Navigating the healthcare system for non–COVID-19 patients

By Liz Meszaros, MDLinx
Published April 10, 2020

Key Takeaways

The effects of the COVID-19 pandemic are far-reaching, affecting not only physicians and the infected patients they are caring for, but all other types of healthcare as well. While the grim consequences of the pandemic are busily tallied, researchers are just beginning to tease out its effects on the provision of non-essential or continuing care to all other patients, including patients with acute conditions or emergencies, those with chronic conditions, those needing preventive care, and those with symptoms unrelated to COVID-19.

How are physicians and practices managing patients with existing medical conditions such as heart disease, diabetes, or autoimmune diseases? How are hospitals caring for patients who need emergency care outside of COVID-19? The answer is, in whatever way they can. There are no set rules of play in place yet, and individual practices and hospitals have been left scrambling to do what they can.

The impact on healthcare

Most physicians are rescheduling patient checkups and follow-up visits or have shifted them to telehealth visits. The lack of personal protective equipment (PPE) has also taken a toll, with many physicians no longer offering in-person patient visits due to this issue. They also have had to contend with reduced staff, as many office and support personnel have been furloughed as a result of reductions in revenue or illness, or have been called elsewhere to help care for patients with COVID-19.

In primary care practices, for example, the impact of COVID-19 has been huge. According to the most recent weekly survey from the Primary Care Collaborative and the Larry A. Green Center—which included responses from over 500 primary care physicians, nurse practitioners, and physician assistants—COVID-19 has had a major impact on primary care offices, resulting in fewer routine visits, high staffing shortages, and more telehealth visits.

Almost one-half (49%) of respondents reported that their practices were experiencing “severe impact” due to COVID-19. Reduced well/chronic visits and staffing shortages due to illness or self-quarantine were the greatest stressors on their practices. Almost 90% reported that they have had to limit their well/chronic care visits. But, only 7% report that sick visit availability is a problem.

Practices must also contend with clinician and staff absences due to sickness or self-quarantine. In all, 46% reported clinicians as being out, 45% reported nursing staff out, and 30% reported the absence of front-desk staff. Each of these figures has doubled since the first survey was done the week before, reflecting the quickly increasing burden COVID-19 has taken.

Perhaps the only good news researchers have is that telehealth visits are becoming more common, and 83% of respondents said patients were accepting of these. Payment for telehealth services varied, however, with 62% reporting that visits were reimbursable by insurance and 52% reimbursable by Medicaid. A full one-third of respondents were unsure of how telehealth services would be paid for.

Still, access to virtual services was surprisingly low, with 70% of respondents reporting that they worked at practices with no e-visits, and 60% at practices with no use of video visits. Over one-third reported that their practice had no patient portal or secure messaging system in place.  

Guidance and help

Fortunately for clinicians, several of the top medical organizations have compiled recommendations on how to navigate non-essential care during the COVID-19 pandemic.

The Centers for Medicare & Medicaid Services (CMS) has announced that all non-critical elective surgeries and non-essential medical, surgical, and dental procedures during the outbreak have been postponed. In recognition of the  existing burden in healthcare, the CMS has also released its COVID-19 Partner Toolkit for physicians, as well as a tiered framework on how to provide necessary services.

According to the CDC, all healthcare facilities and clinicians should prioritize urgent and emergency visits and procedures. They recommend the following:

  • Delay all elective ambulatory provider visits.

  • Reschedule elective and non-urgent admissions.

  • Delay inpatient and outpatient elective surgical and procedural cases.

  • Postpone routine dental and eyecare visits.

  •  Consult your state or local health department about their Pandemic Plans for your community.

Thankfully, the AMA has also provided guidance to physicians and practices for providing non-essential care. Here are some of their recommendations:

  • Tell patients to call ahead of any appointments if they are symptomatic for COVID-19 in any way for advice on how you wish to proceed with their care.

  • Talk with patients about the need to reschedule a planned appointment or be seen in a different setting, such as a telemedicine visit.

  • Postpone elective procedures and medical visits to preserve staff resources, medical supplies, and PPE.

  • Increase prescription medication refills to a 90-day supply where allowed and appropriate.

  • Tell patients to contact their insurance plans if prescription refills are not initially approved. Several insurance companies have agreed to waive prescription refill limits for maintenance medications.

Legislative help

In addition to practice recommendations for clinicians, the AMA has also requested economic help for physicians and practices. The association filed a request with the US government to include provisions specifically geared towards physicians in the COVID-19 economic stimulus package. They’ve asked that Congress ensure that physicians can sustain their practices and provide patients with the best possible care during the COVID-19 pandemic. Specifically, the AMA has requested:

  • That all payers, including Employee Retirement Income Security Act (ERISA) plans, provide coverage and payment for audio-only telehealth visits at the same level as in-person visits.

  • That dedicated and direct financial support be given to physicians and their practices on the front lines of testing, diagnosing, and treating patients at risk of COVID-19, due to the increased costs of caring for these patients.

  • That financial support be given to all physicians and practices experiencing adverse economic impacts on their practices due to suspended elective visits and procedures.

For physicians who feel that they are swimming in uncharted waters, rest assured that you are not alone. Remember your patients, your staff, and yourself in navigating this pandemic. Remember that this pandemic will pass, and that the healthcare lessons we’ve learned from it will shape the future of healthcare—hopefully, for the better. We thank you for your untiring efforts, service, commitment, and sacrifice as the nation grapples with this pandemic. Stay safe. Stay healthy. Stay committed.

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