With the spreading COVID-19 disease disrupting life, causing businesses to close temporarily, putting people out of work while most stay home, many Alabama medical practices are struggling with the challenges of managing a plunge in revenue and the need to safely care for patients.
"Our volume has dropped about 75 percent because our physicians can only perform emergency surgeries and we are currently not starting any new patients on radiation with the shelter in place order," said Jason Biddy, CEO of Urology Centers of Alabama. Urology Centers has responded to the business disruption by consolidating several of their locations and working with skeleton crews. In an effort to maximize safety, the practice has increased the frequency and detail of their regular sanitation of equipment, exam tables, doors, furniture, as well as all surfaces.
Rousso Facial Plastic Surgery is aiming to alleviate some of their revenue shortfall by offering patients discounted pre-paid injectable packages and providing curbside pickup for skin care products. The practice has also donated personal protective equipment and supplies to hospitals in an effort to help with the shortages.
Handling the revenue decline is not the only difficulty practices have faced. "When the state and county sent out declarations that non-essential services should be limited, our group met and decided to reschedule any non-emergent appointments," said David Carmichael, Executive Administrator at Birmingham OB/GYN. "It took some time. Our regular schedulers were contacting patients with the front office staff chipping in and our medical assistants helped when they finished their day.
"Then BlueCross relaxed their restrictions, allowing phone calls to be billable if the physician made the call. That day, we decided which type visits could be handled by phone rather than being rescheduled. When our staff was doing the rescheduling calls, they told these patients that they could keep their appointment by phone."
David McKee, MD, who practices with Birmingham OB/GYN found the phone consultations to be helpful. "Our patients have been extremely receptive to this option," he said. "Many were surprised that I was the one returning their calls. It has allowed us to build a stronger bond with our patients."
BlueCross also relaxed their reimbursement for telehealth, which works well for a number of Birmingham OB/GYN patients, specifically low-risk routine pregnant patients who aren't scheduled for ultrasound or labs.
"Several practices out west have been doing this for a few years," Carmichael said. "The patient can buy a package with blood pressure monitor and a Doppler. The doctor and patient interact through a HIPAA compliant video system. The doctor watches the patient check their blood pressure and monitor the baby's heartbeat with the Doppler. They discuss everything they would normally go over. If the doctor notices something unusual, he may ask the patient to come in. Otherwise, he will see in the patient at their next visit that requires in-office equipment."
Birmingham OB/GYN did around 10 telehealth visits in the first week of the revised schedule. "David Carmichael set up a telehealth system in our office over a year ago, but I had been slow to try it until the pandemic forced me out of my comfort zone," Ashley Przybysz, MD said. "I've made several telehealth visits with patients in the past week, for conditions ranging from depression and anxiety; mastitis; menorrhagia; and recurrent vaginitis. I was able to examine a postpartum patient with a fever and evaluate her mastitis by video.
"These visits have gone remarkably well, much better than I would've ever anticipated. Patients were very appreciative. Not only do they not have to take time out of their schedule to come to the office, they didn't have to pay for parking, they didn't have to be exposed to other patients and we were able to make multiple plans for their treatment. We really appreciate the insurance companies relaxing their plans."
It appears that the majority of Birmingham area practices are embracing telehealth during the crisis. Urology Centers of Alabama mobilized the service quickly, and Rousso Facial Plastic Surgery went to a virtual business model on March 19, using Zoom for virtual consults, while continuing to see emergency cases and performing MOHS surgery for skin cancer.
With telehealth visits having gone so well for both physicians and patients, we have to wonder if the current shutdown will open the door to wide acceptance of the service. Either way, most practices have proven to be agile and creative in adapting to this difficult situation.