NEW YORK—With the spread of COVID-19, just about every aspect of life has been affected for U.S. consumers and patients, and health care ranks high among the part of life under transformation. One significant change is that today both patients and providers are asking themselves what “services” need to be in the office and what services can absolutely be done outside the office via video conference or other means of interacting with the patient.

Many ECPs are testing or implementing these services that—in part because of changes to regulations such as HIPAA—make health care visits both safer and more convenient for the patient, and help the OD adapt to a new in-office care model.

“There are lots of ways that you can improve that patient experience by adding some form of telemedicine or by using it as an adjunct for your in-office visits,” Artis Beatty, OD, chief medical officer of MyEyeDr., told Vision Monday in a recent interview. He noted the patient experience, from start to finish, is evolving in a way that ODs are doing simple things such as intake, history and/or demographic data collection using a portal that enables patients to input data before they get to the office.

MyEyeDr., which has more than 600 locations nationwide, was actively looking into telehealth prior to the March shutdown and considering different ways to interact with patients, Beatty said. The company accelerated this work once it paused in-office visits and, with changes to HIPAA regulations, was able to do things with iPhones and video chat services features that it wouldn’t have been able to do prior to COVID-19.

“This really helped us understand how often our patients really wanted to interact with us … and what the implications of this are,” he said.

Currently, MyEyeDr. is working on a telehealth pilot with EyeCare Live that involves doctors in a few different states.

“One of the things that has been difficult for optometry, and something that we have learned a lot about, is the disjointed technologies,” Beatty added, noting that health care providers outside of eyecare “have gotten much better at being able to provide some sort of advice, diagnosis and examination via telehealth.”

In eyecare, there have been many questions about managed vision care coverage and what’s allowed, and whether ODs are able to bill medical carriers for certain services. Eyecare providers need “more uniformity on what’s covered and what is not covered and how we actually provide telehealth services via a third party,” Beatty noted.

He added, “All of those things came into question very quickly [during] COVID. I think we realized that the industry was behind the curve [and] we needed to be better about developing the technology and about being able to share information across platforms or between providers or between eyecare providers and general health care providers.”

Todd Bellamy, OD, medical director at St. Louis-based EyeCare Partners, spearheaded the effort to launch telehealth in March across the 480-site eyecare group, which had not yet implemented a telehealth option pre-COVID-19.

“We quickly worked with the Backline app available through Doctor First to launch a system in a matter of days once we began limiting our office schedules due to COVID-19,” Bellamy said.

“It was critical for us to provide an option for our eye doctors to safely and securely work with patients during this time. Our patients needed an option that kept them away from an urgent care or hospital for the diagnosis and treatment of urgent eye conditions.”

Bellamy said using telehealth EyeCare Partners now can reach patients who cannot come into the office for any reason and “further expands our options for being available to patients after office hours.”

He added, “We will continue to provide this as an ongoing option to our patients. We realize certain conditions may be monitored via telehealth visits as opposed to having the patient come into the office, and providing that service is valuable to our patients and doctors.”

He also noted that an area where EyeCare Partners sees important advantages is with at-risk elderly patients or for those without meaningful transportation availability.

Regional retailer Shopko Optical had partnered with DigitalOptometrics for a store test in November 2019, and was expanding that to another three stores in February. When the coronavirus led to office/optical closings, Shopko Optical expanded that test so it expects to have 20 stores up and running with DigitalOptometrics during the June-July time frame, according to Kirk Lauterback, chief operating officer of the 80-location optical firm.

“We have worked with them to expand their program even while we were closed,” he said. “So we are able to offer that added level of convenience for our patients, especially in under-served markets.”

The model Shopko is working with at the first few locations utilizes Shopko Optical doctors, and the company expects to predominantly use Shopko Optical ODs as it expands. “We really like the partnership model they provide, and we feel that this is as close to the in-person exam that a patient is going to receive,” Lauterback he said.

He added, “We still believe fundamentally that the best experience a patient is going to have is with an in-person doctor We truly believe that and we value the relationship that we have with our doctors, but there are opportunities where the demand is great or they are in a community where they are underserved. This adds the ability to actually take care of patients and that critical eyecare.”

The patient reaction to the telehealth option has been “very, very good so far,” Lauterback said, noting the retailer closely tracks net promoter scores to stay on top of consumer/patient sentiments.

“The patients like it and the team has really embraced the technology, too. We put together with DigitalOptometrics a robust training program so that we ensured that not only is the training right but that at the same time it’s hands-on and the [team] gets to work with the program and to work with equipment to make sure they are comfortable with it. And then the patient can have a very seamless experience in the center.”

Lauterback said he believes telehealth technology will continue to improve. “We’re scratching the surface as far as what we can potentially have in the future. But I like this model because I think it complements the in-person experience that we already have with our optometrists very well. And in my book, at least right now, there is no substitute for that experience.”

AEG Vision (150-plus locations) also has used the opportunity of HIPAA changes to look at some telehealth options, according to Benjamin Chudner, OD, FAAO, chief medical officer and vice president of eyecare. During the closed-offices period, patients could contact their usual AEG practice location via the call center or office phone, which led to a doctor follow-up and evaluation. Patients could use options such as Zoom or FaceTime to interact with the OD, who would then determine if the patient needed to be seen in the office or if the situation could be handled remotely.

“Obviously, telehealth is growing, and certainly in other [health] professions it is becoming more mainstream,” Chudner said. “It’s not uncommon for insurance companies to allow you to see a nurse practitioner via telehealth prior to going into see the doctor…. So, it’s obviously not on the fringe anymore.”

Still, AEG did not find “a significant number of patients that had conditions that could be managed solely through telehealth” and that would support expanding the telehealth option at this time, Chudner said, noting that the COVID-19 situation presented an ideal opportunity to test telehealth services.

“What we found was that the demand was not that great for telehealth in optometry, and even those patients who did end up using telehealth many of those still had to be seen in person,” he explained. “The doctor didn’t feel comfortable with the tools available to diagnose their condition appropriately without access to a slit lamp or to a BIO [binocular indirect ophthalmoscope].”

He added, “Currently, I think there is an opportunity there and we are going to explore how we can incorporate this into our normal practice in different scenarios. But I just don’t think from what we saw that the revenue is there or the patient volume is there to justify the costs to implement telehealth on a widespread scale.”

In late March, as the coronavirus situation worsened, Palm Springs, Fla.-based My Eyelab and Stanton Optical (both retail brands of Now Optics) moved to a virtual eyecare model at 119 participating locations in partnership with Physicians Eyecare Group, the company noted at the time. Now Optics, which operates about 180 corporate and franchise locations in 25 states, with its affiliated network of doctors have been performing telehealth eye exams for over three years, using a proprietary telehealth technology before and during the pandemic, chief executive Daniel Stanton told Vision Monday in a statement.

The proprietary technology allows for doctors to receive all the diagnostic data that is collected onsite or adjacent to a Stanton Optical or My Eyelab. In addition to collection of data, the technology allows for a remote refraction. The doctors use the collected data and the patient’s oral notes to then determine the best vision plan for the patient, Stanton said.

“Our telehealth technology allowed us to provide patients with a solution during a time when not many options were available,” he said. “We were able to remain open and service all patient needs.”

Stanton added, “This pandemic has opened the door for innovation and telehealth as a viable solution to a changing world. As more patients and doctors embrace new technology and continue to find ways to adapt to what telehealth has to offer, we will continue to see its benefits.”