COVID-19 Notices for Doctors of Optometry


May 14, 2020
URGENT:  LSBOE Update on COVID-19 Pandemic & Resumption of Care
 

With the Governor's lifting of the state's stay at home order and the subsequent resumption of the full scope of
optometric eye and vision care services, the LSBOE reminds all Doctors of Optometry licensed in the state of
Louisiana to safely and responsibly follow the guidelines set forth by the Louisiana Department of Health, in conjunction
with recommendations from the Centers for Disease Control and the best practices of the profession as promoted by
the American Optometric Association. The LSBOE remains in contact with state public health officials and will continue
to provide updates as appropriate.  Should you have any questions, please contact the LSBOE office.

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April 28, 2020
URGENT:  Update from LSBOE & LDH - Allowed Health Care Procedures & Services


All Doctors of Optometry licensed to practice in the state of Louisiana are instructed to read the clarification update (pasted below) from the Louisiana Department of Health (LDH) on 04/24/2020 in its entirety.  
 
Based on this clarification, and after subsequent communications with LDH, it is the LSBOE’s position that in addition to continued medically necessary eye care for emergent & urgent conditions (such as ocular/orbital/peri-orbital trauma, sudden vision loss, diplopia, foreign body, eye pain, photopsia/floaters, high myope who’s lost/broken their only pair of glasses, etc.), other time-sensitive, medically necessary procedures & appointments for patients who are now outside the standard of care for their followup may also be seen (such as those needing post-operative care or followup for glaucoma, macular degeneration, diabetes, etc.).  LDH continues to strongly urge the use of tele-health services whenever medically appropriate, provided standards of care can be met, and LDH still requires that all procedures which can safely be delayed be postponed.  The resumption of vision care for those without clinically significant changes in vision is still prohibited at this time.  Additionally, the original requirement for 10-14 day followup with patients for subsequent diagnosis or symptoms of COVID-19 after a procedure applies only to invasive surgical procedures, meaning within the body cavity in this instance as indicated by LDH.
 
THE SAFEGUARDS RECOMMENDED BY LDH BELOW & IN ANY OF ITS PREVIOUS ORDERS WHICH ARE STILL IN EFFECT, AS WELL AS THOSE BY THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) IN THEIR APRIL 19, 2020, RECOMMENDATIONS, MUST BE IN PLACE FOR ALL IN-PERSON VISITS TO PROTECT PATIENTS, STAFF, & DOCTORS FROM THE SPREAD OF COVID-19.  
 
This includes the use of face masks by patients, staff, & doctors, in addition to other personal protective equipment (PPE) as appropriate; enforcement of social distancing for everyone in the office to minimize interaction, including limiting the number of people in the office at any one time, reducing patient volume, & modifying patient flow as able; and daily logging and pre-screening for signs & symptoms of covid-19 for anyone entering the office (including doctors, staff, & ancillary personnel) to facilitate contact tracing if needed.  Electronic reporting of any presumptive COVID-19 positive or diagnosed COVID-19 cases must be made to the Louisiana Office of Public Health (LOPH), and anyone with flu-like symptoms should be referred to their medical provider and should not physically return to work until cleared by their medical provider.
 
Doctors of Optometry operating in good faith will not be in violation of this order; however, any Doctors of Optometry found to be grossly negligent regarding, or in direct violation of, these orders will be subject to discipline.
  
LDH Notice of 04/24/2020:
John Bel Edwards                                                                                                                Dr. Courtney N. Phillips
GOVERNOR                                                                                                                          SECRETARY

State of Louisiana - Louisiana Department of Health, Office of the Secretary


Allowable Medical, Surgical and Dental Procedures: Update 04/24/2020

 
This message is intended to simplify and clarify the 20-25: Healthcare Facility Notice/ Order #2020-COVID19-ALL-010 that was issued on Monday, April 20, 2020. The notice is applicable to all licensed healthcare facilities in Louisiana, as well as all healthcare professionals licensed, certified, authorized, or permitted by any board, authority, or commission under LDH. 
All CMS guidance for facility reopening should be followed. 
 
Summary Points: 
  • The decision to proceed with any medical, surgical or dental procedure will be up to the professional judgement of the medical or dental professional. 
  • Doctors/Dentists operating in good faith will not be in violation of this order. 
  • If a provider, in their professional judgement, decides that a medical, surgical, or dental procedure is a time sensitive medical condition for an individual patient, the provider must document this in the patient’s medical/dental chart. 
  • All providers should make every effort to follow PPE, social distancing and environmental cleaning recommendations outlined by the CDC to protect their patients and staff both during procedures and business operations. 
  • PPE needs and stockpile should be determined by the medical professional performing the procedure and should correspond to the CDC guidance for the particular procedure being performed: https://www.cdc.gov/coronavirus/2019- ncov/hcp/infection-control-recommendations.html 
  • At time of appointment, screen the patient for COVID-19 symptoms and test (or refer for testing) if appropriate, and postpone symptomatic patients. 
  • Patients and staff should comply with social distancing before and up to the procedure. 
  • Each facility or provider that performs an invasive medical, surgical or dental procedure shall contact the patient 10-14 days after the procedure/encounter to inquire about signs/symptoms and/or testing for COVID-19 and will make recommendations to any patient who responds affirmatively. 
  • Patients who have been identified on follow-up as a COVID-19 presumptive (symptomatic) or positive should be reported electronically to LDH-OPH. 
  • Follow-up within 10-14 days is required from the last date (discharge) of the time-sensitive procedure(s). 
• COVID-19 testing should be performed (or referred) through normal available testing channels using an FDA approved or EUA COVID-
  19 test. 
 
Allowable Procedures 
• An emergency medical condition
• To prevent further harms from an underlying health condition
• To address a time sensitive medical or dental condition
• Time sensitive conditions are those surgical, medical or dental procedures in which a delay, in the opinion of the medical/dental
   professional, might adversely affect the patient or underlying disease process if delayed.
• Preventive procedures/visits can be deemed time-sensitive if performed with recommended preventive and social distancing
   precautions (i.e. dental cleanings, well child visits). 
 
Facility Requirements 
• Adequate supplies, equipment, and medications for the procedure 
• Appropriate staff to perform the procedure
• Adequate COVID-19 precautions and monitoring 
 
COVID-19 Precautions 
  • Prior to, and at the time of appointment, screen the patient for COVID-19 symptoms and test (or refer for testing) if appropriate. 
  • Comply with social distancing before and up to the procedure. 
  • Facility must have adequate and appropriate PPE to perform the procedure based on CDC guidance. 
  • Each facility or provider that performs an invasive medical, surgical or dental procedure shall contact the patient 10-14 days after the procedure/encounter to inquire about signs/symptoms and/or testing for COVID-19 and will make recommendations to any patient who responds affirmatively. 
  • Patients who are identified a COVID-19 presumptive (symptomatic) or tested positive should be reported electronically to LOPH. 
Professional Medical Judgement 
The decision to proceed with any medical, surgical or dental procedure will be up to the professional judgement of the medical or dental professional acting within his/her scope of practice and pursuant to the standard of care for that procedure.  Postpone any medical, surgical or dental procedure that can be delayed without adversely affecting the particular patient or the underlying disease. 
 
FREQUENTLY ASKED QUESTIONS
 
What type of procedures are considered to be “time sensitive”? 
Time sensitive medical conditions are those that need to be performed because they have been postponed due to the previous order and because of that delay, may cause pain, distress, or further negative outcomes for the patient. These can include preventive procedures with appropriate precaution. 
 
Are we differentiating the types of PPE (COVID, surgical, homemade, etc.) for different interactions and is there guidance on how to calculate the 5 day supply? 
Please refer to the CDC guidance on the appropriate PPE for COVID-19 and the procedure being performed. A daily “burn rate” can be determined by a few factors: the number of staff in the facility, the number of patients seen, and number of procedures. 
 
Where can we recommend patients who exhibit symptoms to go get tested? 
You can refer patients to their primary care physician, local hospital, or testing site – please ask that they call ahead. If patients have questions about testing sites or do not have a primary care physician, they can dial 2-1-1 for more information and assistance. 
 
Do all patients need to have a COVID-19 test before coming in for a procedure? 
No. Testing should only be done before the procedure if a patient is exhibiting symptoms, which include a fever, cough, shortness of breath, etc. Obviously, the procedure should be postponed for any (non-emergency) symptomatic patient. 
 
If our clinic has an accredited lab, will the state allow us to perform testing or will we need to send our patients to a different location? 
COVID-19 testing can be conducted by any accredited medical facility/laboratory/test. Results should be sent to whatever lab you would normally use to collect and analyze samples. 
 
Should we continue telehealth visits? 
When available and medically appropriate, preventative checks or procedures should continue to be conducted via telehealth. 
 
Do the current CDC capacity limits (no more than 10 people in a gathering) apply to office staff? 
The capacity limits and social distancing should be followed whenever possible. To assist, it is recommended that you do not have patients packed in your waiting rooms but rather call them “back” individually at the time of their scheduled visit and have patients wait outside (in vehicles) whenever possible. 
 
Do all patients need a follow-up 10-14 days after their procedure, including preventative or follow-up appointments? 
No. The 10-14 day follow-up is only required for patients undergoing invasive procedures. 
 

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April 21, 2020

URGENT: April 21, 2020 COVID-19 Update for Doctors of Optometry

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With its current orders set to expire on April 30, 2020, the Louisiana Department of Health (LDH) has issued new orders to all licensed healthcare professionals, including Doctors of Optometry (reference: LDH HEALTHCARE FACILITY NOTICE/ORDER NOTICE #2020-COVID19-ALL-010 - RE: Medical and Surgical Procedures; Dental Visits, Procedures and Surgeries; Other Healthcare Services).

The LSBOE instructs all Doctors of Optometry to review LDH’s order of April 20, 2020, in its entirety at this link:

http://ldh.la.gov/assets/oph/Coronavirus/resources/providers/LDH-MEMO- UPDATE-RESTORE-MED-SURG-Procedures.pdf.

In summary, effective at 12:01 a.m. on April 27, 2020, and until further notice, this order directs & requires that Doctors of Optometry (and all healthcare professionals) SHALL ONLY perform medical and surgical procedures within narrow guidelines for treatment of an emergency medical condition, to avoid further harms from underlying condition or disease, or for time- sensitive medical conditions. Any medical or surgical procedure whose delay will not adversely affect the patient or the underlying disease shall continue to be postponed. Specific followup is also required for anyone undergoing an allowed medical or surgical procedure regarding possible post- operative diagnosis of COVID-19 or development of its signs/symptoms.

LDH also directs Doctors of Optometry (and all healthcare providers) to offer telehealth services rather than an in-person visit, when medically appropriate and same standard of care can be met. For care that requires an in-person visit, all providers are encouraged to follow LDH (http://ldh.la.gov/index.cfm/page/3880) and Centers for Disease Control (CDC) guidelines to reduce exposure risk for themselves, their staff, and their patients (https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html).

Further, LDH directs any in-person healthcare services be postponed when patient outcomes would not be compromised. Providers are instructed to use their best medical judgment within the scope of their license to make this determination, and each facility or healthcare provider that performs any other healthcare service (other than a medical or surgical procedure or a dental procedure) shall be required to contact the patient within 10-14 days after the procedure to determine whether the patient has signs/symptoms of COVID-19 or has tested positive for COVID-19 since the procedure. Such contact shall be documented in the patient’s medical record. The facility or healthcare provider shall make recommendations to the patient who has signs/symptoms of COVID-19, including appropriate testing. Further, the facility or healthcare provider shall immediately inform the Office of Public Health, via electronic notification, if any such patient has tested positive for COVID-19.

Lastly, the Centers for Medicare and Medicaid Services (CMS) issued Recommendations on April 19, 2020, regarding Re-opening Facilities to Provide Non- emergent Non-COVID-19 Healthcare: Phase I (https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid- services.pdf). LDH and the State Health Officer recommend that each facility and healthcare provider that performs any other healthcare service (other than a medical or surgical procedure or a dental procedure) comply with these CMS Recommendations, or any subsequent Recommendations or Guidance issued by CMS.

The LSBOE will continue to monitor the situation with Public Health Officials and will provide updates accordingly. If you have any questions or concerns about this advisory, please contact the LSBOE at (318) 335-2989, or via email at lsboe@yahoo.com.

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April 7, 2020
Louisiana Department of Health Extends Orders until 04/30/2020


http://ldh.la.gov/assets/oph/Coronavirus/resources/providers/LDH-Order-extend-previous.pdf

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March 22, 2020

URGENT: March 22, 2020 Update on COVID-19 for Optometristspage1image3226060784

Please see the attached notice/order (link: http://ldh.la.gov/assets/oph/Coronavirus/resources/providers/LDH-Notice-Medical-Surgical-Procedures.pdf) from the Louisiana Department of Health (LDH), LDH Healthcare Facility Notice/Order Notice #2020-COVID19-ALL-007, effective immediately, which applies to all licensed healthcare professionals in Louisiana, including Doctors of Optometry.

In summary, per this directive LDH states that any & all non-emergency medical and surgical procedures are to be postponed until further notice, with very limited exceptions (see the attached Notice/Order for full details).

Additionally, LDH directs that all healthcare providers transition all in-person healthcare services to a telehealth mode of delivery, when medically appropriate and when the same standard of care can be met as an in-person visit. Providers shall make a determination about the appropriateness of telehealth on a case-by- case basis. Providers acting in good faith shall not be found to be in violation of this directive (see the attached Notice/Order for full details).

Further, LDH directs that all healthcare providers postpone all in-person healthcare services that can safely be postponed for 30 days. Providers shall use their best medical judgement within the scope of their license to make this determination.

Providers shall consider the entire clinical picture when determining if a service can be safely postponed, including the consequences to the patient of the postponement and the consequences to the healthcare system. Providers acting in good faith shall not be found to be in violation of this directive (see the attached Notice/Order for full details).

 

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March 20, 2020
URGENT: LSBOE Advisory on COVID-19


The Louisiana State Health Officer has ordered that all licensed healthcare facilities in Louisiana MUST postpone all medical & surgical procedures that can be safely postponed for 30 days, from March 19, 2020, through April 21, 2020. This includes eye clinics and optometrists, and providers have been instructed to postpone any non-essential procedures at their professional discretion. Many procedures and services that cannot be postponed will continue as scheduled.

The members of the LSBOE have been monitoring all facets of the progression of the COVID-19 pandemic that faces us today, and take this threat seriously, while advising all Doctors of Optometry to do the same.

The Centers for Disease Control (CDC) also recently recommended that all routine dental and eye care visits be postponed at this time, which has been endorsed by the American Optometric Association (AOA).

THESE RECOMMENDATIONS REMAIN IN EFFECT AS INDICATED. THE LSBOE IS IN CONTACT WITH APPROPRIATE STATE AGENCIES AND WILL CONTINUE TO MONITOR THE SITUATION, AND WILL PROVIDE ADDITIONAL GUIDANCE AS MORE INFORMATION BECOMES AVAILABLE.

What does this mean for you & your practice?
The suspension of “routine care” does not require that all optometric services
stop. This applies to non-essential, non-urgent care. As primary eye care providers and vital members of the health care system, we have a duty to continue to serve our patients’ urgent and emergent eye care needs throughout this COVID- 19 pandemic. We strongly urge, however, that you follow the State Health Officer’s directive, as well as CDC guidelines & recommendations to protect yourself & your staff members with regard to appropriate infection control safeguards, as well as review the CDC’s other COVID-19 protocols, to decrease the likelihood of viral transmission.

If you have any questions or concerns about this advisory, please contact the LSBOE at 318-335-2989 or via email at lsboe@yahoo.com

For the latest guidelines & recommendations on COVID-19, please visit the following websites:
CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html
AOA: https://www.aoa.org/coronavirus