March 2021

PRACTICE MANAGEMENT

How has COVID-19 changed your practice?


 

EyeWorld reached out to ASCRS members and members of the EyeWorld Editorial Board to ask how the pandemic has changed practices a year after the historic shutdown of elective medical procedures.

Are there areas of ophthalmology, in general or your practice specifically, that have improved/gotten better in response to the pandemic?

“During the shutdown, our practice rapidly adopted telemedicine, as did many others. We kept elements of telemedicine after reopening. Specifically, our technicians continue to call patients prior to their appointment to take histories, shortening the in-person duration of the actual visit. This benefits patients, who perceive shorter in-office times and reduce their exposure, as well as our practice by reducing our exposure and freeing workup lanes, increasing their effective number. This efficiency boost offsets the extra time spent per patient on COVID-related safety precautions. We plan to continue taking tele-histories in the future and expect that in the post-vaccine era, our patient throughput will exceed pre-COVID levels.”
Matt Feng, MD
Price Vision Group
Indianapolis, Indiana

“Wait times and efficiency seeing patients have improved. Patient histories and all prep work is done over the phone prior to the visit. Patients call when they are parked outside the office and are allowed one by one into examination rooms or diagnostic areas. Attention to disinfection has been heightened as well.”
Nader Iskander, MD
San Antonio, Texas

“As a resident, I am enjoying virtual lectures, interaction with residents across the country, interaction with faculty at institutions across the country, and a proliferation of free, high-quality online educational content.”
Patrick Commiskey, MD
Resident, University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania

“Since the pandemic started, the one thing that has been improved in our practice is patient satisfaction. Not only have patients greatly appreciated the safety precautions that we have implemented in the office, but they have loved the significantly decreased in-office waiting times since our scheduling templates have been changed dramatically to ensure less crowding in the office.”
Bennie Jeng, MD
Department of Ophthalmology, University of Maryland
Baltimore, Maryland

“We have enjoyed having fewer family members accompany patients during their visits. Fewer family means fewer questions, side conversations, and family members slipping in questions about their own eye problems.”
Kevin Miller, MD
Department of Ophthalmology, University of California, Los Angeles
Los Angeles, California

“One good side of the pandemic is the educational benefits from online webinars and conferences, which allowed me to attend international [meetings] from home; that was impossible for me from my country because of the costs of traveling and time needed.”
Dana Sultan, MD
Resident, Aleppo University Hospital
Aleppo, Syria

“LASIK volumes through the roof”
Christopher Blanton, MD
Inland Eye Institute
Colton, California

“Refractive surgery is up about 40%. I had
the busiest Q4 in my 25-year career.”
Louis Probst, MD
TLC Laser Eye Centers
Ann Arbor, Michigan

“Oculoplastics and LASIK have dramatically increased by 30–40% during the COVID crisis. I think this has to do with patients working at home and having more ability to get their evaluations and surgery without being ‘examined’ by their colleagues [or] friends.”
Jeffrey Whitman, MD
Key Whitman Eye Center
Dallas, Texas

“We have worked on improving our patient communications using new digital technology. I use the Doximity app for voice dialing from my smartphone (using the office caller ID) as well as for easy telehealth visits. Our practice adopted CareCloud Breeze, a pre-visit, patient registration solution that integrates with our practice management system to decrease office visit time. […] We’ve seen co-management of refractive surgeries increase, and we utilize CoFi to improve our compliance and transparency with refractive service fees. CoFi allows us to generate a multi-party invoice, where the patient swipes their credit card once and simultaneously makes direct payments to the surgeon, postoperative OD, and facility.”
Tal Raviv, MD
Eye Center of New York
New York, New York
Dr. Raviv is an investor in CoFi.

“COVID-19 has made it challenging for my practice from a business point of view as I am part owner of a group practice ASC. We have had to adopt lean management practices, and in order to sustain the practice, we have had to drill down to cost control and improve efficiency of our practice to minimize waste.”
Mun Wai Lee, MD
Lee Eye Centre
Perak, Malaysia
“[…] at the outset of the pandemic I began to wear scrubs to clinic daily rather than my typical professional dress. Over time, I treated myself to some ‘fancy’ scrubs, embroidered with my name and specialty. I gradually accumulated enough that I now have five pairs and wear them 5 days a week. Having a ‘uniform’ for work has made a tremendous difference in my morning stress and decision-making, virtually eliminating any thoughts about what to wear. I simply do one load of laundry each weekend and am ready for the new week.”
Alison Early, MD
Cincinnati Eye Institute
Cincinnati, Ohio

“We elevated the decision-making capabilities of our team. We found that we are true to what we always say. Team and patients come first.”
John Berdahl, MD
Vance Thompson Vision
Sioux Falls, South Dakota
“I think that telemedicine has become more developed and more widely accepted as a result of practices being closed during COVID outbreaks. We still have some challenges like standardizing vision checks, inability to check eye pressure, and inability to perform topography or additional testing online with telemedicine, but external diseases can be viewed and treated based on history and exam in many instances. Technicians can also be trained to do fundus photography in other clinics for evaluation via the computer.”

W. Barry Lee, MD
Eye Consultants of Atlanta
Atlanta, Georgia
“One thing that has improved is my clinic max. Prior to COVID, my clinics were out of control with typically 65 patients per day. Since COVID, I have put a hard stop of 55 patients a day and strive to keep to that max, as I don’t want to fill up the waiting rooms with patients and their family members. I have also been more selective in my ordering of tests, forgoing testing in many cases where there is not a surgical need at that particular visit.”

Leon Herndon, MD
Department of Ophthalmology, Duke University School of Medicine
Durham, North Carolina

“Dramatic increase in virtual clinics—color photos of the fundi with OCT, IOP, […] and VA all done by technicians, then the doctor is reviewing, making decisions without seeing the patient. In wet AMD, injections [can be] given on the same visit. [There has been an] increase in telephone consultations where appropriate to reduce the number of patients in the hospital.”
Ziad Estephan, MD
Spire Healthcare
Glasgow, U.K.

What are some of the things in your practice/clinic/ophthalmology as a whole that you will never go back to doing post-COVID?
“I don’t think we will ever be able to go back to regular overbooking of our schedules.”
Bennie Jeng, MD
Department of Ophthalmology, University of Maryland
Baltimore, Maryland

“Hygiene changes in the office probably will not change with the exception of masks if the numbers get really low. We have all learned how to wash our hands better and have learned to be a bit more paranoid about the patient world that comes to visit us.”
Jeffrey Whitman, MD
Key Whitman Eye Center
Dallas, Texas

“We have changed the way we schedule our patients and how we roster our doctors’ activities (i.e., clinics, minor and major procedure lists, etc.), and this has made efficient use of our resources. This is something that we are likely to continue doing even in the post-COVID era.”
Mun Wai Lee, MD
Lee Eye Centre
Perak, Malaysia

“COVID accelerated my practice transition from a comprehensive practice to a surgical practice. Manhattan was hard hit early in the pandemic, and we endured a protracted, 3-month elective surgery shutdown. […] After the lockdown, we reopened our practice slowly—first 1 day a week, then 2 days a week. The limited schedule constrained me to only see surgical and emergency patients. As we got busier, I maintained this surgery-only focus. The other practice doctors are still seeing existing comprehensive patients. Post-COVID, we plan to continue our transition to a surgical practice.”
Tal Raviv, MD
Eye Center of New York
New York, New York

“We will not go back to same-day payment. Sorting all the payment details out before the procedure day has been a huge improvement. We will encourage patient-only visits. The clinics are less crowded, and the drivers appreciate the text message when it is time to pick up, as they can do their own thing rather than be stuck in the clinic waiting room. I will continue to do the postop flap checks myself. I took this over to simplify the patient experience in the pandemic but discovered that I liked examining the flaps under the EX500 laser [Alcon] slit lamp as it allowed me to personally make sure that every flap interface is perfect before the patient leaves the laser room.”
Louis Probst, MD
TLC Laser Eye Centers
Ann Arbor, Michigan

“Post-COVID, we will not be able to offer personal touches like a handshake, offering coffee or refreshments for waiting patients.”
Nader Iskander, MD
San Antonio, Texas

“We will never go back to unnecessary flights.”
John Berdahl, MD
Vance Thompson Vision
Sioux Falls, South Dakota

“We may always do some type of patient screening upon entry into our building at least for the next year. Asking questions about infectious symptoms and temperature testing when entering our office has become a streamlined process. Limiting patient family members and family contacts in the office has also helped increase efficiency of visits and reduced office traffic tremendously. I think our cleaning of rooms and equipment between patients has vastly improved in COVID times. Standardized clear screens attached to slit lamps separating patients and doctors have also improved.”
W. Barry Lee, MD
Eye Consultants of Atlanta
Atlanta, Georgia

How has COVID-19 changed your practice? How has COVID-19 changed your practice?
Ophthalmology News - EyeWorld Magazine
283 110
283 110
,
2021-03-02T11:04:49Z
True, 3