Rethinking Telemedicine


Improved safety, reimbursements, and technology have increased its popularity

Prior to COVID-19, telehealth and telemedicine were not all that widespread among doctors. Just 21 percent of all physicians stated that they used virtual consulting, according to a recent report, and the percentage of physicians interested in telehealth had been declining to under 30 percent. 

COVID-19 changed all of that in an instant. As we explained in a post back in April, expanded reimbursements by the Centers for Medicare & Medicaid Services (CMS) and waived HIPAA rules lowered the barriers to entry for more doctors to offer telemedicine during the pandemic.

Telemedicine by the numbers

Eye care practitioners (ECPs) have had lower utilization of telehealth. However, post-COVID-19, their usage numbers and interest are higher than other physicians. There have been major changes among patients, too. Prior to COVID-19, 76 percent of patients using telemedicine were under age 44, and the vast majority were under age 35—primarily millennials. Post-COVID-19, it appears that the majority of patients are the vulnerable and elderly who don’t want to leave their homes. 

Telehealth, once popular mainly with millennials, has become increasingly appealing to vulnerable, elderly patients and eye care practitioners during COVID-19.

But we’re still a long way from making telehealth work optimally. For example, only one-fourth of optometrists in an Allergan internal survey said they would prescribe medications from a virtual platform—including medications with minimal side effects or risks such as cyclosporin. Perhaps one of the biggest issues in the optometric profession was the fact that most of the discussion on telemedicine prior to COVID-19 involved online refractions, which is not the proper use of telemedicine.

Why consider telemedicine?

The two primary reasons that have caused such a dramatic interest are fairly obvious: COVID-19, which requires us to minimize time with and proximity to patients, combined with reimbursements for virtual exams that are on par with live exams. On April 30, 2020, telehealth reimbursement rates for 99441-99443 went from the $14-$41 range to $46-$110, according to data from Optometric Medical Solutions Inc.

Higher reimbursements for doctors, greater convenience for patients, and improved technology like Rendia’s Exam Mode have contributed to telemedicine’s increased popularity.

But these are not the only reasons. Patients prefer the convenience of telemedicine after they have established a trusting relationship with their eye doctor. Doctors like the efficiency it creates, and it generates new revenue streams and allows improved communications with archivable follow-up patient education. Finally, telemedicine elevates the practice as being innovative and up to speed on technology. 

So do the tools you use during your virtual exams. For example, you can screen-share Rendia’s interactive anatomy software, Exam Mode, which allows doctors to help patients visualize complex anatomy. On Exam Mode for iPad,  you can draw, navigate, and animate the anatomy, conditions, and treatments with your finger or stylus. Visuals have the ability to transcend language barriers and make information more accessible, especially during telehealth visits.

Ease of adoption

When ECPs were asked how they currently diagnose new dry eye patients they selected the following: symptoms, medical history, and current use of artificial tears confirmed with a slit lamp examination. For most doctors, especially in primary eye care, this same order and verification could be performed with telemedicine. Although some platforms have excellent capabilities (e.g. EyeCare Live), there are limitations to the video portion of the exam when it isn’t ocular surface disease-related. 

For one, it would be almost impossible to view the macula, retina, or optic nerve closely, but that doesn’t negate telemedicine opportunities there as well. ECPs will have to consider hybrid models. For example, a technician can obtain the OCT, VF, hysteresis, and IOP, and the patient schedules a virtual telehealth examination to discuss the findings with the doctor. The prescription is sent electronically and often right to the patient’s home. And medication instructions along with Rendia patient education videos can be emailed after the virtual consultation. This creates a resource patients love, reduces the number of callbacks, and establishes trust and loyalty to the provider. 

Ideal uses for telemedicine exams include dry eye follow-ups, contact lens refills, and conjunctivitis consulting in this current COVID-19 environment.

If you’re not sure where to start with telemedicine, begin with a call to discuss the findings after a technician has analyzed the patient’s visual field. Or consider common follow-up exams that are ideal for telemedicine, such as one-month dry eye follow-ups, contact lens refills, and certainly conjunctivitis consulting in this current COVID-19 environment. Then follow up every virtual consult with an electronic recording or video of the findings, the next steps or follow-up schedule, patient instructions, and education via pertinent Rendia animations.

How to succeed with telemedicine in your practice

Mention the option of telehealth follow-up exams to appropriate patients you see in the clinic, or use your email list to inform patients you offer telehealth services. Remember, the decision has to come from the patient, not the practice. That is, providers can’t force patients to have this type of care. Document the patient consent for a telemed exam in the chart and note the total time spent on the exam in the chart, which is required for billing purposes. Keep in mind that to be reimbursed for your telehealth examination you must document HPI, specific exam findings, and other elements in these records in the same manner as you would for an in-person examination.

Telehealth is a terrific opportunity for ECPs and their patients. It provides the needed safety in this current environment while still allowing the patient to connect with their doctor and maintain proper eye health. Even when we do get past COVID-19, I believe that telehealth will become an integrated part of everyday practice for the benefit of patient’s health, safety, convenience, communication, and education.

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Decision Resource Group: Taking the Pulse U.S. 2020
Allergan internal survey results shared with permission
Optometric Medical Solutions Inc. shared with permission


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