Retina practice continues to apply lessons learned from COVID-19 pandemic
Click Here to Manage Email Alerts
We all remember how drastically our lives and practices were changed during the early days of the COVID-19 pandemic.
Temporary closures and early retirements abruptly altered the patient care landscape, while adaptations such as hybrid telemedicine and social distancing aimed to help us move forward under such extraordinary circumstances.
Fast forward to today when the worst appears to be behind us, but the emergence of new variants has made clear that COVID-19 and its lingering impacts will be with us for the foreseeable future. Thankfully, what also remains are new best practices that continue to benefit our Lexington, Kentucky, retina practice.
Patient volume and flow
After a brief lull in the spring of 2020, our patient volume quickly bounced back and now exceeds pre-COVID levels. As a result of the aging population and the prevalence of diabetes in the U.S., our practice has grown at a remarkable rate, and I am certain we are not alone. And while some patients may have been leery about coming in 6 months ago, they understand the importance of coming in for care and feel more comfortable doing so now.
In order to accommodate as many patients as possible during the height of the pandemic, we had to reassess how patients move through our clinic from the moment they enter until the moment they leave. While some of our initial protocols, such as taking temperatures, are no longer in place, we still prescreen patients for symptoms and require a negative COVID test or proof of vaccination before surgery. For a time, we did not allow patients to bring anyone with them to their appointment; we now permit one accompanying family member per patient (before the pandemic, there were no restrictions in place). Setting a limit of one guest helps patients feel more comfortable while still allowing an acceptable degree of social distancing in the waiting room and clinic areas.
Imaging
Imaging has always played an important role in our retina practice, and we relied on it even more heavily during the pandemic, capturing both an optomap (Optos) ultra-widefield (UWF) and OCT of all patients at their initial visit. Doing so ensured that we could accurately and reproducibly grade a patient’s retinopathy while minimizing face-to-face interactions and decreasing the amount of time they spent in clinic. This practice has proven so beneficial to both patient care and practice efficiency that we have continued to use it. We also increasingly rely on imaging during follow-up visits. Having documented images to compare over time provides a clear picture of disease progression and response to therapy, which facilitates better treatment decisions.
One of the challenges we anticipated with our new imaging protocol is the Medicare rule that prohibits billing UWF (photography) and OCT at the same visit. However, we have found the imaging so valuable for facilitating retinal exams, documenting findings and following patients over time that the economics work. The workflow and documentation benefits are so valuable the billing question is a nonissue.
Extending visit intervals
Another efficiency strategy borne from pandemic necessity has been extending the intervals between some patient visits. When I have a patient who has been treated for years and appears stable at 8 weeks on a certain anti-VEGF therapy, we try to extend the treatment interval to 10 or 11 weeks. If they start to leak, we return to the 8-week injection schedule, but instead of a series of three, we may do a series of six in a row at that specified interval, checking an OCT of both eyes every few visits to make sure that everything remains stable. I have found these undilated, injection-only visits help reduce in-office time for patients and are helpful for our workflow.
Finding and retaining staff
While the pandemic created some challenges, it merely exacerbated others that were already simmering, such as the struggle to find and retain nursing and technical support staff in a tight labor market. At surgery centers and hospitals, nurses are increasingly drawn to the financial incentives of relocation or “travel nursing.” Companies such as Walmart and Amazon are offering higher starting salaries than clinics can afford, pulling away many technician candidates. As a result, we have gone from having two to three new scrub techs over the course of a decade to constantly having someone new in training because of frequent staff turnover.
To fill our staffing gaps, we have increased starting salaries to compete against these employers. We have also had success recruiting young people who aspire to careers in health care. These include recent college graduates who aspire to be optometrists, physician assistants or MDs and want real-world medical experience. These are typically smart, motivated people dedicated to helping patients, so we are happy to invest in them and have them on staff. Although we know we will not have them forever, we are glad to help them on their journey.
For those who do stay, we provide salary increases based on tenure and experience. Our practice was acquired by a private equity company in late 2021, and I am now pleased to be able to offer additional resources and benefits to our staff.
Work still to be done
The pandemic has taught us valuable lessons that helped us strengthen our practice. Leveraging technology and maintaining strong staff retention and recruitment strategies are just two key elements to our growing strength. But there is still work to be done. In-person educational opportunities, critical for our referring doctors, have not returned to pre-pandemic levels. At-home OCT has not yet arrived, but we anxiously await this and other remote monitoring technologies that have tremendous potential. I look forward to continued progress on these and other areas in the months and years to come.
- For more information:
- John W. Kitchens, MD, can be reached at Retina Associates of Kentucky, 120 N. Eagle Creek Drive, Lexington, KY 40509; email: jkitchens@gmail.com.
Collapse
Click Here to Manage Email Alerts