them out to healthcare workers at our local hospital. We are also partnering with another local optometrist to offer curbside glasses repair and adjustments to all health care employees and first responders in our community.

Dr. Epstein: Our community outreach began long before this crisis. We are one of very few practices to offer emergency eye care in the area and we continue to do so throughout this crisis. Currently we are seeing more emergency patients than ever since many offices have closed. Staff is available to answer any questions as are doctors when necessary, and supplies are being shipped to patients as needed. Our website has also been updated with current information.

Dr. Hoven: We are fundraising with our local rotary club to benefit the foodbank.

Q: Do you anticipate any major changes within eye care following the COVID-19 situation?

Dr. Anderson: I think a few things will change. One is the shift to more virtual meetings for our industry, as well as increased use and pay for telehealth services. I also think patients are likely to have a different view of both the commodities we sell and the services we provide. I think many will understand that we are medical professionals better than they have previously. Lastly, I think all doctors that survive will be stronger as they streamline their business, look for more efficiencies in their office system and reduce wasted time and materials as a result of having to really look at how they are spending money while they are making none.

Dr. Lin: I could see people looking more toward utilizing remote technologies to handle daily tasks—telemedicine when possible, and potentially even more online shopping.

Dr. Zolman: After the worst is over, my hope is that our communities will support small businesses and our practices to help us all recover from this. I’m also interested to see where telehealth ends up.

Dr. Barker-Assell: I certainly think we will operate differently. We will be thinking about the safety of high-touch areas and items like waiting rooms, magazines, pens, and door handles—and how we can operate to ensure everyone is protected. I also believe telemedicine will be utilized much more on a day-to-day basis. This crisis has pushed us to figure out how to be operational off site in a whole new way.

Dr. Carver-Schemper: No, we do not anticipate any major changes to eye care when this is over. As a practice, we plan to be better prepared for future events like this. Implementation of telemedicine is vital at this time, and we believe it will remain an integral part of our practice.

Dr. Epstein: I expect significant cultural changes in how we interact with each other as a result of this crisis. Some of those changes will be long lasting; however, we are social animals that thrive in close contact, and it is an essential element of the human condition. I do believe some of the initial changes will impact how offices work with patients. Right now, I am seeing colleagues panic with offices closed and increased risk of viral transmission. As a result, we’re seeing increased interest in telemedicine and other forms of indirect patient interaction.

I am not convinced this will be long lasting. While some are predicting major changes in how we practice, especially with telemedicine, I think the changes will not be as profound as many expect. Under normal circumstances, telemedicine is far too restrictive and reimbursements too limited to be of much value for most practices. Telemedicine will likely regain most, if not all, of those restrictions after this crisis ends, such as HIPAA requirements. Eye care requires person-to-person contact more than most other medical specialties. So I expect things to eventually—perhaps slowly—go back to normal. It will be a somewhat new normal, but it will still be clearly recognizable as optometric practice