Independent Strong sat down with Mike Rothschild, OD, one of the leaders in telemedicine for optometry, to learn more about how independent optometric practice owners can leverage these services to better care for their patients. This Q&A dives deep into the most important aspects of telemedicine and the ways that this technology can support and strengthen independent practices.
Independent Strong: What is the importance of telemedicine for all independent eye care professionals (IECPs), especially in the wake of the COVID-19 pandemic?
Mike Rothschild, OD: We can take better care of our patients in two ways with tele-optometry. One way is with a comprehensive eye exam, in which the patient comes into the practice and we use the same equipment that we always do, but we have a remote provider, and it all gets uploaded to the cloud. The provider logs in to talk to the patient and look at them.
We use so much data in our practices, what we do now when we see our patients in person is walk into the exam room and turn our backs to our patients so we can see what’s on the computer. What a tele-optometry exam does is it allows us to focus on the data while looking into our webcams, which makes the patient feel like we have a better connection. If you watch patients interact with a TV screen, they’re interacting so much because there’s a face looking back at them. So, even though they’re looking at a TV screen, it’s not our backs.
The second way is we’re able to offer patients more convenience. When we do virtual at-home office visits (VAHOV), the patient stays home, and we login. The care that we can give in those situations is limited, because we can’t use our equipment and there’s certain testing that we can’t do. But what we can do is communicate with patients where they are. The patient doesn’t have to take off work. You can get really good pictures of the eye, you can talk to the patient about the quality of their care, if they’re using their drops the way they’re supposed to – whatever the case may be. It’s great for follow-ups, and it’s so much more convenient for small office visits.
Independent Strong: What are some of the misconceptions about telemedicine for IECPs?
Dr. Rothschild: By far the biggest misconception is that quality care can’t be delivered remotely. Yes, it can. Not only can it be as good, in some ways it’s better. Also, many practitioners worry that offering telemedicine will send their patients to other doctors. Actually, I’ve found that it can prevent patients from seeking alternative solutions.
Independent Strong: What are some of the mistakes practitioners make with telemedicine, and how can they avoid them moving forward?
Dr. Rothschild: The biggest mistake is presenting your telemedicine services as if they’re less quality or in some way cheating the patient, and that happens all the time. We did that early on. We said, ‘Well, it’s not a regular visit, it’s not as good, but we’re still going to bill you for it.’ Don’t say that. Talk about the quality of the images, talk about the care you’re going to deliver, and how much better it is to take care of them. Don’t downgrade the quality of the services and try to explain it away by saying it’s almost as good. That’s the biggest mistake.
Independent Strong: What are the financial aspects independent practice owners should consider when starting to offer telemedicine?
Dr. Rothschild: The lowest level of investment is what we’d call supportive tele-optometry, which means that you use some sort of technology to communicate with patients to begin the exam to support part of what you’re doing. If you ask patients to fill out a history form or a survey online, then that’s supportive tele-optometry, which most practices are already doing at some level. The investment level there would be $0.
At the other end of the spectrum where you’re trying to deliver comprehensive exams with remote providers, you need to make a significant investment. You need modernized equipment where data can be uploaded to the cloud so it can be reviewed online. That could easily get up to $100,000 or more of an equipment investment, but a lot of practices have already invested in that equipment anyway.
That’s the biggest barrier – if you want to go all in, or you want to invest or start something new. That’s what we did in my practice – we started something new from scratch. We invested all this money in all this equipment, and it’s an expensive endeavor to go all in from the beginning. My recommendation is to ease into it. Start with expanding the services you’re already providing without too much of an investment and see what you’re comfortable with and grow into it gradually.
Independent Strong: How can independent practice owners leverage telemedicine to stay competitive among other practitioners?
Dr. Rothschild: I think the competitive advantage is to expand the level of services you’re able to provide. Since most optometrists are not delivering this type of care, implementing it into your practice puts you a step above your competition.
I recommend starting with follow-up visits that you’re comfortable with – and do virtual at-home visits. Tell your patients: ‘We’re going to offer you a virtual visit in a week to follow up on your red eye.’ Worst-case scenario is it doesn’t go well, and you need to see them in the office. The best-case scenario is you saved them another trip into the office, you’ve seen them for a billable visit, and you’ve provided them with good care that you’re confident with and the patient appreciates.
Independent Strong: In your experience, how does telemedicine affect patients’ perception of eye care practices?
Dr. Rothschild: I think it’s just like any other part of your practice. Perception can be positive or negative depending on how it’s presented to the patient. If you present this as an opportunity to take better care of your patients by honoring their time and their convenience by checking in on them to make sure their treatments are working, then it can be very positive. On the flip side, it can be negative if they feel like it’s cutting corners. If it is presented in a way that it’s a shortcut, or not as good, or lower quality, then it will hurt the perception of your practice.
Independent Strong: What would you say to an independent practice owner who may be on the fence about telemedicine?
If you are on the fence, just try it. I say start with a VAHOV (virtual at-home visit) for contact lens follow-ups. Try something that you are comfortable with and that you feel gives quality care to your patients.