EYECARE Envisioning the Future of Ocular Telehealth By Andrew Karp and Mark Tosh Monday, June 22, 2020 12:32 AM RELATED CONTENT Virtual Vision Care Grows Up Special Report on Telemedicine: The Time for Optometry is Now Making the Leap into Telehealth 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 Key Trends in Ocular Telehealth Now that ocular telehealth’s long-term viability has been established, the question becomes: how can it continue to elevate the patient experience? The wide range of responses from optometrists and ocular telehealth executives points to a future in which virtual vision will integrate with conventional eyecare to satisfy patient needs and create new opportunities for practice and business growth. Keshav Bhat, OD Union Family Eyecare Matthews, N.C. My impression is that telehealth is here to stay, but its value in the core strength of optometry, refractive assessment, has some ways to go. Assessments of dry eye, follow-up visits on contact lens care (which typically have no reimbursement or financial value) can be done remotely, while opening that slot for in-person care. Physicians can now review test findings from glaucoma, Sjogrens and such, making them billable visits. Masoud Nafey, OD, FAAO Chief Medical Officer VisionWeb I think ODs, in general, are going to be a lot more accepting of telehealth visits for specific appointment types, such as contact lens follow-ups… and some medical follow-ups. [But, perhaps eyecare is not ready yet for telehealth for routine exams.] We don’t have the technology to take routine exams to full telehealth virtual visits. And the refraction part is the most sensitive piece to ECPs. We, and I put that in quotes, we have a lot of pride in our refractions. And we know that this is one of the major reasons patients come back to see us, because we help them to see extremely clearly. … I don’t think the technology is there [for refractions] and I also don’t think the trust is there. But I would say that for telehealth there is definitely a place for it. Pre-Covid, busy practices were seeing patients every 15 minutes. With the new protocols being put in place for COVID-19, and health and safety measures, practices now will [see] a patient in every 20- or 30-minute time slots. How will they make up for the volume of patients they were seeing that they can’t see anymore? This is where telehealth can come in to supplement some of those visits and allow [the ECP] to see patients in a different way. Howard Fried, OD DigitalOptometrics The nationwide acceptance of ocular telehealth by all engaged in the optical industry, including practitioners, patients, retailers and government, has resulted in a great deal of traction for it, even prior to the pandemic. But the pandemic further underscored the benefits of remote exams. That has generated even more momentum for ocular telehealth technology solutions, which will continue to supplement traditional methods of ocular exams. Mike Rothschild, OD Leadership OD I think the interest in telehealth is going to stay high, and it’s going to be fueled by two things. In the short term, it will be the interest in staying safe around patients. There is an imminent concern [today] about decreasing exposure to the coronavirus, which will keep the interest level high. Then, as we implement these changes, we will realize there are other benefits from the changes we put in place. For example, I think we’ll find there are benefits to having a conversation with the patient before they show up to the office. Typically, when someone comes in for an eye exam, we do all of the tests that we have available. But, if we’re talking to them before their examination and we get a sense of what they need or what they are concerned with, then maybe we only do the tests they need. In this way, we’re not wasting tests and we’re not wasting the patients’ time. So that will be a benefit. So, yes, there’s going to be long-term interest in telehealth. In the short term, this is fueled by let’s just figure this [safety issue] out. And, long term, it will be finding a way to continue the unintended benefits of telehealth. Troy White, OD Kapperman, White and McGarvey Eyecare Chattanooga, Tenn. Telehealth has huge potential, particularly worldwide. We do missions in foreign countries. Having some type of camera, or video slit lamp with some type of remote imaging system could be very helpful. Moshe Mendelson, OD EyecareLive I see an Uber model for our industry. Let’s say you have dry eye, and there are five doctors in your area who are providing telemedicine services. You choose one, and they take your medical history, general health assessment and a list of medications. If the doctor determines you’re a good candidate for Restasis, then they prescribe it, with no refill, because it’s very low risk. Then you need to come to their office for follow up. This will appeal to a lot of young people who are on the sidelines now. Practitioner reimbursement issues are being resolved. ECPs are being educated on how to use and bill for telehealth. Regulations have been modified. Remote patient monitoring will result in tighter ECP-patient engagement. Reduced no show rate as well as better opportunity cost realization. I also believe that insurance companies will promote telehealth as a cost savings option. Optometry is evolving. The profession must embrace telehealth in order to thrive and stay relevant. John Serri, PhD EyeQue I don’t believe that ocular telehealth has quite reached a tipping point. There is still a way to go. However, COVID-19 has been accelerating exploration and adoption for both consumers and eyecare practitioners. Consumers have sought out ways to do things from home they never imagined and many found EyeQue for the first time. They’ve also been subjected to other telehealth appointments by medical doctors needing to perform regular check-ins with their patients virtually during community lockdowns. So, I think the foundation is stronger than ever for consumers to recognize and enjoy the benefits of telehealth and for practitioners to incorporate telehealth into their practice. Ocular telehealth is here to stay. Vitor Pamplona EyeNetra The age of the shared economy, the defining factor of the last decade, is mostly gone. Shared equipment and office spaces among patients bring real health risks to everyone involved. And those risks have been in constant display in every media, for the past four months, worldwide. Those new risks increase costs for retail. If it was hard to compete previously, it’s about to become harder. We are starting a decade of self-sufficiency. Where people will be more susceptible to owning tools, living further from cities and doing things from home as opposed to going to a service center or to an office, even if such services are better. It might not be as drastic as some prominent pundits are speculating, but it will be one of the defining characteristics of the ’20s. For those developing medical devices today, I hope you are either a direct-to-consumer unit or a contactless tool for providers. There’s little interest in anything else. Greg Lechner 2020Now Historically, the doctors have viewed ocular telehealth as a threat, something that’s going to put them out of business. Over the course of optical history, there have been new technologies that were initially perceived as a threat, but ultimately came to be viewed as an enhancement for the doctors and their practice. The auto-refractor is a classic example. When they first came out, everyone thought they were going to put doctors out of business. That didn’t happen. Today, almost every doctor uses an auto-refractor to make their office more productive. We see the same thing happening with telehealth. Initially it was perceived that the patients are going to be doing online eye exams. Instead we’re going to continue to see eye exams done within physical brick-and- mortar location. It’s going to continue to see patients having eye exams done at the doctor’s office because that’s where all the high tech equipment is located, but we’re going to make that process more efficient and we’re going to enable the doctor to work home if they want to. We’re going to allow the doctor to keep the practice open if they’re not available, we’re going to allow the doctor to expand their hours and their services by using telehealth when they’re not available. And we’re going to allow increased eyecare access in rural communities where there’s a shortage of doctors. Bryan M. Rogoff, OD, MBA, CPHM, FAAO Founder and Consultant EyeExec Consulting LLC Senior Product Manager of Disease Management Carl Zeiss Meditec Inc. One challenge today for ECPs is making sure clinical workflows are compliant so that patients feel safe, as well as staff and doctors feel safe. Another question is whether telehealth will enable us to reduce patient in-office visits, but still provide adequate patient care and achieve the volume that was there prior to COVID-19. Some Electronic Medical Records (EMR) companies have telemedicine or tele-consultation built into their platforms, which allows the process to be more seamless. Doctors who don’t have this built in are working out different protocols and trying different workflows. There isn’t really a one-stop solution yet for ocular telemedicine. When it comes to eyecare and diagnostics, it is complicated with the current solutions that patients have, which basically are a smartphone and a computer. There’s only so much you can do with this. As a result, we are seeing hybrid models come about, which allows us to do a couple of things. We can expedite the process so the patient doesn’t have to be here for an hour and we can create different workflows and change floor plans to have a smaller waiting area. Some practices are using the parking lot as a waiting area. Some larger ophthalmology groups have discussed having a hub-and-spoke model for diagnostics. If they have four or five offices, they create a central office where all the diagnostics can be done. They are using telemedicine applications to conduct the consultation and instructing patients to go to different offices as needed. This is technically a hybrid solution that utilizes centralized diagnostics and telemedicine consultative care. But eyecare is not like other health professions, where the smartphone can be used for essential diagnostics, such as blood pressures or EKGs. When it comes to viewing the fundus or other ocular structures, those capabilities require additional equipment and additional tasks that the patient may not nearly be as good about. As far as the billing side, I think this will be very dynamic. HIPAA regulations will most likely be back in place [at some point] to protect patients’ information. CMS is sure to have some changes in what they are doing. Going forward, you will see the creativity of some practices meeting demands of patients and to increase revenues. There are new drivers of telemedicine and tele-consultation that have been introduced due to COVID-19. You are going to see a lot of solutions from individual practices as they start to try a little piece here and a piece there. And the overall industry is going to respond in various ways to make sure communication with practices and with patients continues.