Staying open and safely providing care during the coronavirus pandemic (if you choose to)

The NBA can afford to suspend operations. NASCAR can afford to race without fans. Broadway can declare the show must not go on. 

The decision is more difficult for eye care providers. You're a health authority in your community and it is up to you and the local and state entities to decide what works best for businesses in the area.

It is totally reasonable to close your business for a period of time in order to protect your family, your employees and your community as COVID-19 spreads.

Other ECPs will remain open, though. We understand these are uncertain times for providers and patients alike. That's why we put together this guide to keeping your practice open during the coronavirus outbreak.

However, please keep in mind: If it is not safe to remain open then please make the appropriate arrangements to shut down for however long is necessary.

Considerations for closing

Update: It seems increasingly likely that your local or state government, or your professional association, will recommend you close shop except for essential services. The American Academy of Ophthalmology has already issued such guidance. It's best to have a plan for closing soon—even if you don't expect to shut down anytime.

Let’s start by reviewing what to consider if you come to the conclusion it’s best to close. 

Ultimately you may decide it’s best to shut your business for a period of time. There are myriad reasons to do so in the current crisis. If it makes sense for you to shut your practice doors for a stretch it’s important to do it the right way. 

Does everything have to stop?

You may know someone who’s working from home during the current pandemic. Can you do the same? There may be aspects of your business you can keep up while sustaining social distancing. 

For example, do you have outstanding claims in accounts receivable? Now’s an opportunity to get a better handle on your A/R. Or you can use your EHR reporting features to improve your understanding of how your business is running. How often do you get the opportunity to really dig into the numbers? 

Or, if your practice isn’t currently set up for telehealth visits you can get a head start on remote appointments. Maybe you can research how leaving vision-plan networks and becoming a cash-pay practice will benefit your business. 

If your practice isn’t set up for telehealth then you won’t have much opportunity for revenue-generation as the coronavirus disrupts patient behaviors. However, you can still run your business. 

Budget for a stretch without appointments

A downturn in appointments is a very different thing than no appointments. We mention below that if you plan to stay open that it will be important to budget for less revenue. If you shut your business for a period of time this will become even more crucial. 

If you’re not generating revenue for a week or two or three, then how do you make up for that in cut expenditures? Unfortunately, once your practice opens again you may have to run lean for a period of time in order to make up for a stretch without appointments. 

Additionally, you may have to start contemplating how you can adjust your personal budget to ride this out. Many small-and-medium practice finances are closely tied to the owners’ own finances. As unfortunate as it may be, you may have to trim back on planned personal expenditures as well. 

Consult with your accountant to learn how both your personal and practice budgets should be adjusted to maneuver the ongoing disruption to your business.

People are looking to healthcare providers

Social adjustments made to prevent the spread of COVID-19 are affecting people and businesses alike.

The coronavirus will remain top of mind for many in your community as confirmed cases rise and coverage of the pandemic continues. Keep in mind your oath as a healthcare provider to tend to those in need.

Your community will look to you for information and stability in uncertain times as the country remains on an emergency footing. Whether you're taking appointments or not you can still serve as a resource. It’s important that you play a role in quelling the concerns of your community and offering eye-care services. 

People cannot simply put their eye-care needs on hold. In fact, according to the American Optometric Association, COVID-19 may be behind ocular signs and symptoms such as photophobia, irritation and watery discharge. 

The people in your community will need their local eye care providers as they always have. So the question is: How do practices minimize the impact of coronavirus on their business while simultaneously addressing patient concerns?

You’ve heard it before but...

Step one: Wash your hands, don’t touch your face and maintain appropriate social distancing. Step two: Tell your staff to wash their hands, not touch their faces and maintain appropriate distancing. Step three: Tell your patients to wash their hands, not touch their faces and maintain appropriate distancing.

Maintaining office hygiene habits

As a quality ECP you already maintain appropriate office hygiene. However, it can’t hurt to review best practices and ensure that you and your staff subscribe to them. This is especially important for ECPs because ocular discharge and tears are potential sources of contamination, per the AOA. 

The Centers for Disease Control and Prevention have released guidelines for disinfecting, handwashing and maintaining proper hygiene amid the coronavirus outbreak. You can find more information at the following links:

• Disinfection and sterilization.
• Hand hygiene in healthcare settings.
• COVID-19 information for healthcare professionals.

Not only should you sustain these routines, but you should inform patients that you’re doing so in order to calm their concerns. Communication from healthcare providers will be especially valuable for the people in your community. There’s value in simple assurances that your office is a safe place because of the hygiene precautions you’re taking.

Adapting to the reality of a pandemic

The World Health Organization has declared COVID-19 a pandemic. As the virus continues spreading practices will have to adapt to new realities. What should you do to keep your practice open and patients safe and cared for amid these disruptions?

Budget for a slowdown in business

A drop in foot traffic normally calls for a tighter budget. With people across the country turning to social distancing and isolation it’s time to begin making those considerations. Practice owners should identify where they can begin temporarily scaling back to keep their doors open, Dr. Alan Glazier explained. 

Start doing the numbers on practice performance: Where can you afford to begin cutting back? Glazier recommended first looking at your payroll. If foot traffic is falling you can ask some employees to stay home. 

However, asking people to skip out on valuable work hours might not be feasible. So what else can you do? 

Consider planned purchases in the coming weeks and months. What’s necessary versus nice-to-have? Cautious spending should be a priority moving forward. This will allow you to ensure your staff continues getting paychecks as you look for ways to tighten the purse strings. 

Make yourself available for all who need help

As people continue adapting to the new norms amidst the coronavirus they’ll change habits and behaviors. That may include the provider they see for their healthcare needs. People in your community may rely on local search tools in order to find an ECP closer than their regular, in-network provider.  

There are plenty of people who will prefer to stay close to home—and who may even spend more to do so—in order to avoid contracting the coronavirus. That means new patients walking through your door rather than their in-network provider a few miles further away. 

Becoming an online resource

If you put all appointments on hold until further notice you can still serve as a resource for your community. The internet serves as a fount of information for just about everyone. This is especially true in the current climate.

Post what you know wherever you feel comfortable doing so; does your community have a local Reddit page, or a regional Patch? Are people nearby asking questions through their social media profiles or on pages like Quora?

Whether you're taking appointments or not there are always opportunities for you to serve as an eye-care resource.

What happens when OON people who aren’t normally patients come in?

Your staff will have to handle cash-pay transactions if people choose your practice rather than their in-network provider in order to stick by their homes. You should be prepared to provide care to these OON, or out-of-network, patients and submit claims for them. 

If your practice doesn’t regularly accept OON patients here are some tips:

1. Introduce patients to OON benefits: Many people don’t know their vision plans include OON benefits in addition to in-network benefits! Explain to new, OON prospective patients that they likely have benefits they can leverage with your practice. 
2. Use discounts to drive sales: OON means more cash in your pocket, which opens up opportunities to offer discounts. This will help you push sales over the finish line while offering additional value to new patients. Such gestures will be especially helpful during the current pandemic. 
3. Utilize AOB to help patients: If you use Anagram explain you’re an open access practice that works with all insurance plans. You can also use Assignment of Benefits to make transactions even easier for OON patients. For certain plan members you can turn on AOB so that patients don’t have to cover the transaction upfront. That way they pay the net cost of the service or materials after factoring in their OON benefits and you receive a reimbursement from the payer. This makes the entire exchange simpler.

These new patients will be looking to you as their closest ECPs in a time of severe disruption to daily life. With proper planning and the right tools, it’s not hard to offer them the care they need. That’s true whether or not you’re in-network with their vision plans.

Maintain low-cost communication to ensure people know you’re open

You should let people in your community know that your doors are open to all patients; existing or not, in-network or OON. 

There are a number of ways you can do this. Pick the method that works best for you and start contacting people! For example, if you normally contact patients exclusively by email then it’s prudent to avoid a bombardment of phone calls. 

Here are a few ways you can reach out to people in your database and community regarding your business hours and services during the coronavirus outbreak:

1. Dial up patients who are OK with receiving a call from your practice to let them know you’re still open and welcoming patients.
2. If your patients allow it you can also send text messages. It’s a great way to engage them: 90% of text messages are read within 3 minutes of being sent! 
3. Run email campaigns to inform people on your list. Some email tools allow you to automate campaigns. Maybe you already use a service that offers email automation. If not MailChimp and similar platforms let you run automated campaigns for free!
4. Post to community news outlets to reach people whose contact information you don’t have stored. Platforms such as Patch send alerts to subscriber inboxes when you post. You should generally avoid being too promotional. However, an informative post that notes you’re remaining open could keep your practice top of mind. 

Don’t forget to update your Google My Business profile, as well. Your updated hours and contact information and more will let people searching for local ECPs know you’re available. When people in your community ask Siri for ECPs near them or your practice you want your GMB profile information to be accurate. 

Yelp is another local resource people will use to find nearby ECPs. Similar to GMB, it’s essential you keep your Yelp profile updated. Maintaining up-to-date information across these and similar platforms will ensure people in your community are giving consideration to your practice.

Dr. Viola Kanevsky, of Acuity NYC, furnished the Facebook group ODs on Facebook with a great letter updating her patients on practice policies:

To Our Patients,

Out of an abundance of caution, we are asking all our patients who are considered high risk, to postpone non-essential excursions outside their homes in order to reduce risk of contracting COVID-19. This includes anyone over the age of 60, pregnant or nursing mothers, and anyone who is immunocompromised.

Although our office staff is vigilant about following all CDC and AOA guidelines, sanitizing all surfaces and eyewear, disinfecting all equipment, and common areas (reception area, bathroom, door handles, etc.), we nonetheless wish to avoid risking the health of our most vulnerable patients with unnecessary exposure to others who may be contagious but asymptomatic.

In an effort to further protect our patients and staff, we ask that you all are mindful of the following precautions:

If you are sick, please stay home. If you have had contact with someone who is ill or are caring for someone at risk, please defer your appointment.

If you have an ocular emergency or any urgent issue –please call us to schedule a telephone, FaceTime, or Skype consult. If the doctor determines that she cannot resolve an urgent concern without seeing you in person, we will arrange an appointment before or after regular office hours so that no other patients are in the office at the same time.

If you or your child are out of contacts or have broken or lost your glasses, and cannot get to our office, we can almost always fabricate and ship a replacement set, as we have your measurements on file.

Until further notice the office remains open for all your needs, including emergencies.

Thank you for your patience and cooperation during this difficult time as we all work together to keep our community healthy and safe.

Working with patients on cancelations and rescheduling

Your communications can include a temporary policy update to cancelations and rescheduling. It’s inevitable these will bubble up as patients consider how best to avoid infection. How can you update these policies in order to make it easier for patients to move around their appointments?

If you're closing business for the time being then you should compose a communication for all existing patients explaining that and describing how to reset appointments after this is over.

Protect yourself!

Providing care to patients in need does not preclude caring for yourself as well. By maintaining the hygienic habits described above you’ll take a big first step toward doing exactly that. 

If you’re in a high-risk demographic - either of advanced age or with an underlying health issue - then it may make sense to avoid the practice and have lower risk staff work on-site. Exposing yourself to the hazards of the virus doesn’t make sense if it poses a critical threat to your well-being. 

There’s an end in sight

There is so much about this virus we don’t understand. Will the warm weather kill it? Will it come back next fall? Will it evolve? 

What we do know, though, is that at some point we will get a handle on the coronavirus and return to normal life. It’s at that time that ECPs can expect more than just a return to normalcy: It’s possible a surge of appointments lies beyond the horizon. 

That’s because people still need to buy contacts or glasses, and they have prescriptions they have to refill—plus the fact that many of them will be due for eye exams. 

There will be the patients mentioned above who simply seek our nearby ECPs instead of in-network practices. However, other people will simply put off their appointments until the coronavirus disruptions have blown over. 

In addition to ensuring your practice is braced for the coronavirus, you should plan for what’s coming afterward.

Continuing to provide care in the age of COVID-19

There are two factors at play for ECPs: The need to offer care to patients in need and the desire to maintain a successful practice despite the ongoing outbreak. Luckily, it’s possible to do both. However, it will take adjustments to the way you operate your business. 

If you can manage to maintain hygienic best practices, keep your community abreast of practice hours and offer care to patients who may not normally come in; then it should be possible to remain open through the coronavirus outbreak. Be sure to consider the requirements in your community—do what makes sense for your area, your staff and your family. If you have to close then, by all means, do that.

Either way, ask yourself: How prepared is your practice?