Physician Practices Modifying Operations to Handle COVID-19

Leaders are revealed during a crisis. At this moment in time, primary care physicians and their staff are rising to the COVID-19 challenges. Those challenges are not just about caring for patients who have contracted the virus, but also looking after homebound seniors or those in retirement centers and nursing homes who need regular checkups.

“Our physicians and their staff who are on the front line of defense are the true champions,” says Ben Kornitzer, M.D., chief medical officer for agilon health.  “The work they are doing is nothing less than heroic.”

Physician leaders across nine markets are in the trenches, making crucial decisions and creating unprecedented protocols to help mitigate the spread of the coronavirus, protect their workforce, handle staffing concerns and care for their chronically ill patients.

Phone Triage

When Preferred Primary Care Physicians (PPCP), Pittsburgh, was overloaded with phone calls, they put a phone triage system in place. Patients are now screened about recent travel abroad, asked if they have been exposed to the virus and if they are experiencing symptoms before being asked to come in for a more thorough checkup. “We are making sure that the health system isn’t inundated with patients who have no reason to be tested,” says Frank Civitarese, Medical Director for the practice.

To deal with this same situation, Austin Regional Clinic has implemented a 24-hour COVID-19 hotline for patients to call when they have questions or need to make appointments.

Patient Communication

Patient education and communication is a key factor in helping to deal with worried patients. “Some people tend to react in a panic,” said Dr. Joseph Corigliano, a family doctor and chair of the Primary Care Department with Buffalo Medical Group. “They should realize that this is very similar to the flu in terms of symptoms, and chances are they’re going to recover if they get it.”

Many physician groups are using email blasts to warn patients about social distancing and frequent hand washing. Others have an online portal that gives patients a list of questions to review to prequalify them for COVID-19 testing. In addition, clinics have called all patients to reschedule wellness exams and recommend they postpone elective surgeries.

Patients with Buffalo Medical Group (BMG) are encouraged to utilize a web portal to ask their doctor questions. BMG physicians have made it a point to try and respond within an hour after receiving the messages.

Staffing Concerns

With schools closed, some medical staff members have to stay home to care for their children.  Physician practices are also reducing the number of personnel in clinics, so as to limit exposure and keep employees safe. Clinics are staggering their staff or allowing some employees to work from home. Austin Regional Clinic has a program in place to help them with childcare needs. “Doctors and their staff can call a nanny service that provides in-home childcare and ARC will help cover some of their childcare payments,” said Heidi Shalev, Vice President of Marketing, Communications & Engagement.

Testing Centers

Some physician practices have transformed parking lots into drive-by testing centers. Patients are screened in their cars or in tents – and those who are symptomatic enter through a separate clinic entrance than asymptomatic patients who are there for other healthcare needs. Some clinics test the patients in their cars after they have a telemedicine visit with a physician. This conserves PPE and keeps clinic spaces safer.

“While we are concerned about patients who might have COVID-19, we are making sure there are safety precautions in place for other patients who need medical care for conditions ranging from urinary tract infections to heart conditions,” admits Patrick Goggin, M.D., Medical Director for Physicians Group of South East Ohio (PGSEO). We have a separate entrance and protocol in place for seeing patients who have COVID-19 symptoms.  In addition, our clinics have staggered visiting hours – asymptomatic patients are coming in for appointments in the morning and symptomatic patients are coming in for testing and treatment in the afternoon.”

Virtual Visits

Telehealth is another tactic physicians are using for screening those who have sympoms of COVID-19 and other patients who need a check up or an annual wellness exams. Since the CMS recently announced Medicare will reimburse for telehealth services at the same rate as regular in-person visits, PCPs can do audio or video consults using a smart phone or computer. A few weeks ago, across all of PPCP’s clinics, there were only a few telehealth visits conducted every week. Since the outbreak, many of the practice’s 70 providers are conducting a total of 500 to 600 tele-visits every day.

“With the COVID 19 outbreak, the use of telehealth is now imperative,” says PPCP CEO Greg Erhard. “It is an excellent way to reach out to homebound seniors and chronically ill patients who need constant care and are feeling scared and isolated. It also limits exposure for medical personnel and allows us to preserve our supply of protective equipment, such as masks and gloves.”

At Central Ohio Primary Care (COPC), the nation’s largest independent primary care physician group that serves over 450,000 patients, the number of virtual patient visits is now nearing the 4,000 a week mark.

agilon health is assisting practices to get telehealth operations up and running by providing them with information, scripts for patient outreach, and a platform to share best practices.

Home Healthcare

Home healthcare is an important care delivery service during this national health emergency. Physician practices are sending out medical staff members to treat chronically ill seniors who are in isolation or residing in senior facilities on lockdown. “In Southeast Ohio, we have a lot of homebound seniors who need to be seen on a frequent basis,” admits Dr. Goggin. “ Right now, we have a designated physician and nurse practitioner who are visiting the sickest and most isolated seniors needing the most attention.  With the help of agilon health, we are also deploying care managers to reach out to patients by phone and visit the chronically ill who need their blood pressure and glucose levels monitored, and medications refilled.”

While PCPs are taking preventive steps to limit the exposure of the coronavirus in their communities and workforce, they won’t turn down a patient who needs to be seen. Kevin Spencer, Medical Director for Premier Family Physicians says it best. “We went to medical school to take care of people and this is the time they need us most. We will not let them down.”