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Telehealth: Where Changing Technology Challenges Traditional Vision Care

By Mark Tosh, Senior Editor
Wednesday, April 18, 2018 12:24 AM
NEW YORK—Telehealth is a topic on the minds of most everyone in eyecare. Perhaps this is due to the fact that telehealth is almost a perfect personification of an eyecare marketplace that today is caught up in rapidly changing technology that directly challenges the traditional notions of how vision care is delivered to patients. Telehealth also is a concept that is top-of-mind with patients and consumers who are exploring the new options for interacting with health care practitioners today.

The rapid rise of telehealth and its impact on vision care was the focus of a multi-part discussion at the VM Summit. The session, “Tackling Disruption: The Telehealth Frontier,” featured telehealth experts, leading providers, eyecare professionals and optical retailers. The objective was to examine how health care and business leaders are grappling with the challenges of new technology and how this is reshaping relationships between doctors and patients.

The session consisted of three parts. The first featured three experts in the telehealth field who discussed regulatory and compliance issues: Latoya Thomas, director, State Policy Resource Center, American Telemedicine Association; Daniel Cody, attorney, Jones and Day; and Wallace Lovejoy, founder, Lovejoy Eyecare Consulting.

Thomas noted that ATA (which is based in Washington, D.C.) focuses on helping to expand coverage and reimbursement for telehealth services and also to integrate telecommunications and technology into the health care space, among its other initiatives. The organization defines telemedicine, telehealth and virtual care “as health care services provided from one location to another location using telecommunications,” she said, noting that the association has intentionally left the “patient,” the provider and specific sites of care out of its definition of telehealth.

Experts in the telehealth field discussed regulatory and compliance issues. (L to R) Jobson’s Marge Axelrad; Latoya Thomas, director, State Policy Resource Center, American Telemedicine Association; Daniel Cody, attorney, Jones and Day;
and Wallace Lovejoy, founder, Lovejoy Eyecare Consulting.
“We want to create opportunities and space for developing innovative models for telehealth,” she said. “We also look at opportunities to really enable health care providers to fully utilize these technologies and services.”

She noted that, according to ATA’s data, 34 states and Washington, D.C., are “fully embracing some component of telemedicine for their state-regulated health plans, at the very least.” In addition, there have been recent policy improvements with respect to the Medicare-coverage landscape, she noted.

The forecasts for growth rates going forward for telehealth are in the 10 percent to 13 percent range, attorney Cody said. “The case for telehealth has been answered, and I think it is widely acknowledged that we can deliver better quality care more efficiently using telehealth,” he said. “And the second piece of this is that telehealth really goes a long way in terms of lessening some of the traditional socioeconomic barriers there are to access.”

Cody noted that state boards of optometry and medicine have gotten “much, much more active in terms of looking at telehealth,” particularly in the optical space. “And they are asking questions about how [the] operation is structured and where is the physician located,” he added.

Among the regulatory issues of concern in the telehealth sector are licensing and credentialing, Cody said. Various states have different regulations, which means that any company involved in setting up a telehealth program should review the current regulations in the jurisdiction where they will be operating the telehealth program. “What works in New York might not work in other states,” Cody said.

Privacy also is a concern in the telehealth process, and states also have privacy provisions that need to be considered. There is going to be an increase in state and federal activity from a fraud and abuse perspective, Cody said.

Lovejoy, a longtime industry executive, talked about how telemedicine is being used for retinal imaging for diabetic retinopathy, to manage cataracts, glaucoma and for tele-education purposes among doctors or doctor-to-staff training.

“Remote prescribing is probably the hot-button in our industry right now,” he added. “How and when can you use telehealth, and who can use telehealth to either write a prescription for the first time, or more typically, renew or slightly change an existing prescription? But there also are issues around prescribing therapeutic pharmaceuticals using telemedicine, as well,” he noted.

The second part of the telehealth discussion featured executives from four optical telehealth providers. (L to R) Brent Rasmussen, CEO, Opternative; Greg Lechner, director, marketing and communications chief, 20/20NOW; Lee Kuczewski, director of operations, Smart Vision Labs; and Howard Fried, OD, the founder of DigitalOptometrics.
Still, ocular telemedicine is positioned now to improve both access and outcomes, and also offers a way for doctors to expand their influence, Lovejoy said. “I think it’s also a way for doctors to get their patients to be more adherent to whatever they are prescribing in terms of treatment plans,” he added.

“It certainly lowers costs and expands the doctors’ range of ability to consult and to be consulted, which means a doctor can extend his/her influence and it also makes the doctor more efficient [because they can be working in one location and reviewing data from patients in another location] and with optometry averaging still barely over one exam per hour there is capacity in the profession to be able to see more patients.”

The second segment of the telehealth discussion featured executives from four optical telehealth providers: Howard Fried, OD, the founder of DigitalOptometrics, a tele-optometric startup offering comprehensive eye exams using automated technology; Brent Rasmussen, chief executive officer of Opternative, which offers online vision testing; Lee Kuczewski, director of operations, Smart Vision Labs, which has developed a proprietary, smartphone-based telemedicine platform; and Greg Lechner, director, marketing and communications chief for 20/20NOW, which provides in-store remote eye exams using tele-ophthalmology.

Improving access to vision care was the “genesis” of Smart Vision Labs, according to Kuczewski, and that was followed by asking patients what they wanted out of the eye exam experience. The three things that patients asked for were convenience, “connectedness,” and clarity, he said. “We’ve been following through on this, and over the course of the last several months we’ve been trying to deliver this.”

Kuczewski noted that Smart Vision Labs has 600 of its devices in the field and 100,000 patients have utilized the test, and that the company is still “learning a great deal about this information.” He said that Smart Vision has basically taken an auto refractor and miniaturized it. “We are not a replacement for comprehensive care,” he added. “But what we do is provide a solution for quick updates to prescriptions for patients.”

Fried, describing his company’s official launch of a “tele-optometry” service at Vision Expo East, said the DigitalOptometrics approach does permit “real-time communication between the optometrist and the patient.” He also noted that the system is designed for both an in-office OD and a remote OD to operate, and that the company exclusively utilizes licensed optometrists for its testing. The company has completed successful tests of the remote comprehensive eye health exam on hundreds of patients in a retail optical environment, he noted.

“This [system] is all about patient access to care,” he explained. “There are about 200 million people in the U.S. who need some form of [vision] correction, and there are about 100 million to 115 million who are actually getting eye exams annually.”

Lechner, of 20/20NOW, acknowledged that “there are a lot of different flavors when it comes to telemedicine,” yet he noted that telemedicine options could be a key to addressing the significant shortage of doctors in the U.S. today, particularly in rural areas. The focus of 20/20NOW is to provide comprehensive eye exams that are delivered through a retail store. The company has opened 65 locations and, after completing its first comprehensive exam four years ago, has now completed roughly 35,000 exams.

“If you look across the optical landscape, there are literally thousands of stores either without a doctor or with only partial coverage,” he explained. Even in major metropolitan markets, with big practices that do a lot of volume, there is still an underserved population.

“Our mission is to provide customers with on-demand comprehensive eye exams,” he said. “So our tagline, ‘The doctor is always in,’ is a promise that we deliver to our clients because we have doctors and certified ophthalmic technicians employed throughout the country.”

Opternative’s Rasmussen said the Chicago-based company wants “to partner with the industry” to drive high-quality eyecare. He related his past experience with the job site CareerBuilder.com, and how that business opted to partner with newspaper job sites rather than try to drive them out of business as Monster.com stated it wanted to do. “At CareerBuilder, what we wanted to do was embed our technology, embed what we do, at the [newspapers’ online job site] and help job-seekers look for jobs in both print and online.”

This type of partnership is what he would like to see in the future for Opternative, Rasmussen noted. “We want to partner with the industry in terms of driving patients to high-quality care, and also driving patients to the areas in which they need to go.” He said 25,000 people come to Opternative every single month with some kind of eyecare needs “and we can’t serve all of those patients,” for various reasons, whether it’s age, health issues or other factors, he said.

“Our ophthalmologists are super conservative and they are not going to write a prescription for something [or someone that looks amiss]. What should we do with those people?” he asked. What Opternative is able to do, as of March, he said, is to send these patients to an ECP in the zip code in which they live. “We’re excited to do this today, and we’re doing it every single day,” Rasmussen said. Opternative expects to be operating in five countries overall by the end of April, he added.

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