As practices around the country take steps to recover from the many impacts of COVID-19, one of the key success factors to returning to, or exceeding, 2019 patient volumes is the perceived feeling of safety by patients. In rural areas of the country where the impact was less because social distancing is already a way of life, many client practices are back to 100% or more of their typical volumes (as this article goes to press). In the harder-hit urban and suburban regions, practices are back to around 80% of their accustomed patient volumes.

Here is what we are seeing and hearing in the more densely populated and challenged areas of the country along with some strategies for offsetting the impact.

THE CURRENT PATIENT MINDSET

Patients are still canceling surgeries, including short notice cancellations. What are patients saying and doing when they postpone surgery?

About 10% of patients are scared enough to delay cataract surgery. They are worried about being around other patients who are in the office and the surgical center. They are not as worried about being around the surgeons and staff.

The patients who are delaying surgery say they want to wait “just a couple more months” before they will be ready to reschedule. Many anticipate being ready for surgery in November/December — if there is not a COVID case spike. If there is a spike, they plan to wait “another couple of months.”

PRACTICE DELAYS/BARRIERS

Are there typical types of delays or barriers to booking surgery that practices are experiencing?

Even when patients book surgery, a common delay for scheduling the surgery is the delayed COVID testing results. Another typical delay is primary care clearance for patients. Because many primary care offices are not completely back to having fully staffed offices, their appointment bookings are tighter and patients have to wait longer than usual for a surgery clearance appointment.

The majority of eye-care practices did not delay emergent or urgent treatments, such as retinal injections and glaucoma treatments. Even so, some patients have needed to be coaxed back for care. Some patients are still fearful to leave their homes and are delaying care.

Practices need to prioritize efforts for recalling patients back for appointments, not only to provide medically necessary care but so those patients are not unintentionally lost — permanently — from the practice. In our experience, most practice recall protocols are more lax than they need to be in the best of times. With the operational disruptions of COVID, these protocols have gotten even softer.

Months into this pandemic, we are finding numerous practices with thousands of patients in a tickler file that need to be recalled. Rather than informally asking the reception or technical staff to “get after these recalls as time allows,” it’s more effective to assign one person to be in charge of these crucial reconnections. Keeping established patients “live” in your appointment system, to return regularly based on the doctor’s return to clinic order, is both clinically crucial and vital to the economic continuity of your business.

As a worst-case default, at least try to keep up telehealth appointments as a bridge to healthier times in 2021. This gives you an opportunity to educate patients about the often slow, painless progression of many eye diseases and the rationale for not foregoing regular exams.

DEALING WITH THE FINANCIAL IMPACT

In addition to the now-receding acute financial disaster of closing ophthalmology practices for 4 to 10 weeks for anything other than urgent and emergent care, what financial impacts are lingering and what can be done to offset the reduced revenue?

First, these continued surgical cancellations and delays will have a big impact on the bottom line. Some practices may see a 20% or higher drop in annual surgical revenue and are exerting best efforts to close that gap to single digits by year-end.

To offset the financial impact of the pandemic, practices have employed strategies such as:

• Delaying capital expenditures
• Expanding office hours to evenings and weekends to increase (and offset) the limited number of appointments available during the day due to social distancing and space constraints
• Stalling re-hiring and working with less staff (having not brought every employee or position back)
• Extreme penny-pinching
• Reviewing all contractual agreements with vendors, to either renegotiate terms or eliminate services that may now seem extravagant
• Applying for loans and grants to bridge the gaps during the worst of the decreased patient volumes.

IMPROVING THE PATIENT EXPERIENCE

One way to offset patient safety concerns is to provide COVID-testing at the office. Clients report that patients love having this as an option and feel very relieved when they learn favorable results.

One example is Horizon Eye Care in Margate City, N.J. Suzanne Bruno, MBA, administrator, shares their experience: “We learned early in the process that many patients are intimidated by the idea of a COVID test and will postpone procedures indefinitely when faced with making the test arrangements themselves. To relieve their worries, we began testing in our parking lot. At specified times during the week, we convert part of our parking lot into a drive-through PCR testing site. Patients are given an appointment with our nursing staff who are fully protected with PPE and perform the test in less than 5 minutes.”

Also, many patients prefer to not see or be exposed to other patients in the office. One way to accomplish this is to reduce or avoid moving patients around the office. Placing them in one exam lane for their whole visit, provided that you have the space to accomplish this, has been helpful to reduce patient anxiety.

Other ways to limit time in the office include pre-registering patients and obtaining their present illness and review of systems via the phone, having patients upload insurance cards to a portal and sending forms to be filled out before they arrive.

Conclusion

We have been reminded yet again, even after experiencing many years of reimbursement reductions, that ophthalmology remains a resilient profession for both doctors and staff, alike.

In our observation (we’re just back from 25 days on the road visiting clients), physicians and their dedicated staff have faced this latest challenge with grace, bravery, humor and perseverance, and they will continue to thrive in the years ahead. OM

About the Authors

Corinne Z. Wohl, MHSA, COE, is president of C. Wohl & Associates, Inc., a practice management consulting firm. Corinne earned her Masters of Health Services Administration degree at The George Washington University and has over 30 years of hospital, physician practice management and management consulting experience. Her latest book, co-authored with John B. Pinto, is “UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction.” For information on how to purchase this book or other inquiries, she can be reached at czwohl@gmail.com or 609-410-2932.

John B. Pinto is the founder of J. Pinto & Associates, Inc., an ophthalmic practice consulting firm established in 1979. He is the most published author in the world on the subject of ophthalmic management and economics. The firm serves organizations worldwide, ranging from solo practices to high-volume market leaders, teaching centers and medical product companies, providing strategic planning, financial benchmarking and analysis, operations enhancement and marketing counsel. He can be contacted at pintoinc@aol.com or 619-223-2233.