As the coronavirus spreads across the globe, many ophthalmologists are left wondering how to continue to care for their patients, keep their staff safe, and their practices afloat, all while complying with the new “normal” of social distancing.
Reducing Services and Staff
At the recommendation of the American Academy of Ophthalmology (AAO), many practices have stripped down what services they offer to just the bare minimum.
“Since the pandemic began, I have stopped performing surgery and elective procedures and have reduced my clinic schedule to urgent care only,” said Jennifer Loh, MD, an ophthalmologist practicing in Miami, FL.
William F. Wiley, MD, an ophthalmologist in Brecksville, OH, has also limited services to urgent and emergent cases. “COVID-19 has completely disrupted eye care services at our practice,” he said. “It is hard to foresee the long-term impacts this will have on our practice.”
The lasting effect may be unknown, but the short-term ones have already become clear as many practices are forced to lay off staff.
“We are prioritizing team and patients,” he said. “The team that has dedicated their lives to us is our foremost priority, so we have spent enormous time understanding the CARES Act to ensure they are OK,” said John Berdahl, MD, an ophthalmologist in Sioux Falls, SD.
Intended to provide financial aid to families and businesses impacted by the pandemic, the CARES Act (Coronavirus Aid, Relief, and Economic Security Act), amongst other things, sends direct payments to Americans and expands unemployment insurance.
Dr Berdahl is not alone in worrying about his staff. Nearly all the doctors we spoke with were concerned about how the reduction in services would impact their team.
“Our practice has been closed to surgery and new and routine patients [since March],” said Ralph Chu, MD, a medical director in Bloomington, Minnesota. “Most of the staff has been laid off. It’s a very difficult and emotional time because staff was our ‘work family.’”
The Way Forward
Although most ophthalmologists have taken the AAO’s recommendation to only treat urgent cases, that doesn’t negate the very real problems that their patients with less pressing issues are facing. To that end, telemedicine has found a place in ophthalmology.
Since the start of the pandemic, the Centers for Medicare & Medicaid Services have expanded telehealth guidelines, removing restrictions on which patients are eligible and allowing physicians to bill for professional services in all settings, like a patient’s home via teleconferencing technology.
“The COVID-19 challenge will accelerate the adoption of tele-ophthalmology in many of our practices,” said Ehshan Sadri, MD an ophthalmologist in Newport Beach, California. “Ophthalmology enjoys the visual aspect of the examination so the transition should be easier. The HIPAA guidelines and CMS positions [allowing for] reasonable reimbursement will facilitate faster adoption.”
Although telehealth seems to be securing its spot in the future of ophthalmology, not much else is clear.
“The most difficult thing to manage is the uncertainty of the future,” said Dr Chu. “When to bring patients back, when can we open for surgery, what limitations in patient care will look like…what will the new normal be?”