COVID-19 and Use of Teleophthalmology (CUT Group): Trends and Diagnoses

• DOI: 10.1016/j.ophtha.2021.02.010
• Publication Date: 2021-02-10T16:46:45Z
• Authors: David S. Portney; Ziwei Zhu; Evan M. Chen; Emma Steppe; Priyanka Chilakam...; Maria A. Woodward; Chad Ellimoottil; Ravi Parikh
• Keywords: 2019-20 coronavirus outbreak

The coronavirus disease 2019 (COVID-19) pandemic altered how clinicians care for patients. Ophthalmologists saw an estimated 81% drop in volume, the most of any specialty during initial and public health restrictions.1Strata Decision TechnologyAnalysis: ophthalmology lost more patient volume due to COVID-19 than other specialty. Eyewire News.https://eyewire.news/articles/analysis-55-percent-fewer-americans-sought-hospital-care-in-march-april-due-to-covid-19/Date: 2020Google Scholar Concurrently, Centers Medicare Medicaid Services removed many regulatory restrictions (i.e., rural designation zones) on telehealth began reimburse professional services at same rates as in-person visits, with goal increasing access via synchronous methods such virtual visits.2Centers ServicesTelehealth: telemedicine provider fact sheet.https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheetDate: may have difficulty visits because much evaluation requires a slit lamp, tonometer, dilation, advanced imaging OCT. Evidence proportion actual ophthalmic use beyond single institution is lacking. Potential trends, reduction after surge or prominently by certain subspecialties within ophthalmology, are not confirmed primary data. Our study first demonstrate characteristics large scale data before pandemic. This was deemed "not regulated" University Michigan's Institutional Review Board, adhered tenets Declaration Helsinki. requirement informed consent waived retrospective nature study. We used Blue Cross Shield Michigan claims identify encounters using local code, including all outpatient fee from September 1, 2019, through 2020. A encounter defined presence specific procedure modifier codes (25 GT). Store-and-forward retinal (Current Procedural Terminology 92227 92228) were added analysis separately. Postoperative global postoperative period included they billed regularly. Current code 99024 (postoperative follow-up visit) accounted only 0.006% total ophthalmologist Two Z tests completed determining differences between (P < 0.001 considered statistically significant). frequent 100 overall diagnosis determined onset state stay-at-home order March 24, Diagnoses grouped into 13 subspecialty categories accordance diagnostic groups Clinical Classification Software, organizational system developed Agency Healthcare Research Quality (Table S1, available www.aaojournal.org). 362 355 occurred Telehealth 91 235 327 (0.04%) 14, 2020, 2031 127 028 (1.6%) 15, 2020 0.001). peaked 17.0% (4/5/20–4/11/20; Fig 1). maximum 84 (30%) ophthalmologists (3/29/20—4/4/20). By 228 610 (37.4%) had telehealth. Chalazia, common diagnosis, 9.4% claims. Dry eye (4.8%), conjunctival hemorrhage (2.1%), allergic conjunctivitis (1.9%), unspecified blepharitis squamous (1.3%) also top 10 diagnoses categorized cornea external disease. Moderate open-angle glaucoma (2.8%), exudative age-related macular degeneration (2.2%), preglaucoma (1.3%), mild commonly S2, Cornea conditions 48.0% 13.2% Retina vitreous 16.8% 13.4% respectively, but 38.6% 0.001) 23.8% respectively. Cataract lens disorders 3.1% No difference found strabismus = 0.407) neuro-ophthalmology 0.002) S3, identified rapid increase subsequent decrease phases low levels teleophthalmology overall. Ophthalmology has been reported discipline lowest number users telehealth.3Aguwa U.T. Aguwa C.J. Repka M. Teleophthalmology era COVID-19: early adopters academic institution.Telemed J E Health. 2021; 27: 739-746Crossref PubMed Scopus (17) Google Scholar,4Mehrotra A. Chernew Linetsky D. et al.Impact COVID care: prepandemic all.https://www.commonwealthfund.org/publications/2020/oct/impact-covid-19-pandemic-outpatient-care-visits-return-prepandemic-levelsDate: diseases significantly greater did whereas retina conditions, glaucoma, cataract constituted fewer evaluations. Currently, associated corneal pathologic features assessed best telehealth, these reduce visits. Expansion technology home tonometry OCT (which already developed) further home-based innovation allow increased adoption care, especially established patients.5Liu J. De Francesco T. Schlenker Ahmed I.I. Icare tonometer: review clinical utility.Clin Ophthalmol. 2020; 14: 4031-4045Crossref (20) Scholar,6Galiero R. Pafundi P.C. Nevola importance pandemic: focus diabetic retinopathy.J Diabetes Res. (2020:9036847. Oct 2020)Crossref (106) previously focused asynchronous forms store-and-forward address workforce shortages, visits.7Rathi S. Tsui E. Mehta N. current United States.Ophthalmology. 2017; 124: 1729-1734Abstract Full Text PDF (182) that well equipped shift clinics patients' homes. key limitation inclusion one payer (Blue Michigan) (Michigan). coincided both new federal rules Each factor confounds far causality However, percentage declined April 11, equivalent reimbursements continued. decline likely related need examination assess patients accurately. Various procedures higher-level office typically feasible, creating financial disincentive continue along ethical, safety, legal ramifications incomplete inadequate evaluation. These challenges must be balanced perceptions efficacy convenience. Existing could effective Until reimbursed further, symptoms indicative chalazia, blepharitis, hemorrhage, dry benefit Download .pdf (.01 MB) Help pdf files Table S1 (.04 S2 (.03 S3