While practice revenues may have been drastically reduced or even halted, we now face the task of re-evaluating operations and procedures, both during the COVID-19 pandemic and after the crisis has passed.

First and foremost is the health and safety of staff and patients. Although difficult to predict, it is likely contagion precautions will continue for months. Even with a return to pre-virus schedules, we still may be wearing masks, washing our hands and disinfecting equipment more frequently. At least for a while, social distancing may require us to separate waiting room seats by six feet, either by removing chairs or taping signs on those chairs not to be used.

Organizations such as the New York Optometric Association (nysoa.org ) have published a list of the surfaces that should be wiped between each patient visit. The list includes virtually every surface touched by the patient, technician, doctor and scribe, from doorknob to phoropter.

Increased time and reduced schedules

These precautions will increase the time between patients, and require practices to control the number of patients in the office. One option might be to ask patients to stay in their cars until the technician is ready for them. (Some practices continued to check the IOPs of concerned glaucoma patients in the parking lot.) When possible, ask companions to remain in their cars. To comply with these precautions, offices will likely reduce the patient schedule (fewer visits per hour) while extending evening and weekend hours, which will need to be staffed.

To optimize a reduced schedule, triage patients in advance. Here, doctors or lead clinical personnel review the records of patients who were scheduled during closed weeks to determine when they should visit. Patients with visually compromising conditions such as glaucoma, dry macular degeneration and corneal pathology should take priority. When reviewing records, consider the patient’s medical history, especially of patients who may be immunocompromised. When calling to reschedule visits, the technician can update the medication lists and histories (medical, family and social), saving considerable time during the office visit.

Regarding postponed cataract surgeries, some patients may fear contracting the virus and prefer to wait, leaving space for others. Of those eager to have surgery, consider scheduling patients who opted for presbyopic or toric correction among the first surgical blocks. Doing so will boost the cash flow before the insurance payments arrive.

Speak with the surgical facility about extending the 30-day window for pre-op evaluations. (This may be subject to carrier rules.) If your practice has the primary care physician perform these exams, discuss the possibility of your surgeon or anesthesiologist updating their clearance.

Evaluate work-up protocols

To improve efficiency, evaluate work-up protocols. For example, there may be no need to refract every year if the patient’s vision has not changed more than a line and they have no intention of purchasing new glasses. Complete the CC/HPI, ocular medications, work up and dilation, and then finish the elements of the comprehensive history. Dilating first will reduce the amount of time the patient has to wait before seeing the doctor.

In order to reduce the number of contact points, the doctor may choose to defer some diagnostic tests until the following visit. Also, consider leaving patients in the work-up room where the doctor will do the exam. Rooms that are not fully-equipped for work-ups can be used for post-op visits and quick follow-ups if a portable slit lamp is available.

Tips for using your time effectively

A final word: use your time effectively. If there is not enough work to keep you busy, ask a coworker to train you on a new skill. Cross train so you can jump into another area if necessary. Work towards your certification or next level up. Most of all, remain positive—COVID-19 has affected everyone. A positive attitude may comfort an anxious or sad coworker or patient for just a moment or two. OP

The table that follows presents an office re-opening checklist for ophthalmology practices.

COVID-19 OFFICE RE-OPENING CHECKLIST

The following checklist, from BSM Consulting, provides a list of work items required for office re-opening. The complete checklist, including implementation notes, is available with the online version of this article. To begin: 1) Review the list and customize as necessary. 2) Assign responsible party(ies) to each activity, and a timeline for completion. 3) Update the work plan regularly to note activity that has occurred and circulate to all members of the work team.