Strategies for managing ophthalmic practices during the COVID-19 crisis

Dr Suresh K. Pandey MBBS, MS, and Dr Vidushi Sharma MBBS, MD, FRCS, give an Indian perspective on the steps Indian ophthalmologists need to take to tackle the COVID-19 virus. 1. Patient Visit and Surgery to Hospital or Day Care Centres While seeing emergency cases or in routine OPD, take all adequate precautions and follow the guidelines as suggested by the All India Ophthalmological Society (AIOS). Use of face mask, frequent hand washing, social distancing, minimal touching and talking, use of slit-lamp with protective cover etc. will be helpful. Emphasis should be given on social distancing, frequent hand washing and hand hygiene. 2. Digitisation/Online Consultation The rise of digital solutions means that patients might replace routine check-ups with virtual remote consultations long after it is safe to venture outdoors. Other tech-first practices include the availability of slit-lamp protectors using special sheets, and other devices that help to see ophthalmic cases while maintaining distance. It will be pertinent to go to EMR (electronic medical records, etc. if you haven’t already) and begin scheduling online appointments and collecting payment. 3. Cost Management and Financial Contingency Plans Private practices need to start adjusting their budget plans. The finance department needs to calculate current cancellations and possible setbacks in the coming weeks (and months). 4. Revive the Financial Reserve of the Practice Assess cash reserve of the practice and prepare a plan for survival taking worst case scenario. Accelerate collection of due amounts by the Third-Party Agency (TPA) and all insurance companies and by chasing debtors. Consider reduction of the fixed cost by converting full-time doctors to part-time doctors, and convert full-time anaesthetists into on-call duty professionals. One should cut short all unnecessary expense such as minimising cost in marketing (newspaper, television, etc.). 5. Force Majeure Clause and Equipment Maintenance Consider a reduction in rental cost by following the Force majeure clause or by handing over extra space that is not needed at present. Also, consider the extension of CMC and AMC of important equipment by a few months as mentioned before. Train and sensitise your staff to save money by preventing wastage and by minimising use of costly disposable items. 6. Review the Inventory of IOLs, other Supplies and Pause Expansion Do an inventory of the intraocular lenses (IOLs), cassette, viscoelastic products, surgical adjuncts, pharma items/drug supplies in-stock and those required in future. Identify expenditures that aren’t necessary to ensure that you don’t run out of essential supplies. Unnecessary expenses could include planned extensions within the facility, renovations or offsite training programs. Postpone the idea of expansion, new instrument or hiring non-essential staff until further notice. 7. Insurance Cover for COVID-19 and Business Interruption Insurance Review your insurance policy to check if it covers COVID-19 associated liabilities. Understanding the validity of your insurance coverage and its potential will make it easier for you to make an administrative decision. Request your insurer to provide coverage for preoperative COVID-19 tests. 8. Legal Aid Consult with a legal adviser to ensure all your paperwork is up to date. Your legal adviser can create a liability form that safeguards your practice. The form should state that your medical practice will not be held liable in the event of a COVID-19 outbreak within your premises. 9. Staff Salary and Incentives Develop a financial contingency plan. Inform employees about possible salary cutbacks, bonus incentives, working hours or other amenities. Request them to cooperate if there is a delay in their annual salary, bonuses and incentives. Communicate and sensitise the entire team to be ready for salary cuts, working on weekends and layoffs, in the worst-case scenario. 10. Reshaping Contract, Medical Protocols & Collaborations It is essential for medical practitioners to take complete precautions while with a patient. These include wearing masks for nose, eye and mouth during surgery. These measures are mandatory for treating patients who have recently travelled or who show visible symptoms of fever or a respiratory disorder. We should also start screening patients beforehand. The best strategy is to cancel non-urgent appointments and consulting patients who are ill. We should also ask staff to stay home if they are having fever or cough. Also, make sure that your employees are updated about revised guidelines and regulations. Medical staff must re-evaluate their assignments. Ask them to assist each other during emergencies and swap clinical hours whenever required. It is important for the practice to prepare a revised staff contract and include all details about COVID-19 and possibility to get infected while working in hospital. It is important to get it duly signed (on stamped papers) by all staff members. Following these guidelines can mitigate the spread of infection. It will also save the practice from legal implications if some staff come positive COVID-19 and file the compensation case against the hospital. 11. Group Practice and Models Sharing the Costly Equipment Other initiatives include sharing facilities (e.g. surgical facilities, laser and surgical equipment) with other private practices. If possible, share medical staff and send terminated employees to aid understaffed practices. 12. Leadership in Lockdown The coronavirus pandemic is described as humanity's worst crisis since World War II. It will undoubtedly take time to overcome. It is important to be proactive and communicate things effectively.

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