While virtual eye care is certainly not new, the pandemic was a catalyst to adopt a virtual eye care platform to continue to care for patients — even during mandatory closures or periods of quarantine. (See “Types of Telemedicine,” p. 36.) As those regulations lifted, many found that virtual eye care had a permanent place in their practices. But, the implementation and use of various telemedicine platforms has looked quite different from one practice to the next, as you’ll see in reading about the experiences of three optometrists.
EMERGENCY/AFTER-HOURS VISITS
Christopher Wolfe, OD, FAAO, of Exclusively Eyecare, in Omaha, Neb., says he typically uses telemedicine for emergency or after-hours visits.
“With telemedicine, I am now on call 24/7 with my patients, but in a way that is reasonable, and I am comfortable doing it,” he says. “Previously, if my patients were out of the area or I was out of the area, I would have to find another doctor who could see them. But now, I can take a look at them myself.”
Dr. Wolfe provides the example of when he and a patient were both out of town, in Washington, DC and Arizona, respectively: He divulges that the patient reported a swollen eyelid, though a description alone wasn’t enough to distinguish between allergies or an internal hordeolum or preceptal cellulitis. Telemedicine enabled him to see the patient’s eye, ask more specific questions based on that examination, and, therefore, determine the best management. (See An Eye on Telemedicine in Practice,” p. 38.)
The telemedicine platform Dr. Wolfe uses employs a login link that is texted to the patient, which then places the patient in “waiting room” mode, until he is ready to see them.
“In my opinion, telemedicine is a good intermediate step that keeps us better connected with patients,” he offers. “It’s also important to consider that our time as a physician is valuable. If we are giving up time with the family to see patients, there should be a mechanism that allows us to be compensated for that time. Telemedicine is that mechanism.” (See “Reimbursement for Telehealth Services,” p. 38.)
STAFF GAPS
While some practices are using telemedicine to see patients outside of the office, others are using it to fill voids created by doctor and staffing shortages. This is the case for Douglas Jones, OD, of Feather Sound Eyecare, based in Bradenton, Fla. Specifically, Dr. Jones says patients still come into the office as they would for a normal eye exam. The main difference is that patients undergo a digital video slit lamp exam, and engage through a video conference with the doctor.
“We primarily use telemedicine to fill in slots in the morning when I am running a second business,” Dr. Jones says. “Patients who use it have been happy, and there isn’t much that is different about their visit other than the video conference. The staff still sets everything up and keeps it all running smoothly.”
Types of Telemedicine
Glenn S. Corbin, OD, of Wyomissing Optometric Center, a three-location practice in Pennsylvania, says having his glaucoma patients use a home tonometer is like having a sphygmomanometer at home for blood pressure monitoring, as it can be a valuable tool to control glaucoma more accurately.
“Also, some patients have significant diurnal variations in IOP, never captured during their visits to our office,” he notes.
Amanda S. Legge, OD, who practices with Dr. Corbin, adds that home tonometry gives one more piece of information for ODs to better manage glaucoma if fluctuations are occurring:
“Because glaucoma treatment is not contingent on IOP alone, it is not a replacement for in-office visits, but knowing how a patient’s IOP changes during a single day or trends over a few weeks is valuable information for us as clinicians.”
Matthew Marsich, OD, who owns and operates 25 optometric practices across Georgia, says he uses his telemedicine platform in a similar way to Dr. Jones: Patients still come in for their visit, but might have a telemedicine visit if a doctor is not available.
“Doctor recruitment is incredibly difficult right now, and we have used telemedicine to supplement that on-site coverage when we don’t have it available,” Dr. Marsich explains, adding that in one of his locations they went a full year without an on-site doctor. “Offices that have had limited coverage are still able to provide access to patients through telemedicine.” (See “Implementing Telemedicine,” bottom.)
Dr. Marsich adds that patients have been very receptive to the virtual eye care platform:
“In some ways, it allows the doctor to be more engaged in the visit. They do not have to spend five minutes refracting someone or looking at the slit lamp. Instead, their only task is to engage with the patient and really focus on the plan for them.”
Reimbursement for Telehealth Services
AS OF JANUARY 2022, the following codes that pertain to eye care are included in Medicare’s list of telehealth services:
Documentation should be comprised of date of service; participants in the call and titles; length of call; nature of call; and all medical decisions made. For additional information, see:
bit.ly/AOATelehealthGuide
bit.ly/RPMTreatmentManagement
bit.ly/AAMCRPM
An Eye on Telemedicine in Practice
THESE OCULAR CONDITIONS can be managed via a virtual visit:
Blepharitis
See optometricmanagement.com/issues/2021/june-2021/the-virtual-practice .
Implementing Telemedicine
Both Drs. Marsich and Wolfe say it’s important to find a platform that suits the optometrist’s specific needs and how they plan to use it. In other words, some platforms are going to be better suited to the practice that wants to be able to see patients from home, whereas others will be set up for patients coming into the office.
Dr. Wolfe says that integration with his EHR is one of his needs, so that he can pull up a patient’s records when out-of-the-office.
Depending upon how the OD plans to use telemedicine, they might want to be selective about which patients it will work best for — and which patients might be better off with a traditional visit, notes Dr. Jones.
“In our case, we have found our simple, healthy eye patients are perfectly suited for a telemedicine visit,” he explains. “I do try to avoid scheduling my contact lens patients for telemedicine, as I am charged more on the platform for that type of visit.”
Dr. Wolfe adds that in his case, he uses telemedicine exclusively with patients with whom he has already established a relationship:
“My goal is not to expand my practice through telemedicine,” he says. “It is my goal to expand my access to the patient — or my patients’ access to me. I can meet them where they’re at — literally.”
NOT A REPLACEMENT
Virtual eye care is the wave of the future, and it is not going away, asserts Dr. Jones. “That being said, it will never replace the real doctor, which is something that I know many people fear. But what it can do is provide supplemental help when practices really need it. It’s a very useful tool.” OM
Editor’s note: For additional reading on virtual eye care, see the following:
- “Choose a Telemedicine Platform:” bit.lyTelemedPlatform
- “Implementing Telehealth:” bit.ly/TelehealthOM
- “Optometric Telehealth Steps for Success:” bit.ly/TeleSteps
- “Myopia Management Consults Possible Through Telehealth:” bit.ly/TeleMyopia
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