As pandemic messaging moves from containment to mitigation to recovery, national experts are giving healthcare providers tips on how to weather the storm:
• End barriers to telehealth. Federal and state governments could remove some of the financial and other barriers to telemedicine.
“The first barrier is being able to enter the content of the telephone visit into the patient’s medical record in a way that is HIPAA compliant,” said Michael S. Policar, MD, MPH, professor emeritus of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco School of Medicine. Policar spoke at the National Family Planning & Reproductive Health Association National Conference, held March 8-10, 2020, in Washington, DC.
The second barrier is payment by Medicaid, state family planning programs, and commercial payers for phone visits, Policar said.
“Most payers now pay for telehealth visits, but they require that these visits are synchronous, meaning there is a real-time interaction between a provider and a patient that includes both audio and video — a Skype-like application,” Policar explained. “Some family planning providers and at least 10 telehealth companies offer this service already, but the majority of family planning clinics do not have the software platform to be able to do this in a way that is synchronous, HIPAA compliant, and directly tied into the patient’s medical record.”
The solution is for state Medicaid programs and commercial payers to relax the rules and permit audio-only telehealth visits, Policar said.
Governments also should allow asynchronous visits. For example, clinicians and patients could interact via a questionnaire completed by the patient and sent by protected transmission to a clinic or telehealth company. Then, it is reviewed by a clinician, who can decide whether to complete a prescription for the patient, Policar explained.
“Asynchronous visits currently are provided by all the telehealth companies that I mentioned. But, so far, either the patient has to pay out-of-pocket for the visit and supplies, or — in some cases — it might be covered by commercial health insurance,” he said. “I don’t know of any Medicaid programs that cover strictly asynchronous family planning visits yet.”
• Go beyond basic public health measures. “With COVID-19, the disease is spread by asymptomatic individuals and before individuals feel sick,” said Paul Biddinger, MD, MGH, endowed chair in emergency preparedness, director of the Center for Disaster Medicine, and vice chairman for emergency preparedness in the department of emergency medicine at Massachusetts General Hospital in Boston. Biddinger spoke at a web conference on March 13 that was co-sponsored by WIRB-Copernicus Group and Accumen. “This coronavirus, in some ways, does not act like two previous coronaviruses — SARS and MERS. With MERS and SARS, you could not transmit before there were symptoms, and both were amenable to public health controls.”
SARS was controlled relatively soon after it occurred on the global stage. MERS still occurs, but not in large outbreaks, Biddinger explained.
Once COVID-19 is in a community and has asymptomatic spread, it takes root before patients even have symptoms. “Some communities have been tremendously hard hit, while others like the outbreak in Taiwan have been mild and contained,” he said. “In the United States, we have increasing community transmission and have to focus on mitigating the impact of outbreak and provide the best care we can.”
• Practice social distancing. “In the ambulatory space, social distancing is something to think about,” Biddinger said. “The mortality rate increases substantially with age. There’s an inflection point at age 50. At 60 and 70 and 80, it’s an accelerating relationship between age and mortality.”
Ambulatory providers do not want patients to visit unless they have to. “We can do lots of things, like telemedicine and virtual visits, so providers can see patients in a way that’s safe,” Biddinger noted.
• Help patients manage anxiety. During any period of uncertainty, people become anxious. Providers can reassure their patients and offer suggestions for actions that will help them reduce risk and anxiety.
For example, providers can ask patients to avoid crowds and group settings, and to wash their hands more frequently, said Jennie Kuckertz, PhD, a psychologist at McLean Hospital in Belmont, MA. Kuckertz spoke at a March 16, 2020, COVID-19 video conference. (The recording is available at: https://www.newswise.com/articles/covid-19-exploring-the-unanswered-questions-with-newswise-live-expert-panel?sc=sphn.)
“People can call their friends and relatives to let them know we’re thinking of them, and they shouldn’t constantly glue their faces in front of the news, where there is a lot of conflicting, confusing information,” Kuckertz said.