EYECARE Making the Leap into Telehealth By Andrew Karp and Mark Tosh Monday, June 22, 2020 12:40 AM RELATED CONTENT Virtual Vision Care Grows Up Special Report on Telemedicine: The Time for Optometry is Now ECP Groups Support Members’ Access to Telehealth Solutions Retailers Find Telehealth Options Improve the Patient Experience Mapping Ocular Telehealth’s Multifaceted Ecosystem Adjusting to the New Normal: How Ocular Telehealth Can Help Payers See Longer-Term Role for Telehealth in Eyecare Coming Soon: NAVCP’s Telehealth Statement Direct-To-Consumers: DIY Eye Tests Envisioning the Future of Ocular Telehealth Key Trends in Ocular Telehealth Many optometrists began using ocular telehealth this spring, when the spread of COVID-19 and subsequent shutdowns of optometric practices and optical retail stores cut them off from seeing patients in person. We spoke with several optometrists who are new to telehealth about what their experience has been like. They report that remote consultations via a mobile app have proved to be an effective means of providing at least a basic level of care. The ODs described what type of patients are best served by telehealth, to what extent they’re being reimbursed by insurance companies for telehealth services, and the ongoing role they envision for telehealth in their practice. They also described how adding telehealth services has allowed them to expand their patient base by increasing access to eyecare. Keshav Bhat, OD Union Family Eyecare Matthews, N.C. Prior to the onset of the pandemic, there were basically no virtual exams in our office. A good friend who had just joined a telemedicine company was asking me to demo and perhaps sign up. I was reluctant to allocate the resources then. With the outbreak, our office came to a dead-stop on March 16 and I had to quickly formulate a plan. The first option I attempted, and still like the most, is Doxy.me. I started with the base plan that offered a Low Definition Video platform and unlimited usage. It also included a waiting room feature and browser notifications. Through my social media interactions, I understood that Imprimis Pharmaceuticals had an exclusive agreement with doxy.me offering a free upgrade to the Professional Version that not only offered the above benefits, but also included options such as customizing the waiting room, photo capture, file transfer and even accepting payments (via Stripe). I was able to set up my clinic in a matter of a few minutes and a customized URL was available for me to post on my site (unionfamilyeye.com) and on our social media like Facebook. My personal experience is this: patients love the fact that the physician takes time to get on a call/review history and provide ‘best guess solution.’ I say best guess because, besides a swollen lid(s) and/or blood-shot eye(s), it’s hard to make any conclusive diagnosis without the appropriate tools we are used to. A diagnosis like a sub conjunctival hemorrhage is best suited for this scenario. All advertising avenues for telehealth resources have images of ‘perfect looking models, posing at the camera;’ in reality, patients are using their kitchen table with a light source directly above or behind them making an assessment of their ocular complaint that much more challenging. One of my first calls in this pandemic had a classic case of iritis—it was an existing patient with Sjogren’s who has had a past episode; her description was ‘I feel the same kind of deep pain; but my eye is clear’. So it was not my ‘observation’ through the screen, but a detailed history made this tele-consult very productive, allowing me to send the right medication to the pharmacy. It is very reassuring for the patient to be able to see and listen to you; but I am left with a lingering question about the nature of my diagnosis, until I follow up in 24 hrs. Fortunately, the cases I’ve handled have all gotten better. My ability to deliver quality care has not changed; but my reach has increased to non-patients. A classic example is a wife who sees me for her eye exam, but her husband has always seen a provider close to his work. Since, I’ve had an opportunity to communicate with the wife at home, and the husband looking over, I was able to win him over with my approach to care. So, my reach into other family members has surely increased. The few patients we have seen thus far have paid us co-pays, and the insurance companies have paid little to nothing. That doesn’t come as a surprise at all, as optometry has never had the influence at the table, when it comes to reimbursements. Of course, the $20.00 collected is better than zero dollars, and the opportunity to help someone in need is not measurable in dollars. Dr. Allan Tocker Tocker Eyes Wilmington, Del. Last year, way before COVID, I started thinking that the paradigm was about to shift in the way that patients seek health care. The old paradigm is if you don’t feel well, you call the doctor and make an appointment. That appointment may not be for a week. Then you have to drive to the doctor’s office, see the doctor and then maybe go to the pharmacy. That takes a lot of time, which is not consistent with where the world is going. I knew there must be an easier solution. I thought about what Millennials do. If they’re home and craving pizza but don’t feel like going out, they call Door Dash. That’s how they operate, that’s their life. I thought there’s got to be some way for optometry to get a foothold in this. My staff and I did some exploring and came up with EyecareLive. We learned the platform, downloaded the app, notified our patients and signed them up. The way it works is that if you wake up in the morning and your eye hurts, maybe you have a sty, or maybe you just broke your glasses, all you have to do is go onto EyecareLive, and within seconds, I’m FaceTiming with that patient and the problem is solved. I can say to them this is what you need, I’m going to call this into your pharmacy and it’s over. They list their chief complaint and you can answer, or text. There are a number of ways to communicate with patients. Usually patients call about pretty simple things. Ninety-five percent of the time, it’s ‘My eye is red, it hurts.’ Most ODs can handle that in about 5 seconds. The main thing is that the patient doesn’t have to leave the house, except maybe to go to the pharmacy. That’s it. The whole thing is quick. Compare that to the old way, which is a three-hour operation. Patients are so happy with this. Brittany J. McMurren, OD Chief of Clinical Research Werner Optometry El Cajon, Calif. I had no experience with telehealth prior to the pandemic. But we’ve all gotten that super close-up shot of a red eye from a neighbor at 10 o’clock at night asking for help, so I feel like we’ve actually been practicing telehealth already, but not getting paid for it. We recently began using doxy.me. We found it through education provided by Vision Source early on during this pandemic. I’m also to going to demo the new telehealth platform our EHR system just released. I was pleasantly surprised with how much faster these telehealth visits can be compared to in-office visits. On average, I think the telehealth visits have only been taking one half to one third of the time our traditional office visits take. I love the increased efficiency. I think as patients become more familiar with telehealth, the efficiency will improve even more. Telehealth allows us to have multiple doctors working at the same time, despite the fact that we only have three exam lanes. I can do telehealth appointments from home while my colleague is physically seeing patients in office. No office remodel required! We’re finding that the patients who are best served by telehealth are those with emergency red eyes and dry eye follow ups. Some contact lens follow-ups have been a really easy transition. Also, reviewing test results with patients has been great. We can even screen-share and show the patient the results directly. Telehealth has really expanded the reach of our clinic. It’s helped us connect with people that physically cannot easily make it to the office. We’ve gotten an overwhelmingly positive response from our patients. The added convenience makes it possible to get eyecare when you need it. I really think that removing the barriers of having to take time off from work, drive to the office, and sit in the waiting room, is going to encourage more people to look after their ocular health. Now that we’ve experienced the tools telehealth can provide us, we definitely want to continue using it in the future. Telehealth was our second largest source of revenue while we were under shelter-in-place. Only time will tell how much it will contribute to our profit once we are back up to running at full capacity. 100 percent of our services have been reimbursed from Medicare and Commercial insurance. Aside from PEC, who did reimburse in full, only medical insurances were billed. We did not attempt to get 99-exam coverage through vision only plans. Chris Owens, OD Carolina Center for Eye Care Advance, N.C. “We weren’t using telehealth before the pandemic, but now we use doxy.me for emergencies and contact lens prescription refills, and our usage is increasing. During the pandemic, it’s provided a small revenue stream that otherwise we wouldn’t have had. It’s a great avenue for patient to have face time with their trusted provider, especially during the pandemic. It’s also a great starting point for emergent care with an established practice that may not have had availability for many new patients. I’ve found that the patients that are best served by telehealth are ailing seniors with poor access and poor mobility, and for patients who have time sensitive follow-ups for medical testing or treatments. Although telehealth is innovative, it doesn’t take the place of interacting in-person with patients. Now that we’ve reopened, in-person encounters are ramping up, and that’s time consuming, so we’ll rely less on telehealth.” Troy White, OD Kapperman, White and McGarvey Eyecare Chattanooga, Tenn. We didn’t start until using telehealth before the pandemic, but the virus has forced telehealth into the limelight. We’re using doxy.me. It has a secure platform, and one version lets you email a link to the patient and they can just click that link and they’re in a virtual waiting room. I just click on that patient and now I’m seeing them face to face over their phone. There’s no download. We’ve also used a tele-optometry service developed by an optometrist, Mike Rothschild. We’ve used Zoom or FaceTime to meet with patients who have dry eye or irritated eyes. We saw one patient, an older lady, who had double vision. Her husband held the phone so I could get a look into her eye and see her eye movement. We set her up with her primary care physician to get a scan. She didn’t have to come into the office or risk getting exposed to the virus. Seeing patients this way can be challenging, though. Even if you have somebody hold their camera up to their eye it’s hard to see much. You’re really using your doctor skills. If you know their age and take a good history, you’re going to know 70 percent to 80 percent of the time what their diagnosis is.