Ryan Bucsi named Vice President, Claims

OMIC announced that Mr. Bucsi, who has served in several roles within the Claims Department for more than 15 years, will become the 2nd Claims VP in OMIC’s history. He has presided over the best performing period for OMIC insureds with regard to the most common claim defense benchmarks for our industry.

OMIC has a proven record of successfully defending ophthalmologists and has consistently outperformed the industry with respect to percentage of claims settled without a payment and average indemnity (when a settlement is required).

See more about OMIC’s superior record in defending ophthalmic malpractice claims and lawsuits here.

Ensure safe use of equipment

Equipment Malfunction or Improper Set Up of a Surgical Device?

A 51-year-old male patient presented to the OMIC insured’s practice for consideration of LASIK and was subsequently scheduled for the procedure. Our insured physician’s first encounter with the patient was on the day of the surgery. The procedure was complicated when the blade of the microkeratome entered the anterior chamber of the right eye, causing a corneal laceration. The insured recognized the complication and placed four sutures in an attempt to repair the injury.

Read more on pg. 6 in the Digest.

Safe Practices in the Office: COVID-19

OMIC Risk Management is committed to supporting our insureds as they establish protocols to address COVID-19 in the office. The best sources for the latest scientific information and safety guidelines remain the AAO, the CDC, and your local health authorities.

Here are some key concepts to consider that will protect you, your staff, and your patients.

We have included links to relevant topics and guidelines published by the U.S. Centers for Disease Control and Prevention (CDC), as well as guidelines from the American Academy of Ophthalmology (AAO).

Assess risks for staff and patients and establish safety protocols

Create an easy-to-read reminder sheet about safety precautions, such as these from the CDC that can be posted at workstations, in exam rooms and waiting areas:

• Wash hands often with soap and water for at least 20 seconds
• If soap and water are not available, use an alcohol-based hand sanitizer with at least 60 percent alcohol
• Avoid close contact with people who are sick
• Avoid touching your eyes, nose, and mouth
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash, and wash your hands
• Clean and disinfect frequently touched objects and surfaces
• Stay home when you are sick

Establish protocols for patient screening on the telephone and at the office

AAO recommendations [https://www.aao.org/headline/alert-important-coronavirus-context]:

• When phoning about visit reminders, ask to reschedule appointments for patients with nonurgent ophthalmic problems who have respiratory illness, fever or returned from a high-risk area within the past 2 weeks [see additional OMIC recommendations below].
• Patients who come to an appointment should be asked prior to entering the waiting room about respiratory illness and if they or a family member have traveled to a high-risk area in the past 14 days. If they answer yes to either question, they should be sent home and told to speak to their primary care physician.
• Sick patients who possibly have COVID-19 with an urgent eye condition can be seen, but personal protective equipment should be worn by all who come in contact with the patient. The CDC’s recommendations for personal protective equipment include gloves, gowns, respiratory protection and eye protection. Place a facemask on the patient and isolate them in an examination room with the door closed; use airborne infection isolation rooms (AIIR) if available.
• Keep the waiting room as empty as possible, and reduce the visits of the most vulnerable patients.
• Several reports suggest the virus can cause conjunctivitis and possibly be transmitted by aerosol contact with conjunctiva.
• Patients who present to ophthalmologists for conjunctivitis who also have fever and respiratory symptoms including cough and shortness of breath, and who have recently traveled internationally, particularly to areas with known outbreaks (China, Iran, Italy, Japan, and South Korea), or with family members recently back from one of these countries, could represent cases of COVID-19.
• The Academy and federal officials recommend protection for the mouth, nose and eyes when caring for patients potentially infected with SARS-CoV-2.
• The virus that causes COVID-19 is very likely susceptible to the same alcohol- and bleach-based disinfectants that ophthalmologists commonly use to disinfect ophthalmic instruments and office furniture. To prevent SARS-CoV-2 transmission, the same disinfection practices already used to prevent office-based spread of other viral pathogens are recommended before and after every patient encounter.

OMIC recommendations:

• Provide written questions for staff to ask patients to determine health/recent travel status.
• Provide written questions for staff to ask patients to help determine which problems are urgent (patient needs to be seen) or nonurgent (appointment can be rescheduled).
• Document the conversation about the eye condition and warnings. To facilitate documentation, prepare a sheet with the questions, and put in the medical record, or scan into the EHR.
• Provide written instructions for staff on when to get input from an ophthalmologist and what urgent problems need to be reported to an ophthalmologist right away.

Review your cleaning and disinfecting protocol and revise as needed to meet guidelines

AAO recommendation:

Rooms and instruments should be thoroughly disinfected afterward based on current CDC recommendations specific to COVID-19. Slit lamps, including controls and accompanying breath shields, should be disinfected after every patient, particularly wherever they put their hands and face.

OMIC recommendation:

• For further guidance see https://www.cdc.gov/infectioncontrol/guidelines/index.htmlhttps://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html

Train all staff and physicians about the new protocols

• Review the phone records periodically to ensure staff are following the guidelines appropriately.
• Retrain after changes to the protocols.

The future ain’t what it used to be.

Daniel Briceland MD
OMIC Chair

It is with great humility that I begin my tenure as the Chair of the Board of a truly extraordinary company – OMIC. Following such legends as Rich Abbott, Tamara Fountain, and immediate past Chair George Williams is a tall task, but one I embrace. Dr. Williams served on Board committees for 14 years and before becoming our Chair he led the Finance Committee. He oversaw the growth of our company to a record high of 5000 insured ophthalmologists and his leadership left OMIC in the best financial condition in our history.

Looking forward, I am reminded of Yogi Berra’s prediction that “the future ain’t what it used to be.” Ophthalmology and all of medicine are facing tremendous disruptive changes, which are coming at a fast and furious pace. Every ophthalmologist encounters unsettling challenges on a daily basis, whether from new federal or state mandates, scope of practice issues, private equity agendas, or drug supply and pricing issues. Fortunately our partner, the American Academy of Ophthalmology (AAO), has unequalled federal and state advocacy staff and physician leadership to advocate for our patients. Dr. Williams transitioned from leading OMIC to current AAO president earlier this year.

OMIC’s mission is twofold. First, we want to provide high quality insurance. In other words, we want you to sleep well at night. OMIC’s board and committee members are practicing ophthalmologists who face the same disruptive changes all of you do. To make life easier, the Board asked staff to streamline our application process and change our bylaws so we may continue to insure practices that are owned by private equity firms.

The second part of our mission is to promote quality ophthalmic care and patient safety. This Digest focuses on ocular toxicity of commonly prescribed drugs often listed in our senior patients’ medical records. These include hydroxychloroquine, ethambutol, glucocorticoids, osteoporosis medications (bisphosphonates), erectile dysfunction agents (tamsulosin), topiramate, anticholinergics, and anti-hypertensive agents.

This issue is personal for me. I followed a patient in her mid-seventies who presented with complaints of decreased vision from 20/25 to 20/50 while on ethambutol for three months for treatment of atypical mycobacterium infection. Her exam was unremarkable with subtle VF changes and few color vision abnormalities. Stopping ethambutol therapy and observing the patient’s vision drop to 20/200 over two agonizing months is an ophthalmologist’s worst nightmare. Fortunately, her vision gradually returned to normal within 3 to 4 months. It was alarming to learn that the patient had been prescribed the correct dosage based on her weight yet still developed optic neuropathy.

This patient was lucky: ethambutol toxicity is preventable with careful monitoring of dosage and examination, and immediately discontinuing it prevented irreversible damage. Other drugs present greater challenges. In this issue we provide insights on how to best protect our patients.

Finally, Yogi said it best about our future and as I step up to the plate as your Chair I will be ready for whatever is thrown my way. You can be assured that OMIC’s team has its eye on the ball, our head in the game, and we will always have your back.