Physician practices adopting new strategies to keep staff, patients safe
STAFF AT Indiana University Health Physicians last week were busy calling patients with appointments for routine care to come in at a later date, many being scheduled six weeks out.
They started making the calls even before the CMS issued guidance March 18 that non-essential medical, surgical and dental procedures, as well as elective surgeries, be delayed until the COVID-19 outbreak is over.
“The key message to our patients is we are not closing down; we are here for you. But if you don't have to be here, we want to protect you and your families and our workforce by not having unnecessary exposure,” said Brian Kremer, chief operating officer of IU Health Physicians, which consists of 200 primary-care and 1,700 specialty physicians spread across over 150 ambulatory locations in Indiana.
IU Health Physicians is one of many physician practices nationwide taking preventive steps to limit the exposure to the coronavirus in their communities and workforce while at the same time taking care of patients who continue to need routine care.
Educating the community is another service that practices are providing as they continue to field calls from worried and confused patients.
"The public, our patients and our communities are very concerned, and the questions of course are, ‘Do I have this or not? And how sick am I going to get from this?'” said Dr. Andy Anderson, CEO of RWJBarnabas Health Medical Group, which has about 2,000 providers across 300 practice sites in New Jersey. The group initiated robocalls to educate patients on how to protect themselves.
Low-risk patients are being told to stay home and practice social distancing. For those at high risk, some RWJBarnabas sites have access to testing for the virus.
Although shortages of protective equipment weren't an issue as of last week, Anderson said RWJBarnabas can redistribute supplies among sites if that becomes necessary.
Aledade, a company that partners with physician practices across the country on value-based payment contracts, is getting questions from clinicians about how to test for the virus in their communities, said Dr. Farzad Mostashari, CEO of the company.
“We are working very hard on behalf of our practices,” Mostashari said. “We are out there trying to find a source of masks for them so they can continue
The key message to our patients is we are not closing down; we are here for you. But if you don’t have to be here, we want to protect you and your families and our workforce by not having unnecessary exposure.” Brian Kremer Chief operating officer IU Health Physicians
to run their business.”
Illinois-based DuPage Medical Group, which has about 120 locations, is testing patients who screen as high-risk. At deadline, the medical group was in the midst of planning to test patients at some of its clinics, but it would be the drive-through style hospitals have been adopting to limit exposure, said Dr. Mia Taormina, the group's infectious disease department chair.
Telehealth is also proving a vital tactic. IU Health Physicians last week started bringing more than 100 physicians onto its telehealth platform to reduce in-person visits across its sites.
“We have had telehealth capabilities for a couple of years but uptake (by the physicians) has been slow,” said Dr. Greg Kiray, chief health officer of IU Health Physicians. In response to the COVID-19 outbreak “it's now completely obvious the importance of virtual capabilities.”
Over the past few weeks, primary-care provider ChenMed shifted care for most its Medicare Advantage patients from clinic visits to either telehealth or home visits in order to protect both patients and staff from exposure to the coronavirus.
“We're 90% center-based patient care, and now we'll pivot to 90% virtual appointments,” said Dr. Christopher Chen, CEO of the family-owned company, which operates 59 centers in 39 cities around the country. “Our patients are the highest-risk population for the coronavirus, and I want to keep them healthy, happy and at home.”
ChenMed plans to keep its clinics open to serve the small percentage of patients who need to come in to deal with urgent medical conditions.
ChenMed is dropping off iPads at the homes of some patients so they can make virtual medical visits. Clinical staff will visit patients' homes, as needed to administer tests, including EKGs. ●
A NUMBER OF not-for-profit health systems have postponed sizable new bond issues given the significant uncertainty COVID-19 has thrown into the municipal bond market.
It’s not just healthcare—the trend is happening across the municipal market. Volatility has prompted interest rates to skyrocket and has made pricing bond offerings extremely difficult. Billions in new issuances have been put on hold over the past two weeks.
“It happened pretty drastically,” said Rick Kes, healthcare senior industry analyst with RSM. “This is unlike anything we’ve seen before.”
Evanston, Ill.-based NorthShore University HealthSystem, for example, is delaying a roughly $400 million debt issuance. TriHealth in Cincinnati is delaying its $200 million issue. Stanford Health Care has postponed issuances worth more than $940 million.
It’s a sharp departure from where the municipal bond market had been weeks ago. In November, health systems had been issuing bonds at a feverish pace to lock in historically low interest rates.
“In most previous downturns, municipal bonds are held off as an offset for market declines,” said Sudip Mukherjee, a senior municipal credit strategist in UBS’ Chief Investment Office. “In this one, pretty much all bets are off.”
TriHealth planned to use the proceeds of its bond offering to refinance debt and build a new heart hospital on its Bethesda North campus, spokesman Rob Whitehouse wrote in an email. The health system has not yet determined when it will issue the debt. Administrators weren’t available for an interview because they were involved in COVID-19 planning, Whitehouse said.
Until the number of new COVID-19 diagnoses peaks in the U.S., there likely won’t be much new activity in the municipal market, including from healthcare providers, said Howard Sitzer, senior municipals analyst with CreditSights.
Despite the uncertainty facing healthcare more broadly, Mukherjee said he expects children’s hospitals and large health systems with a national footprint and strong liquidity will remain financially stable through the downturn.
In fact, Froedtert Health in Wisconsin is moving ahead with issuances, according to Kevin Holloran, a senior director with Fitch Ratings. The health system did not return a request for comment.
FROM HOME HEALTH to specialty hospitals, every sector of the industry is readying to help acute-care providers alleviate expected capacity issues resulting from the COVID-19 pandemic.
Home health
Providers are preparing to see a rise in demand for their services as more elderly patients and those with underlying health conditions stay home to lessen their risk of exposure to COVID-19.
Early in its preparation for the pandemic, Dallas-based supportive healthcare provider AccentCare launched an education campaign to train all 25,000 of their care professionals to identify symptoms for COVID-19, and properly wash their hands and use personal protective equipment.
CEO Stephan Rodgers said the company plans to also expand its telehealth services. Rodgers wants to have 30% of AccentCare’s 25,000 home health patients turn to telehealth.
“We’re probably not going to get reimbursed for all this telehealth we’re going to put out there, but it’s the right thing to do,” Rodgers said.
Medicare does not reimburse home health providers that use telehealth services to substitute for in-person visits and stakeholders say steps thus far taken by Congress and the CMS do not address that concern.
Veterans Affairs Department
The Veterans Affairs Department is bracing for a potential surge of 1 million veterans infected by coronavirus and at the same time is preparing for the possibility it may have to absorb overflow civilian patients if private hospitals are overrun by the pandemic.
Based on a “worst case” scenario that up to 1 in 5 of its mostly elderly population of veterans will need coronavirus care, the government-run hospital system is seeking $16.6 billion in emergency money, according to a VA document submitted to Congress and obtained by the Associated Press.
If called upon by states and HHS, the VA network of 170 hospitals, 1,074 outpatient sites and more than 350,000 employees could provide care to first responders and civilians in hard-hit communities.
It could be an unprecedented task for the VA, which has faced past criticism for staff shortages, management disarray and long patient wait times.
Since January, the department has run drills and checked stockpiles of medical equipment.
Specialty hospitals
Specialty hospitals, ambulatory surgery centers and other health care settings may be enlisted to take on patients who aren’t infected.
“I’m telling hospitals ‘You’ve got patients we can take on, I’ll get your doctors temporarily credentialed,’ so acute-care hospitals can focus on taking care of COVID-19 cases,” Dr. Pat Basu, president and CEO of Boca Raton, Fla.based Cancer Treatment Centers of America said, adding that the company can find ways to help with other surgery needs and ICU overflow.
While there’s been no official call for ambulatory surgery centers to provide specific assistance, the Ambulatory Surgery Center Association said ASCs would respond in any manner needed, as long as patient safety is assured.