Like most of the rest of the county, when the COVID-19 pandemic struck, ophthalmology practices had to think quick and make some tough decisions. Front and back office staff are adept at managing clinical schedules, but complying with lockdowns, navigating reopening log-jams, and instituting safety measures were in no one’s training. The ophthalmic professionals who work alongside physicians have shown their ability to adapt to these new measures and protocols for a radically changed world. Now, as practices begin to rebound, Joy Woodke, COE, OCS, OCSR, a coding & practice management executive at the American Academy of Ophthalmology (AAO), is asking which of those measures and protocols are likely to become standard, even long after the masks come off. This topic is at the center of her upcoming presentation, “Here to Stay: Successful COVID Operations to Keep Post-Pandemic” at the AAO meeting in New Orleans. 

She spoke with Ophthalmology Advisor about what she and her colleagues at the Academy have seen since March 2020, and what long-term changes to practice management ophthalmology is likely to see coming out of the pandemic.

1. With respect to the front and back offices of an ophthalmology practice — the billing and coding, the intake teams, the practice managers — the pandemic caused, at first, a severe reduction in patients. Many offices closed for all but urgent care for a period. Then, as patients started coming back, practices experienced a backlog of patients eager to reschedule. What was that like for practices?


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Many offices closed for a time, and bumped routine exams out into the future, but the patients who needed elective surgeries really backlogged. A lot of practices were looking for ways to be able to accommodate that increase once they did reopen the offices. Some of the strategies they used included opening additional surgical days, or even looking to other facilities to be able to offer more surgical time to their patients. 

As offices reopened, even just to regular visits, they found that there were so many safety protocols they needed to implement that it impeded some practices’ ability to have a good clinic flow. They had to quickly identify ways to embrace this new emphasis toward safety protocols. Some of the things they did included making sure that patients weren’t congregating in a waiting room. Some tried a “parking lot waiting room” approach. One of the most important changes is going to be identifying ways for clinics to still flow with all these new barriers. 

2. What kinds of protective measures — both physical, but also organization had to be implemented for patients and staff — what worked, and what’s been abandoned?

A lot of practices really started embracing digital technologies. That was transformational to a lot of practices. They asked ‘how can we minimize the amount of time that the patient spends in the clinic. Patients spend time with paperwork, passing back and forth pieces of paper and pens. So, practices started embracing ways that patients could prepare for the encounter from home online. Also, they embraced telemedicine for a period of time, and we did see practices with a lot of interest in that. But, as physicians and staff started returning to the clinics full time, they found it was much easier to change their protocols to accommodate the patients in a way that did not necessitate so much telemedicine. So, we did see an uptick in telemedicine, but as time went on, it wasn’t something many practices felt was sustainable. I wouldn’t say the interest in it has gone away completely, but the focus is more on operational changes to embrace new safety protocols that eliminate waiting time as much as possible. Sometimes that included having patients go directly to an exam room or minimizing movements by having patients wait in a sub-waiting room, and making sure that the schedules accommodate a very efficient patient wait experience. 

Another goal was making sure that anything the patient could do to prepare, or any information that we might need, could be received from the patient prior to the actual encounter. Some practices even had some of their technicians call the patient ahead of time to help facilitate some of the history or registration or any additional information, including insurance information. 

3. What about online portals? Was there a lot of intake transferring to online portals?

Yes, that’s that digital transformation that we have really started seeing during this time. Practices, perhaps, may have had it on their practice management list of things-to-do sometime down the road. They very quickly started embracing some of these new technologies, such as virtual payments or secure text messaging to their patients. When practices had to close suddenly, they found that calling all their patients on a particular schedule was not efficient. Some embraced new technologies that helped them securely contact or communicate with their patients. All of the new technologies and apps that work alongside their practice management  and electronic health record (EHR) systems can make it much easier for practices to communicate openings, closings, schedule changes, and safety protocols with their patients. So, all of those new digital technologies really are helping practices transition and continue to have a really good clinic flow. 

4. Your upcoming AAO presentation considers the strategic responses necessary to provide ongoing care through the pandemic. With about 18 months of pandemic behind us now and an uncertain future, can you discuss some of the protocols that were originally developed for this period, but which now may become commonplace?

I think when the dust settles, telemedicine will have some sort of place in ophthalmology, but it’s not going to be widely used. I do feel that the ongoing digital transformation will continue. Patients now are used to ordering their dinner on an app and having it delivered directly to their homes. So, they’re looking for ways to access healthcare using technology. And healthcare is technically behind in their respect. Now, clinics are looking to embrace using their portals and using their third-party software systems that work with their practice management system to communicate with their patients. 

I think, though, moving forward, what practices are going to continue to embrace is, first of all, in the midst of a crisis, focusing on what’s most important. What did we do when a pandemic came? The first thing we did was talk about safety for our patients, our physicians, and our employees. That was it. I think that having a focused vision really helped practices identify the protocols necessary to meet those needs. The people — the patients, the employees, the physicians — are what’s important at a practice. Once we recognized that, we were able to create workflows with that focus moving forward. 

Sometimes, after a tragedy, like the pandemic, people really embrace how they were able to change and pivot, and come up with solutions very very quickly. That momentum of operational management and change management is very effective. Continuing to embrace that focused vision on the priorities within the clinic are important.

5. The pandemic also brought with it a number of societal changes that may have people re-evaluating their priorities for what employment looks like. What kinds of changes to staffing practices could ophthalmology clinics consider? 

That’s a big challenge right now. We’re asking ‘how are we going to be able to recruit and retain good staff in this environment?’ In the current environment, it’s really hard to find good staffing. Going forward, practices will need to think outside the box of what they would normally require. In the past, practice managers might have said candidates ‘have to have experience, or have to come from an ophthalmology practice.’ Moving forward, they might have to ask ‘what are the character qualities of the kind of person who succeeds in our practice?’ Then, those candidates can be positioned for success with a good training program that can empower them to continue to grow.

Also, with the pandemic, employees are being allowed to work remotely. With some positions it may make a lot of sense to continue that moving forward and that could give practices the opportunity to free up real estate in the office and open that office space up in a way that helps them see more patients. Some practices’ call centers or business office staff could continue to be remote workers. 

Ms Woodke’s presentation “Here to Stay: Successful COVID Operations to Keep Post-Pandemic” is Monday, November 15, 2021 at 9:45 am at the American Academy of Ophthalmology Annual Meeting in New Orleans. Ophthalmology Advisor’s coverage of the meeting will be available here.