Ready for routine care? AOA offers guidance for post-COVID-19 reactivation

Nationwide, a patchwork of temporary lockdowns and stay-at-home orders to abate the coronavirus pandemic could be ending with phased reopenings soon, prompting AOA guidance on practice reactivation preparations.

While the U.S. public health response to the COVID-19 virus has created unparalleled challenges for many Americans, including doctors of optometry, these drastic social distancing efforts may be slowing spread of the pandemic enough to envision reopening of "routine" eye and vision health care. To prepare for the eventual and safe return to delivering the full range of essential services that Americans need, the AOA offers new guidance for reactivation of optometry practices.

The Optometry Practice Reactivation Preparedness Guide provides doctors of optometry step-by-step recommendations necessary for reopening their practice to "routine" patient care visits. While that decision should be made with informed guidance by the Centers for Disease Control and Prevention (CDC), federal, state and local governments, and the AOA, the re-activation guidance will help ensure practices can hit the ground running.

"This COVID-19 pandemic is very well the greatest public health crisis that we've experienced in our lifetimes, but despite this, we have to be ready to move forward with a 'new normal' when it is safe to do so," says AOA President Barbara L. Horn, O.D. "Doctors of optometry need to be fully prepared today for the actions they take tomorrow, and AOA is at the ready to guide them and be a resource along the way."

'Routine,' urgent and emergent eye care

In March, the CDC and the Centers for Medicare & Medicaid Services (CMS) advised providers to prioritize only urgent and emergent visits and procedures during the COVID-19 public health crisis, and postpone "routine" eye care visits. The AOA supports this guidance and reiterates that doctors of optometry can help reduce current and expected burdens on emergency departments by seeing urgent and emergent eye care cases.

Based on patients' immediate health needs, doctors of optometry can and should use their professional judgement to determine the timing and course of care, including assessing patient-expressed urgency, necessary preventive care, and the monitoring and refilling of prescriptions.

Unfortunately, not all eye care organizations adhere to the federal guidance or directives from local and state authorities, in turn prompting an AOA response that reiterated adherence to current orders and best practices during this pandemic. However, many doctors of optometry remain available in their communities for urgent and emergent care, as well as expanding their services to provide telehealth consultations under current CMS guidance. But already, a return to the "new normal" could be just over the horizon.

On April 16, President Donald Trump unveiled his Opening Up America Again guidelines for a three-phased rollout to reopening a largely shuttered U.S. In response, the CMS issued guidance on April 19 concerning reactivation of essential non-COVID-19 care in regions with low, stabled incidence of the virus.

The CMS' new guidance recommends a gradual transition and encourages providers to coordinate with local and state public health officials, while also reviewing the availability of personal protective equipment and other supplies, workforce availability, facility readiness and testing capacity when making the decision to restart or increase in-person care. Still, the CMS stresses these new recommendations are targeted to communities in Phase 1 —those with low incidence or relatively stable COVID-19 cases.

"Every state and local official will need to assess the situation on the ground to determine the best course forward, but these guidelines provide a gradual process for restarting non-COVID-19 essential care while keeping patients safe," said CMS Administrator Seema Verma, in a news release.

Recommendations on reopening optometry practices

Against this background, some states have already taken steps to reopen parts of their economies, yet this comes as public health authorities and legislators debate timing and concerns over a potential second wave of COVID-19 cases. As communities begin looking toward their phased reopenings, below are a few considerations from AOA's Optometry Practice Reactivation Preparedness Guide about doctors' of optometry own reopenings:

1. Anticipating when you will return to a normal (or new normal) schedule.
2. Develop an action plan for staff to bring the practice back up to speed before reopening doors for both routine and emergency care.
3. Develop a new system for sterilization of the office based on available guidelines.
4. Continue messaging to your patients about urgent and emergent care, as well as reopening for routine care.
5. Prepare for staff needs as they assimilate into the new working environment.
6. Contact other medical professionals in the area to inquire about their own reopenings or new protocols.
7. Post signage in the office indicating new steps and protocols to ensure safety.
8. Utilize AOA resources available at aoa.org.

Finally, don't forget the emotional and psychological toll this pandemic is taking on people, says Chris Wroten, O.D., AOA Federal Relations Committee member and contributor to the reactivation guidance. Engage staff and associates in decision-making on new protocols or policies to enhance buy-in and comfort levels for implementation.

"Be sure staff hear from you as the doctor and ask them to share any concerns —an enthusiastic, reassuring talk and knowing that you value their input can go a long way," Dr. Wroten says. "Make staff aware of counseling options available through their health insurance provider or perhaps other free community options.

For more information on how doctors of optometry and optometry practices can prepare for eventual office reopening, view the April 29 webinar, #AskAOA Webinar: Practice Reopening Guidance, presented by Dr. Wroten.

Have a COVID-19-related question? Send AOA an email to AskAOA@aoa.org.

Find the latest COVID-19 guidance, resources

The AOA continues to closely monitor all developments in the U.S. public health response to COVID-19, as well as institute an all-out mobilization on behalf of the profession that includes not only 24/7 advocacy for optometry in Washington, D.C., but also launching an unprecedented, multifaceted relief and recovery package.

Given the evolving nature of this pandemic, the AOA remains committed to providing the most up-to-date information, relevant care guidance and resources, and timely reports on federal actions through AOA's COVID-19 Crisis Response page. This online resource includes:

• The AOA Health Policy Institute's "Doctors of Optometry and COVID-19" statement and FAQ.
• #AskAOA COVID-19 webinar series.
• State-by-state COVID-19 resources and information.
• Latest information from CDC and White House Coronavirus Task Force.

Doctors of optometry are encouraged to be aware of the current COVID-19 situation in their communities and stay attuned to the latest public health guidance.