Feature, Report

Innovation and opportunity shine in uncharted waters

Although few can compare with the magnitude of COVID-19, crises are an inherent part of business. RHIANNON BOWMAN examines how the ophthalmic sector can rebound from this latest crisis and capitalise on new opportunities it presents.

Few could have anticipated how widespread and sudden the coronavirus would shut down large sections of the Australian economy.

The weekend of 21-22 March, when the federal and state governments unveiled the first phase of strict lockdown measures, will be a moment etched into the memories of Australian business owners once they emerge from the other side of the crisis.

While the disruption may be painful from an economic standpoint, optometrists have been quick to adapt and keen to share how they are handling the economic downturn. Sections of the eyecare community are also using this moment to pause and identify new opportunities in terms of innovation and business management.

Chief among those is expanded use of telehealth services, which has emerged as a chance for the sector to significantly change the service delivery model. Elsewhere, with employees stood down across the country, practices are being encouraged to mobilise their staff to drive the future direction of their business, while also invest in other key areas such as professional development.

Time will tell

Independent optometrist Mr Harry Notaras, practice owner of EyewearYouwear in Surry Hills, Sydney, is no stranger to business disruption, but he says the COVID-19 pandemic is unlike anything he’s ever experienced.

In 2014, Notaras’ auxiliary practice Optometrix in Darling Street, Rozelle, closed for more than a week following a fatal explosion and fire in a neighbouring property.

The practice was located diagonally opposite but didn’t sustain any damage thanks to security screens fitted on his shop front windows. However, concerns about asbestos contamination resulted in an exclusion zone being established around the blast site. He was unable to enter the premises, even to hear messages on his voicemail, and had to cancel all patient appointments. He also had to inform his staff that they were not to go to work until it was safe to reopen the business.

“The biggest difference between that experience, and the current disruption, is that I could see the light at the end of the tunnel very quickly. Today, we don’t know what will happen, it’s changing day-by-day,” Notaras says.

As a member of Optometry Australia, Notaras is receiving regular notifications advising how coronavirus and government measures are affecting allied health practitioners.

“There is a lot of communication, from organisations and manufacturers. It’s important to keep up with the latest information. You need to be proactive with the advice that Optometry Australia is giving.”

When Notaras spoke with Insight in March, the government was advising allied health practitioners to exercise discretion in order to limit the risk of infection and treat only urgent cases.

“We did tailor our practice, trying to minimise the risk of infection following guidelines that were provided by Optometry Australia, such as limiting time spent with patients, only seeing urgent patients. Patients are triaged according to what Optometry Australia guidelines have indicated to be an urgent consultation. We’ve called every patient with a booking, we’ve sent text messages and SMS reminders. We’re essentially triaging over the phone.

“Our staffing has also changed. Normally, we have four full-time staff, one permanent part-time, and two casuals. Unfortunately, we’ve had to let our casual staff go, and we’re splitting our hours to retain two optometrists and two dispensers working half-days to minimise the risk of infection for both patients and staff.”

An experienced businessman, Notaras anticipates the biggest challenge could be yet to come. He believes the longer the economic disruption goes on, the longer the recovery time will be.

“Our practice is fortunate in that we have no business loans, but we pay leases on expensive equipment. I’ve been in contact with the people we do finance through and discussed delaying payment for six months, but it could drag out to 12 months.”

Notaras has also spoken with his practice landlord about paying rent and “trying to come to a mutual agreement”. In the days following his conversation with Insight, the Prime Minister announced a ban on evictions over the next six months for commercial and residential tenancies who are unable to pay rent due to the impact of coronavirus.

“Our practice is street-facing in a retail strip. Every other business affects us. The popular local coffee shop, for example, brings people past our door, but that’s closed, as well as many other retail shops near us. All these closures affect us.

“If we’re forced to close the practice, I’ve made changes so we can access our database remotely and continue running the business in some capacity. We can still monitor phone messages remotely, take orders for specs and lenses, we can mail directly to the patient, patients can deposit payments into our account.”

Catalyst for change

Eyeclarity founder Mr Jim Papas also knows how an economic slowdown can impact a business. He opened his first practice in Melton in 1986, not long before the 1990s recession Prime Minister Paul Keating infamously described as “the recession we had to have”.

Papas’ business survived the Global Financial Crisis (GFC) in 2007 too, and he eventually opened practices in Sunbury, Bacchus Marsh, Watergardens, Southgate, Hoppers Crossing and Melbourne CBD.

“We have opened and closed practises based on the business case.”

When he spoke with Insight, Papas – like many other optometrists – was reviewing his business on a daily basis, including his trading hours, leasing arrangements and staffing levels.

He believes one challenge the eyecare profession is facing is the “problem of doing the same thing the same way for several years”. He says the health and economic crisis COVID-19 has created could prompt significant change, with telehealth potentially becoming a more viable option.

“I think an important lesson that came out of the GFC is to make sure you’re close to your patients,” he explains. “The problem in optometry is it’s a provider-lead service; it’s on the provider’s terms.

“It has been this way for the last 20 to 30 years. Really, the industry needs to change to a more consumer-centric model. With 24/7 internet, access to latest offers and transparency on pricing, consumers are now making decisions.

“This crisis could be the catalyst to change the system to be more consumer-centric. The practices which provide eyecare this way are the ones which will thrive.”

Working ‘on’ the business

With 460 businesses, ProVision is the largest network of optometry practices in Australia. Amid the widespread economic disruption, CEO Mr Steven Johnston has made it a top priority to keep each practice informed with weekly updates on business management. He believes the COVID-19 crisis has raised three unique opportunities for practice owners, managers and staff.

“This is an opportunity for practice owners to shore up business cash flow, work on their business plan, and invest in professional development,” he says.

Johnston described the Federal Government’s JobKeeper payment program as a “real godsend for practice owners and their staff”.

“The number one point to be considering is cash flow to take your business out to the end of this calendar year or at least for a six-month hiatus or hibernation. A business owner needs enough cash to get through the next six to nine months,” he explains.

Johnston says practices can utilise allowances like PAYG concessions and other government-led initiatives to survive financially. “But you’ve got to understand with cash flow that you need to reduce your obligations, and the biggest cost in small business is staff. That’s the same for everyone.”

He explains that temporarily closing or reducing practice opening hours creates other opportunities. “The second point to be considering, is that practice managers and optometrists will have a lot of time on their hands, if they are not consulting with patients.

“This is the time to plan for what your business is going to look like out the other side of this. Optometrists are practicing for most of the year, there is no down-time, they don’t get time to work on their business. There will be time to take stock, re-evaluate your purpose, value, and mission. This is a perfect opportunity for practices to come out the other side different to how they went in; it’s an opportunity to work ‘on’ the business – not just ‘in’ the business.”

Further, Johnston believes the JobKeeper payment, which is designed to keep staff connected to businesses, is an opportunity to engage practice staff in driving the future direction of the business.

“Business planning can be team-based. It’s something that can be shared across the whole team. Establishing your practice values should be team-based, all your staff can contribute to that,” he says.

“At an operational level, this is also a great time to look at your product range. Ask yourself: is it the right range for the clientele we want to attract moving forward? What marketing plan will you have in place to promote that your practice is back up and running?”

The third important point, Johnston notes, is that the downturn presents an opportunity for personal development.

“Fortunately, we launched ProLearn Max, an online learning platform for our members in October last year. So rather than having ‘stood down’ staff at home watching Netflix, ProVision practice staff can continue to improve their knowledge-base, learning from home.

“The lesson here is, if we’re all going to be working from home, use the time effectively. Business planning doesn’t have to fall on the shoulders of the business owner. It can be shared across all employees. There is going to be extraordinarily bored people over the next six months. Find a way to stay productive.”

Telemedicine trending

At the time of writing, the ophthalmic community recognised telehealth as an ideal method to overcome challenges posed by COVID-19, and has been advocating for new optometry-specific Medicare items.

Last month, the Australian developers behind cloud-based telemedicine platform Oculo helped form part of the solution. They identified an emerging gap in patient care with COVID-19 and immediately added a new feature that will help eyecare professionals connect with their patients via videoconference.

CEO Dr Kate Taylor says Oculo is used for 90% of the teleophthalmology currently billed in Australia. She described COVID-19 as a “curveball” for the eyecare profession that is “creating a lot of challenges for everyone”.

“What the future of eyecare will look like after coronavirus hasn’t yet been spelt out; everyone is highly focused on the acute crisis,” she says.

“But we’re getting a sense of what could potentially happen, and that was the trigger to change our business response. Disruption can create opportunity.”

At present, approximately 3,200 optometrists across corporate and independent groups and more than 770 ophthalmologists use Oculo to support communication with over 800,000 patient records.

Taylor says the company accelerated its plan to add the videoconference component, recognising that eyecare practitioners immediately needed another way of communicating with patients and each other.

She foresees COVID-19 unfolding in three phases: acute, sub-acute and recovery.

“The acute phase is happening right now [early April]. As you look around, you can see the crisis management with emergency shutdowns, social distancing, and self-isolation measures to flatten the curve,” she explains.“We’ll move into the sub-acute phase when, speculatively, an antibody test becomes available and we can distinguish between people who have been infected and become immune, and those still at risk. Hopefully, we can progressively rebuild a partial workforce able to better care for the community.”

The final stage, Taylor says, will be the recovery phase as the population reaches a critical mass for herd immunity, prophylactic treatment and/or a vaccine. “This could be a phase marked by an enormous backlog in healthcare need as people who have stayed away from care or not been able to access it will come forward.”

Taylor suspects eyecare practitioners could have a period of detecting unusually advanced disease, including vision loss that would have been better managed under normal circumstances.

“This may be a turbulent time, considering how most public outpatients around the world were not adequately coping with demand before COVID-19,” she says.

While there may be greater demand for healthcare when self-isolation restrictions are lifted, Taylor also questions whether it will be provided through the same mechanisms.

“Patients may abandon their private health insurance because they see little benefit if they can’t use it for six months. So, post-coronavirus, patients whose cataract surgery was postponed during the pandemic may no longer be privately insured and now seeking surgery though the public health system. Ask yourself: what does that mean for my business?”

Ultimately, she believes telemedicine can play a part in each phase of the pandemic.

“In the acute phase, telehealth can be used to screen patients, share clinical information, reduce duplication, reduce contact between patients and health care practitioners, keep people self-isolated at home and socially distanced.

“The sub-acute phase amplifies the potential for telemedicine. We will still need to protect the vulnerable in our population. With part of the population hopefully immune or with a prophylactic treatment, we can create scalability – remote capture and telemedicine review give scale to a partially resourced health system.”

In the recovery phase, Taylor envisages telemedicine could hasten the process of working through heightened demand, while still protecting pockets of vulnerable people.

Perfect storm gathering

Dr Ben Ashby, optometry director at Specsavers, believes the Federal Government is moving towards supporting telehealth, but as restrictions on social-distancing and self-isolation tighten, subsequently curtailing face-to-face optometric consultations, more needs to be done in the immediate term to help optometrists support their patients.

“If you look beyond COVID-19, a lot of older people who aren’t mobile, who are in aged care facilities, or regional and remote locations, have difficulty accessing eyecare,” Ashby says.

“Ten million people are not getting their eyes checked regularly and access has to be a significant factor in this worrying statistic.

“In the short-term, Specsavers is working hard alongside Optometry Australia and others within our profession to lobby the government for optometry to gain access to telemedicine but to be sustainable in the long-term, we’re also making technology changes within our software programs – Socrates and Genesis – to support telemedicine services.”

He says supporting off-site practitioners to provide care included granting remote access to health records and the ability to update them so as to accurately document telemedicine outcomes. This supports good clinical decision making and continuity of care over time.

“Telehealth in optometry is a critical tool for the profession to help those in the community who are challenged to physically attend practices. This unique time is an opportunity to research and measure what we’re doing, to demonstrate the benefit of telemedicine. Measuring referral patterns, patient outcomes, and clinical interventions is vital, so we can learn from it, and ultimately it is our patients that benefit from that.”

Ashby notes that four telehealth items have been previously added to the Optometry Medicare Benefits Schedule, but they are under-utilised mostly because the wording of the item code meant the optometrist and patient needed to be together while an ophthalmologist participates via video conference, a process that is inherently difficult.

“We hope this might change in the next tranche of announcements as telemedicine is ideal for short (10916) and subsequent (10918) eyecare consultations, which could be achieved by removing the need for physical attendance in the current descriptors, as part of the delivering of primary care,” he says.

Although optometrists have been advised to exercise discretion and limit themselves to urgent cases only, many are wondering how the profession will deal with a backlog of patients who have missed routine eyecare.

More pressingly, Ashby fears there could be an increased risk of vision loss in the community if patients break their appointment cycle.

“We’re already stretched as a workforce. We need to work together more closely, sharing the care of patients with other professions, and telemedicine can facilitate that.”

Ashby notes that the current crisis raises more questions, such as; how does optometry bring in more clinical decision support? How can the sector leverage artificial intelligence (AI) to reach best clinical decisions in a shorter period? With limited staffing, what can be done to upskill ancillary staff to support optometrists? He says the sector needs new triage protocols to reflect current workforce skillsets, the changing environment and closer working relationships with medicine.

“Currently optometry does not have a practice management system with all the needs of the future with integrated telemedicine, remote record access, clinical decision support and AI built into it,” he says. “But the conditions are ripe for innovation to kick in. Circumstances such as the state of the economy, and people with time on their hands, makes for the ‘perfect storm’ for innovation.”

Support for staffing and wages

WageLoch is set up to “talk” to accounting software such as MYOB and Xero, so wage categories under the modern award system can be mapped and managed. Since starting the company with her husband, Lachlan, in 2006, director Ms Kobi Sedsman says the technology has been increasingly adopted in health professions including medicine, dentistry, pharmacy and ophthalmology where the modern award landscape is inherently complex and varies from state-to-state.

The company has been responding to shifts in staffing trends as the coronavirus outbreak has continued to affect small business.

“As a business-to-business software solution, many of our clients have been contacting us since a new category under the modern award system called ‘stand down’ has come to the fore.”

Under Fair Work legislation, employers may be able to stand down their employees without pay during the coronavirus outbreak. Employees that are stood down remain employed during the period of the stand down.

“We’ve had a flood of customers asking us to set up a ‘stand down’ wage category as part of their WageLoch service. It’s a good option for businesses facing closure as a result of the government’s lockdown on non-essential services.”

With more staff working from home, Sedsman says clients have also needed to access their services on home-office computers, as opposed to accessing the cloud-based software from their typical place of business.

“It’s been vital to employers to be able to shift their business to working from home, and not be reliant on being on site,” she says.

“Contingency and business continuity planning is important, but some scenarios, like COVID-19, you can’t see coming. No one would have planned for this. You have to be flexible and creative and consultative as a small business owner.”