8 lessons the COVID-19 pandemic has taught us
Excerpted from page 36 of the September/October 2020 edition of AOA Focus.
About eight months have passed since the COVID-19 outbreak first struck the U.S. And during that time, the world has had to learn how to live with a virus that has infected millions.
According to a survey by the AOA Health Policy Institute, 80% of doctors of optometry provided emergent and urgent care services to patients during the pandemic while 11% did not provide patient care at all. More than two-thirds of doctors saw less than 5% of their typical pre-pandemic patient volume and three out of four doctors had personally taken a reduction in income to protect the practice during the pandemic.
It’s been a bumpy road, but some of the lessons learned have changed optometry practices forever.
“The eyes are vulnerable and merit our protection and care. They can be a point of entry or they can manifest the infectious or inflammatory effects of the disease,” says Lynn Greenspan, O.D., who practices in Philadelphia, Pennsylvania. “But now, as we reemerge from our seclusion, while the masks protect and hide our faces, it is the eyes that endure and peek out visibly to others. Socially, we have become strangers except for our eyes. There has never been a better time to share that true smile—the one so big that it reaches the eyes.”
1. Rethink office flow.
“The COVID-19 pandemic shutdown allowed us to reevaluate our policies, procedures and systems and really come up with a better way to see patients in a more streamlined and efficient manner. We’ve done this by sending out patient forms ahead of time and then calling the patient the day before their exam to get the chief complaint, review medications and preliminary history data, and go over COVID-19 screening questions. When the patient arrives at our office, their temperature is taken, they sign the screening questions form and they are taken immediately back to an exam room. This process has sped up the preliminary history taking and decreased the amount of time the patient waits to see the doctor. We’ve been able to cut the patient’s time in our office in half and develop an overall better eye health experience for our patients.”
–Jeff Klein, O.D., Norfolk, Nebraska
2. Telehealth won’t work for everyone.
“Telehealth was much less accessible than I thought it would be. Our office remained open as a covering facility for several optometry and ophthalmology practices in our area. It was interesting to see that the majority of the patients who probably could have been seen remotely either did not have the technology or the interest in doing so. Many of the elderly with mundane issues either could not figure out how to use the virtual systems or refused to do online visits stating that they wanted to be seen in person. The final frustration was that the insurance carriers changed the rules on submission weekly regarding what to bill, what modifiers to use and who could use the codes. While our profession was definitely positioned to help reduce patients’ exposure to hospitals and urgent care facilities, it was a difficult learning curve for us.”
–Harvey Richman, O.D., Manasquan, New Jersey
“As the majority of my patients are visually impaired, what I’ve learned as an optometrist during this pandemic is how isolated my patient population felt. They were looking forward to their appointment as they struggled with daily living activities and needed my services as a means of obtaining and mastering the skills needed to function. We did offer telemedicine via phone and video calls, but many of them live alone and did not have the visual or technical skills to participate. Combine that with poor hearing or reduced cognitive skills, and the virtual visits were overly frustrating to the patients and my practice. Fortunately, our state now allows for full eye care services to be delivered, and these patients are back to being taken care of.”
–Maria Richman, O.D., Manasquan, New Jersey
Read the AOA’s newly revised, agenda-setting position statement on telemedicine’s role in optometry.
3. Cut through the clutter.
I learned how quickly your inbox can fill up. No one individual could process, research and be aware of all that was necessary to keep our practices running during the closure and the preparation for reopening. The AOA, Pennsylvania Optometric Association and Vision Source provided invaluable resources to filter, interpret and reinforce what was essential knowledge as we navigated this period. This was an excellent example of the value of support from organizations dedicated to optometry’s survival.”
–Carl Urbanski, O.D., Kingston, Pennsylvania
4. Keep a cash reserve.
“Whether you are an owner, associate, employee or contractor, you need a strong financial safety net. Keep at least 90 days of cash reserves/liquid assets in case of an emergency. This applies to both your personal and business finances. What if the Paycheck Protection Program, Economic Injury Disaster Loans and Health & Human Services stimulus were not available the next time? Prepare for the ‘what ifs’ and you will sleep better. I personally made it through fine, but it would have been even less stressful had I had greater reserves. I am building that now, so I will be prepared for anything. The fact that as soon as the shutdowns happened, businesses (not just optometry offices) laid off or furloughed many of their employees I think points to the fact that many businesses operate day to day or week to week and are not built to survive. No matter the size of the business or how much one makes personally, I firmly believe in using a professional team consisting of a financial adviser, an accountant and an attorney.”
–Jerry Neidigh Jr., O.D., Richmond, Virginia
5. The office has and always will be a safe environment.
“As an optometric practice that provides urgent and medical eye care, we remained open during the global pandemic. Our local hospital referred ocular emergencies to local eye care providers and we treated many patients to help reduce emergency clinic patient load. We met with our staff to remind them that we see contagious diseases in our office on a regular basis, using viral conjunctivitis as an example. For all patients, we implemented our typical protocols of using personal protective equipment and cleaning the office and exam lanes. We adjusted our schedule to accommodate patient social distancing in order to provide our essential optometry services and provide a safe environment for ocular emergencies.”
– Jamie Casper, O.D., Wilmington, North Carolina
6. Don’t be so hard on yourself.
"I derive a lot of my identity from my profession. Being a homeschooling, fulltime mom on unemployment was hard for me to embrace as my new identity—and my new job was freaking hard! I loved the full-time mom part, but it was hard to not be proficient in my new job of homeschooling. I realized that a great deal of how I define myself is based upon optometry. From homeschooling, I also learned to give myself grace. Homeschooling certainly was not my strength, but it was crisis homeschooling. (In optometry), when we choose a new endeavor, we research, we contemplate and we make informed decisions. It was OK during a crisis to be mediocre.”
– Mamie Chan, O.D., Albuquerque, New Mexico
7. Rekindle the fire.
“I always knew I had a fire in my belly but was unaware that fire had become a low, constant flame—an auto pilot of sorts. The pandemic kicked that pilot light into a full, roaring flame that reenergized my passion for my craft. I have never worked so diligently, for so little financial gain with so much fulfilment! The smiles of gratitude hidden under the masks of patients in dire need of eye care are priceless. I have a renewed sense of honor and pride in fulfilling the optometric oath I took 32 years ago! I have learned many other things related to the specifics of patient care and office efficiencies, but this was my most rewarding takeaway after nearly two months of urgent-care-only visits prior to re-opening to comprehensive care.”
–Pamela Lowe, O.D., Niles, Illinois
8. Learn from each other.
“As an optometrist and AOA chief public health officer, I have had the unique honor to communicate directly, often by phone, with over 400 optometry offices (doctors and staff) throughout the nation who reached out to the AOA for advice and counsel. I learned much from those conversations including: 1) Most have ongoing concerns about quality and accessibility of personal protective equipment; 2) All have assisted the public health response to the pandemic by providing emergency and urgent care, successfully diverting patients away from hospital emergency departments; 3) All the doctors were most concerned about patient and staff safety and were intent on making their care delivery as safe as possible; 4) Some had instances of positive COVID-19 office exposures and each closed their practice and followed public health guidance to reduce community spread and assist contact tracing. There will be growing demands as the pandemic progresses and office sustainability stretches, but these communications assure me that optometrists and their staff are open to learning how best to assimilate knowledge and to adapt for the public health and clinical challenges ahead.”
– Michael Duenas, O.D., Alexandria, Virginia
For the latest updates, visit the AOA’s COVID-19 crisis response page.
Under new rules for the 21st Century Cures Act, doctors of optometry will need to prepare for changes going into effect April 5. Doctors should check in with their health IT vendor in order to make sure they meet the new requirements.
The IRS’ decision regarding the tax treatment of PPP loans could turn what was intended to be a tax-free loan into taxable income for 2020.