How to hit the ground running once practices reopen

Doctors of optometry weigh how to hit the ground running once practices reopen

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Doctors of optometry, like small-business operators countrywide, are grappling with the new normal of the pandemic crisis, even as they deliver emergency and urgent care to their patients.

"If the crisis that each and every one of us is facing has taught us anything, it is that doctors of optometry are resilient and we are identifying new and out-of-the-box ways to navigate this challenge," says Barbara L. Horn, O.D., AOA president. "The urgent and emergent care we are delivering today and the plans we are establishing for tomorrow demonstrate our collective strength and the passion we have for our patients and communities."

Beyond reorganizing their offices and joining webinars, they are considering how they can best serve the needs of their patients and staffs going forward. It won't be care as usual, they say.

New perspective on practicing

It used to be on a nice day in North Bergen, New Jersey, Rodolfo Rodriguez, O.D., could walk the half dozen blocks from his practice to the Hudson River and get a view of the spectacular New York skyline. The view isn't nearly as rosy now, as the city is considered the epicenter of the COVID-19 pandemic. New Jersey also has been hard hit by cases.

His practice provides overwhelmingly medical eye care, for such conditions as diabetic retinopathy, glaucoma and dry eye. Since the virus exploded across the globe, Dr. Rodriguez's thoughts have increasingly turned toward what the future will bring. He calls it a "new normal."

"We've definitely been thinking about it," he says. "We've definitely been talking about it."

For instance, once they reopen, he says, social distancing will become standard procedure in their waiting rooms. The practice will be purchasing more thermometers, so each patient's temperature can be taken upon their arrival visits. Patient histories will be adjusted to include questions about the virus.

And even his approach to telehealth is getting a second look, as he has reviewed routine patient cases via email and patient-generated photos during the pandemic. Many states are reducing barriers to providing telehealth services, the Centers for Medicare & Medicaid Services has temporarily waived requirements on out-of-state providers, and Medicaid has plans to expand telehealth coverage. Read the AOA guide to telehealth-based care during the pandemic.

"Definitely we will be doing things differently," Dr. Rodriguez says.

Getting a handle on the crisis

The practice of Jeff Klein, O.D., and Ann Feidler-Klein, O.D., is a rural one. Located in Norfolk, Nebraska, population of about 23,000, their practice typically sees about 40 patients a day. It's not unusual for some patients to drive from two to three hours away for eye care provided there. These days, however, there's not so much patient traffic-not since the Centers for Disease Control and Prevention and AOA guidance came down on providing safe care during the pandemic.

"Things are really slow," Dr. Klein says. "We're down to about four patients a day in the practice (for emergency care). We're screening patients on the phone. I've probably done eight telehealth exams so far. That's been working well. I've also been doing some FaceTiming.

"I think the first few weeks there was a lot of uncertainty and a lot of angst trying to decide how we were going to take care of our patients and staff," he says. "The last two weeks have been a little bit better. The (Medicare stimulus money and the PPP loan) are helping us and we're getting a little better handle on this. The first three or four weeks were a little dicey. There were a lot of sleepless nights, webinars and emails."

What was weighing so heavily on his mind?

Patients and staff.

He was committed to providing the best care possible to patients under these unusual circumstances. Further, Dr. Klein knew he would have to eventually reduce his 10-member staff, which he dreaded. The SBA loan will cover the cost of payroll and some other expenses. Pandemic financial relief, under the CARES Act, has enabled doctors of optometry to keep paying staff and seeing patients.

Dr. Klein had always preferred to see patients in the office, which offers the best opportunity for more thorough comprehensive eye exams. He still prefers the office. "But this may be something that pushes me to do more telehealth," he says.

"The challenge now is when we get back to seeing patients," he says. "We want to hit the ground running."

New way of learning

Bibin Cherian, AOSA president and fourth-year student at Northeastern Oklahoma State University College of Optometry, had imagined his final year being different than it has been since the pandemic, though he's making the best of it.

Cherian normally would be in clinic, seeing patients in person.

"With the current pandemic, students are unable to go to clinics and have to substitute with cases from professors or other types of online learning," he explains. "Although patient interaction can't be substituted with virtual learning, students are at least able to review cases during this time.

"This pandemic has also been especially disappointing as a fourth-year student," he adds. "Every student looks forward to walking across the stage but will now have to experience that virtually or have it postponed."

If there is a silver lining during these uncertain times, it is this:

The CARES Act, signed in March, provided for temporary relief for student loan borrowers. Student loan payments, principal and interest, would be deferred for six months through Sept. 30 for optometry students and others without penalty for all federally owned loans.

"The temporary suspension of interest has been extremely beneficial," Cherian says. "As a fourth-year student with approximately $160,000 in student loan debt, the interest was steadily increasing, especially with the high principal. This temporary stop is helping to save money in interest.

"Although some students choose to pay down principal/interest in school, the loan repayment only starts six months after graduation," he says. "However, deferred payments are extremely beneficial for recent graduates who may have been furloughed and unable to make payments. It helps all students who had to take out loans during optometry school. I'm grateful they included that provision in the CARES Act. I hope student concerns continue to be addressed in further legislation if this pandemic continues longer than expected."

For more information on how doctors of optometry and optometry practices can secure federal crisis relief aid, please visit aoa.org/coronavirus or send an email to AskAOA@aoa.org.

April 16, 2020

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