This summer, Pulmonologists & Sleep Physicians converged via a virtual round table to share Go Forward plans for the current COVID-19 climate. Panelists hosted and dissected key issues being asked by Pulmonologists & Sleep Physicians from around the country, including strategies to respond to a precipitous drop in business, aspects of COVID-19 care that would likely become permanent, strategies for re-opening in stages, and more. See below for a webinar recap or watch the recording here.

TOPICS COVERED

Telemedicine Response:

• Incorporated Telemedicine into clinics – implemented and established workflow quickly.
  • Promoted Telemedicine via mass email communication, making the patient population aware.
  • Offered Telemedicine to both New & Existing Patients.
  • Converted all mid-level appointments (PA/NP) to work from home and be 100% telemedicine-based.
  • Consistent among practices is that practice staff are calling patients ahead of time to walk older patient population through set up prior to a virtual visit.
• A two hundred provider group installed, tested, and started seeing patients on NextGen® Virtual Visits (OTTO Telehealth) within 3 days.

 Short Term Changes for Foreseeable Future:

• Patient prep and access to practice:
  • Two days beforehand and the day of the visit: Screening patients by phone or text with in-person visit/encounter. (using patient engagement tools such as Luma Health™).
    • Repetition is key! Have a consistent script.
  • Day of: Someone at the practice either meets the patient in the parking lot for temperature check or doing temperature checks at the entrance of the building.
  • Day of: Masks required for service. Providing masks for patients.
• Provider schedules:
  • With ICU services and in-patient work increasing, there is a concern of physician fatigue & burn-out.
  • Giving physicians with responsibility in the ICU option to work from home because of cloud-based EHR and telehealth virtual visits.

 Permanent Changes & Future Thoughts:

• Foresee permanent use of telemedicine dependent on payer coverage.
• The ability of physicians to provide remote care can promote more flexibility and prolong careers, delaying the need for practices to constantly recruit and hire.
• More people working from home and general downsizing of brick-and-mortar practices to reduce overhead.
• Utilization of marketing campaigns on Facebook, Instagram, & Google to advertise patient portal usage, telemedicine, and patient engagement tools.

Practice Changes:

• Research:
  • 70% of these patients are “in-office” visits, need tight detailed prep and planning.
  • Interesting COVID-19 trials/research going on.
• PFT Response:
  • PFT testing spaced an hour apart to allow for heavy decontamination.
• Sleep Lab Response:
  • Sleep Labs were closed across multiple states.
  • At home sleep study testing revamped. Utilized disposable devices (WatchPAT™ One). Found this was embraced by patients because they liked that it wasn’t a reusable device.
    • Also found this device has a better reimbursement rate than some other studies, depending on the payer.

 Internal Office & Business Process Changes:

• Held bi-weekly provider calls.
• Held daily and weekly internal staff meetings.
• Developed a crisis management plan.
• Planning, collaboration, & communication with the entire practice team could not be more important! Make sure that your team maintains an open channel of constant communication.

 Q&A SESSION

What are you doing for COVID-19 testing?

• PCR testing was far too cumbersome & proved too much of a hindrance so we opted for full PPE in the sleep lab & office.

What are your plans to prepare for a potential surge in your community?

• Try to get as many people out of the office, if possible, to help minimize exposure and spread, increase working from home.

Are any groups doing titrations and if so, how are you doing them safely?

• Staff in full PPE, alternate rooms (one room used, then shut down for extensive decontamination and use of the other room).

What advice would you give regarding COVID-19 testing in healthy patients?

• Various kinds of testing are going to be dependent on where you are (antibody testing not available everywhere). Had a question of whether they needed to test patients before they went into their sleep lab. Decided it was insurmountable to do properly so went with just using full PPE instead.

How are you securing PPE for your practice?

• Be resourceful, look to places you perhaps wouldn’t think of having PPE.

How did you implement informed consent for COVID-19 risks and what did it entail (what kind of visits did you use it for)?

• Created a one-page supplement for patients to sign about understanding the COVID-19 risks when coming in for elective procedures.

What are your plans for a potential surge in your community?

• Chest Medicine Associates created internal plans for what happens if a patient, staff member, or physician develops COVID-19. Have created internal plans for what happens if they need to shut down their practice again.
• Minnesota Lung Center has been planning for this exact scenario. They pushed to get non-clinical staff out of office & get as many people as possible working from home that can (even nurses with telemedicine).
• Tidewater Physicians Multispecialty Group looked over what would happen if a staff member tested positive. Everyone is prepared to work from home if need be.

 Are any labs doing titrations, and what changes are you implementing to do so?

• Yes, with the filters & staff in full PPE. After using one room one night use the opposing two rooms the next nights. Putting water-proof covers on things & wiping them down.

 Any thoughts on what to do for HEPA filters and methacholine challenges?

• Not running general HEPA filters in the office. No urgency on methacholine challenges, but probably will return in the future.

How do you get the WatchPAT™ ONE and what are your thoughts on how it pays back?

• Minnesota Lung Center explained a representative came to them and got them what they needed. Compared to re-usable devices vs. the disposable WatchPAT™ ONE. Spending was close to the same amount as what they spend on re-usable, but getting more reimbursement at the same time.

KEY TAKEAWAYS FROM MODERATOR, DR. MITCHELL KAYE:

• Identify the challenges.
• Create a picture of hope.
• Be honest and forthright about changes/personal sacrifices.
• Mentor your future leaders.

Panelists: Stephen R. Gorman, DO, MBA President/CEO, Chest Medicine Associates Manjit Bhamrah, MD Arizona Premier Pulmonary & Sleep Specialists Vijay Subramaniam, MD Tidewater Physicians Multispecialty Group Moderator: Mitchell G. Kaye, MD President, Minnesota Lung Center / Minnesota Sleep Institute

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