In These Extraordinary Times, Telemedicine is Emerging as a Viable Ophthalmology Option

By Marguerite McDonald, MD, FACS

Across the country, ophthalmology practices are slowly and carefully re-opening. But with the novel coronavirus continuing to circulate, it is hardly business as usual. In fact, the pandemic has prompted ophthalmologists and their patients to widely embrace a tool many previously had shied away from: telemedicine.

In May, Updox, a provider of online patient platforms, reported that 42 percent of 2,000 adults it surveyed said they had used telehealth services during the COVID-19 coronavirus pandemic.

Of patients who responded to the survey, which was conducted online, and said they like using telehealth services, 65 percent said telehealth visits are more convenient than in-office appointments. Sixty-three percent also said they like telemedicine because by avoiding in-person contact with providers, they don’t have to worry about potentially being exposed to the virus.

Those who said they like using telehealth services also reported that it is easier to schedule an appointment that way.

The findings represent a significant increase over pre-pandemic telemedicine use. Just a year ago, only 9.6 percent of Americans surveyed by J.D. Power said they had used telehealth services and nearly three-quarters (74.3 percent) said they either weren’t aware of telehealth options or didn’t have access to online health visits.

Such a large jump in a short time likely reflects both patients’ and practitioners’ fears about contracting the virus through close contact, and incentives provided both by commercial payers and by the Centers for Medicare and Medicaid Services (CMS). As of April 30, CMS has expanded coverage of telemedicine visits, on a temporary basis in recognition of the pandemic, to allow patients to “receive a wider range of services from their doctors without having to travel to a healthcare facility.”

Of course, proper coding is key to receiving reimbursement, and the process remains somewhat complicated. The American Academy of Ophthalmology website provides several resources to help guide ophthalmologists and their staffs through the electronic coding wilderness.

The AAO website’s coronavirus page also offers numerous tips and several webinars for practitioners considering providing a telemedicine option.

In one of those webinars, The Ease of Implementing Telemedicine into Your Practice, Traci Fritz, COE, executive director of a Detroit-area pediatric eye practice, shares what her practice learned in the process of adding a telemedicine option. Her advice includes:

Thoroughly research the many available telemedicine platforms to find one that best fits your practice needs. Under the emergency CMS provisions, the platform does not have to be HIPAA compliant, but must be secure enough to prevent intruders from accessing the conference.
Ask physicians to review every scheduled patient and determine the urgency of seeing each, and which patients need to be seen in person and which can be seen through telemedicine.
Because patients seem more likely to forget remote appointments, it is important to remind them to put those dates and times on a calendar just as they would an in-person appointment.

In the same webinar, David B. Glasser, MD, AAO’s secretary for federal affairs, advised keeping expectations for telemedicine exams realistic. It may be possible to conduct a motility exam but slit lamp exam probably won’t be possible. “The best you’re going to get for cornea or iris is a gross evaluation; you’re not going to be able to evaluate the inner chamber, the lens or the fundus.”

And, he said, it can be helpful if the patient has a friend or family member nearby with a flashlight.

Telemedicine may never take the place of hands-on medicine. But at a time when so much of normal life has been upended, online patient visits can play a role in maintaining the eye health of patients’ and helping restore the financial health of ophthalmology practices.

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