Pharmacy is Making News in Eye Care

CVS recently launched an online prescription renewal tool. It seems that patients who meet certain requirements can have their existing contact lens prescription renewed for up to four years. These extensions are approved by ophthalmologists who sign off after patients report their visual acuity and upload a picture of an eye. The doctor and patient do not communicate.

Optometry has responded by accurately pointing out that this action is reckless, dangerous and greedy. While well-intentioned, all of the published responses are arguably defensive and may miss the most obvious point. CVS is behaving how corporations behave when they are motivated primarily by profitability. They are stretching limits to fill their customers’ unmet needs.

We really should be asking……”How can we better meet the needs of our contact lens patients?” “Can we utilize available technologies to provide teleoptometry services?”

If not, CVS will continue to take our patients.

See how optometry has been reacting to the news from CVS:

American Optometric Association

Editorial from AOA President, William Reynolds

Review of Optometry

Vision Monday

Jack Persico, Editor-in-Chief - Review of Optometry

INVISION Magazine

Missed Opportunities....

Will teleoptometry be a part of your future? Have you experimented with offering services via telehealth to get through this pandemic crisis and learned that it has benefits that you would would like to continue?

If so, I would like to encourage you to take some time NOW to take a look at how your current telehealth processes. Most of us jumped in urgently when the pandemic emerged and we were forced to close our practices to routine care. As the restrictions were lifted, we reverted back to “normal” and virtual care faded to varying levels.

Now is the time to look at your overall process for a variety of reasons:

The Surge - COVID infections, hospitalizations, and deaths are all on the rise. It’s impact will impact more of us. Even if we aren’t mandated to close, doctors and staffs are more likely to affected as will our practices. Be ready.

The New Administration - Joe Biden has promised more “guidance” and continues to make it one of his administration’s priorities. No one is sure what changes will occur, but be ready.

As you prepare, please start by reading this great article by Rendia blogger, Stephanie Barlas. She points outs three commonly missed opportunities that we can all utilize in teleoptometry.

Is waiting worth the risk?

Since the pandemic began, we have been weighing the risk of delaying eye care with the risk of exposure to COVID-19. For some, it’s been easy because the risk of waiting is low and the risk of being exposed is also low. Early in the crisis timeline, we stopped (or almost) “routine care” then started bringing back the “low-risk of serious illness” patients.

Patients with significant health problems continue to be at the most risk of serious complications if they contract the illness during an eye exam. However, these same people are at the most risk of complications from delaying their eye care. We’ve done our best via telemedicine and other means, but how far can we push it?

In November, Primary Care Optometry News published a thoughtful article by optometrists Dr. Derick Cunningham and Dr. Nabila Gomez. They explore the consequences of delayed care and encourage us to be ready for the “snowball effect” headed our way.

Public Health Emergency Extended.....Again

COVID-driven Public Health Emergency has again been extended by the HHS on Oct 23, 2020. Generally given for 3 months at a time, this declaration should expire in January, 2021.  

This means that Medicare will continue to cover telehealth services, uncleared medical devices can continued to be used (including optical devices), Stark Law waivers will continue, and other loosened HIPPA restrictions will remain active.

Opportunities AND Risks

Ophthalmology Times recently posted a thoughtful article by Jason Metha exploring all sides of the telemedicine boom in eye care in response to our pandemic.

He begins the article with an accurate warning, “Despite current flexibility, future enforcement could prove troublesome.” We completely agree.

The article explains in detail how CMS relaxed restrictions and even “promoted” telehealth during the emergence of COVID-19. As the relaxed restrictions end, will CMS react to the lessons learned?

Taskforce Report worth reading.....

The Taskforce on Telehealth Policy (TTP) is made up of 23 healthcare experts who are charged with defining the opportunities and challenges in telehealth in light of the current pandemic. The just released their report identifying current findings and recommendations.

The Report is designed to be a blueprint for policymakers to harness the the rapid expansion of telehealth and create lasting healthcare improvements that prioritize patient safety, quality, and equitable access to care.

They will call your office first.......then what?

1-800 Contacts provides asynchronous online vision exams that are legal in many states, but fails to meet the standards set by most eye care professionals practicing quality telehealth. While no standard of care has been set, signing doctors remain liable for providing quality patient care and that requires a synchronous conversation between the doctor and the patient, particularly when there is no doctor-patient relationship.

Right or not - 1800Contacts is providing this service to your patients. They are doing it, because your patients are not getting what they want from your practice.

You have to do something!

Scenario: Patients call your office to ask for more contacts for their prescription that expired last week. Your office explains that they will need a new exam but the patient has already used all of their “sick days” and can’t get it. Next stop……1800Contacts and their inferior, impersonal, asynchronous “exam.” Wouldn’t it be better if you, their doctor who prescribed the contacts, conducts a VAHOV (Virtual, At-Home Visit) to extend the CLRx and fill the order?

"Normalization" of Telehealth

As we have come to realize that we are going to have to live with this pandemic for a while, we have been discussing “the new normal.” How has our world changed? How many of these changes will affect how we live in the future and what will go back to the way it was.

At TheTeleOp, we believe that most changes will be both - old and new. This interesting read from Ophthalmology Times describes the “normalization” of telehealth in eye care practices. This article focuses on Medicare’s acceptance of the technique and consideration of its continued approval.

Let’s explore how much we can use this technology to improve our patients’ lives and continued reimbursement will follow.

Scientific Proof!

At TheTeleOp, we are always looking for updated information to help eye care professionals better understand the teleoptometry environment. We share articles, updates and all sorts of developments - good and bad.

In our research, we came across this scientific study that “proves” high levels of satisfaction of patients who experience high quality telehealth visits. Several interesting points in this study that contributes to the success of the program. It is well organized, well communicated and easy for the patients.

Most interesting however, is the study was conducted way back in 2015.

Need more? Here’s an analysis from JD Powers and Associates from July 2019.

83% Expect Telehealth Visits

There was “normal,” then there was “not normal,” and now we can’t stop debating about the “new normal.” We all agree that telehealth is here to stay in all aspects of healthcare. Combine that with the fact that running a practice with all these new restrictions is tougher than ever, it is a challenge to incorporate new technologies into the flow of an existing practice.

This blog from Katie Moyer is a great piece on how to get started on incorporating our telehealth emergency lessons into the new normal.

More Policy Activity

This week, the President signed an Executive Order intended to support the continued development of telehealth in the US. The document extends the availability of teleheatlh services after the public health emergency ends, directs the HHS to reveal a new payment model that will include telehealth services and commits to improving healthcare services to rural areas.

There was also a press conference highlighting the expansion of telehealth services at the Veterans Administration. VA Secretary Dr. David Shulkin gave a demonstration and said, “We can provide telehealth services in 50 different specialities, from ‘tele-dermatology’ to ‘tele-intensive care’ to ‘tele-dentistry.’ “

This is seen as a signal to Congress that the administration will be quite receptive to any legislation that supports long-term use of telemedicine which is being strongly pushed in Congress now. At a time where all politicians are looking to appeal to voters, telehealth policy changes are almost certain.

Are we ready?

Teleoptometry Part of Your Future?

Most optometry practices have all but abandoned telehealth practices as part of their eye care routine. Many utilized the technology when it was necessary, but as restrictions were lifted, we returned to doing things “the right way.”

There are those in eye care who believe it will be a primary portion of eye care practices of the future. Read this interesting article for a unique perspective from ophthalmology.

Update on Telehealth's Future

Over the last few days, there have been some significant developments in our ability to continue providing telehealth services to our patients…….

First is the extension of the National Health Emergency by the HHS. These declarations extend the relaxation of the restrictions for another 90 days.

Second is the letter from the American Telemedicine Association to Congress supporting HR 7663 which makes many of those changes permanent. It was signed by over 200 healthcare organizations, including Leadership OD.

It is important to realize that an “emergency” can’t last forever. Sooner or later, it just has to become “the way it is.”

Future of Access to Telehealth

Prior to COVID-19, many Americans had never heard of or tried telehealth visits with their doctors. Yet, during the national emergency, millions of beneficiaries were exposed to their existence, quality and value. The American Telemedicine Association is lobbying hard to make the temporary policy changes permanent.

  • Do you have a position on this?

  • Should Medicare pay for telehealth visits?

  • Will it increase or decrease the disparity in access to care?

This article about the effects of telehealth governmental policy and its long-term consequences is worth a read. Let us know what you think…..

Mike's Uncomfortable Lesson about Telehealth

Some of my biggest growth moments have come when I feel bad about something I have done. I hope this is one of those moments and I hope that by sharing it with you, you won’t have to experience this.

In this video, I explain a situation where I was trying to do the right thing but didn’t do a good job thinking about the world from my patient’s perspective. Putting the patient first doesn’t always look the same to everyone and we need to remember that as we progress into this new world.

Access to healthcare is a topic that many proponents of telehealth like to talk about, but this is an example of how we can use it to cause some people to have less access. Let’s be careful.

See Mike’s Message HERE

Looking Forward?

As we get a handle on providing telehealth to our patients in an emergency situation, it is time now to explore how we will provide this care to our patients when the emergency is over. One day, we will return to standards of care in infection prevention and it will be “safe” to visit the optometrist’s office.

We will have schedules that are “booked out,” patients who arrive early or late and those who don’t understand their insurance benefits. As we imagine, getting back to “normal”, do you see intermingling some VAHoV’s into your day? Or having a doctor remote into your practice for comprehensive exams in another room?

As you consider building this new reality, read this interesting article about the telehealth after COVID from a legal perspective. No doubt, the world will be different, but there are many questions about how we will practice in it.