Keeping Your Practice Open: Key Strategies During the COVID-19 Pandemic

Announcer: 
You’re listening to Perspectives with the AMA on ReachMD, produced in partnership with the American Medical Association.

Here’s your host, Dr. Jennifer Caudle

Dr. Caudle:
As the COVID-19 pandemic continues to rage on, medical organizations across the country have been working to provide physicians with efficient tools and resources to help them continue caring for their patients all while keeping their practices operational and themselves safe.  So, to get a better sense of the resources that are available, we’re sitting down with the AMA to uncover key strategies for keeping physician practices open during the COVID-19 pandemic. 

Welcome to Perspectives with the AMA on ReachMD.  I’m your host, Dr. Jennifer Caudle, and joining me in this important discussion is Carol Vargo, Director of Physician Practice Sustainability in the AMA Physician Satisfaction and Practice Sustainability Group.  Carol actually spoke with us towards the beginning of the COVID-19 pandemic about reopening practices and has returned to do a follow-up to share some helpful tips and resources for physicians as they continue to battle COVID-19. 

Welcome back, Carol.   

Ms. Vargo:
Thank you, Dr. Caudle.  It’s a pleasure to be back again speaking with you and the audience.  

Dr. Caudle:
Absolutely.  Well, we’re very excited that you’re here and to learn more about what the AMA is doing.  So, to kick off our discussion, let’s begin with a quick overview of what the AMA has been hearing from clinicians during the COVID-19 pandemic.  What have you observed regarding the opening and closing status of physician practices, and what are some of those physicians’ top concerns? 

Ms. Vargo:
Well, first, I think it’s important that we understand the ongoing landscape.  When we spoke with you earlier this year, we had entered into a world in March of great uncertainty and a lot of concern around making sure that patients could access care, that physician practices could stay open to deliver that care, as well as address all the fears and concerns with what then was a very unknown quantity of COVID-19.  I would say now, approximately 6 months later, I want to remind everybody that we are still in the midst of this.  We here at the AMA view this as a marathon, not a sprint.  We know that the HHS Secretary on October 2^nd just recently extended the public health emergency through January 2021, and at the same time, we know that attention has turned towards vaccine development and vaccine distribution, and while that’s very hopeful, we know that there are current concerns remaining among physicians and patients about COVID-19 and the spread.  The AMA has been addressing this throughout the PHE, and we will continue to do so. 

I would say the top physician concerns to date remain very similar to what we talked about in March, unfortunately, a lack of PPE, inadequate testing in many pockets of the country.  We are also now entering into the fall flu season and a large concern around resurgence, a potential wave 2, and what folks have termed the “twindemic” of flu as well as COVID-19.  Physicians continue to be concerned about delay of care for patients who may not feel safe coming into a physician office or a healthcare facility for much-needed care.  And we also know that—again, back to this being a marathon—physician practices have invested a great amount of time, effort and energy, particularly around the adoption of telehealth, and we want to maintain that, and we want to ensure that those investments and that provision of care is adequately covered and paid for, for both physicians and their patients. 

Dr. Caudle:
That’s very helpful to hear.  If we focus on those concerns for just another moment, Carol, what has the AMA done to help address them?  

Ms. Vargo:
Well, we’ve put out a tremendous number of resources, whether that be written guides as well as webinars and podcasts such as this with ReachMD in our partnership with you all.  We have developed resources along the great lines of greatest needs particularly right at the beginning of the pandemic around what available loans and financial help at the federal and state level would be available.  We put together financial relief guides, and we updated those continuously through the pandemic so that physicians know what access to resources they have and how to actually access them via the application process.  I would say, to address the shortage of PPE and testing, we continue to advocate for that at the federal and state level, but more importantly, the AMA launched a project with an organization called Project N95 earlier this year.  Over the summer we helped members through this project get PPE for their practices, and we’re actually pleased to let you know today that in early November we just decided that AMA members will have another exclusive opportunity to purchase quality certified PPE with no minimum for a limited time, so stay tuned for that. 

Another very important aspect that we have been focusing on is physician mental health.  As we all know, physicians have been on the front lines during this very stressful time, and we also know that physicians themselves have been trained to provide care regardless of the stresses and the problems of the world around them, and during COVID we have found that that has, unfortunately, caused a lot of distress among physicians.  We hear a lot around increased burnout, which was already at a record level among our physicians.  We hear a lot about concerns for their families.  And, unfortunately, we have had some instances of physicians taking their own lives due to the stress and strain of being on the front lines of this very, very serious pandemic.  And with that we’ve actually been working with Congress at the federal level and had a bill introduced that Dr. Lorna Breen Health Care Provider Protection Act that actually seeks to provide grant money and more training and funding to help physicians and clinicians access behavioral healthcare resources for themselves.  Unfortunately, Dr. Lorna Breen was one of those physicians who ended up taking her own life, so this is a big priority for the AMA, and we will continue to fight for that so that physicians and their families are safe during this time. 

With that as a backdrop of the work that we’ve been doing, I would like to switch gears slightly to focus specifically on our keeping your practice open guide.  We actually over the last several months have updated and reframed what we were referring to as our reopening guide that we released back in May, and now that we are seeing physicians that are opening but we continue to be in this marathon, we are focused on helping physicians stay open.  

Dr. Caudle:
That’s excellent.  As a physician, I have to say, before we move on, I’m a family physician, and it’s definitely reassuring to hear of all of the amazing things that the AMA is doing to help physicians, so I definitely am appreciative.  I know my colleagues are as well.  Moving forward I’d like to really zero in on the updated reopening guide.  What are the exact areas covered in this guide, and what can physicians really expect to learn from it? 

Ms. Vargo:
Great question, Dr. Caudle.  And let me talk about some of those few key areas.  I would say just as a reminder to these folks, this guide as well as all the other resources that the AMA has put together are free to all physicians, members or not, and they are available at our COVID-19 resource center, so everything I’m talking about today, you can go to that and avail yourselves of these important tools and resources. 

With regard to the keeping your practice open guide, we cover a lot of areas, but let me touch briefly on first the governmental guidance.  It is important for physician practices to understand what the current state of play is in their own state and locality with regards to what can remain open and what needs to either scale back or close in terms of operations.  While we have seen a loosening of those in many areas across the country over the summer, we are now actually seeing, as we have seen an uptick in cases, potential new orders coming through.   And a lot of those are not blanket.  They are very specific to local and communities.  So we urge physicians to first understand what’s happening with regard to that governmental guidance. 

We also—and this is very important—have added to the keeping your practice open more information around planning for potential COVID-19 exposures among your own staff and yourself.  This is important for you and your employees to have protocols in place to prevent exposure, but we also talk about what to do if, in fact, there has been an exposure, both from a care and legal standpoint.  We also remind folks constantly about the provider and patient safety with regard to having protocols in place; with regards to screening; testing; when you do have cases, where to refer; where to access that testing equipment.  We also cover some of the legal implications and protections for when you as an employer have folks on your staff who become ill with regard to some privacy and, for example, paid leave off.  And finally, we remind practices that in order to keep your operations running smoothly, we really encourage pre-visit screening. One of our most downloadable resources is a pre-visit screening script that your staff can use when calling your patients before they are about to come in, which can alleviate some of the uncertainty once the patient enters your practice.  And finally, we talk a lot and continue to talk a lot around the use of telehealth in your practice so that you can triage, address patient concerns via telehealth without them having to come in but yet still remain open in your practice. 

Dr. Caudle:
For those of you who are just tuning in, you’re listening to Perspectives with the AMA on ReachMD.  I’m your host, Dr. Jennifer Caudle, and here to talk about the available resources designed to help keep physician practices open during the COVID-19 pandemic is Carol Vargo from the AMA.  

Now, Carol, if we keep in mind what you shared with us up to this point about the resources that physicians can draw on, what else do you think is important for physicians to know? 

Ms. Vargo:
Yes, Dr. Caudle, there is a lot going on, and so we appreciate you providing us this opportunity to reach out to your physician listeners today.  I would really like to let them know that we recognize the pandemic has brought on an increased level of burnout and anxiety among them and their patients.  We actually have brought in some new resources, including one on managing mental health care, and we actually recently just launched a new series with 7 of our specialty society colleagues around integrating behavioral health care into a physician practice.  This has been very widely received where physicians can listen in, understand from leaders who have adopted behavioral health into their practice and how that’s working, and we’ve gotten great reviews in terms of learning about how to integrate behavioral health, how to bill and code for that and how to address some of the stigma that goes with behavioral health.  We also continue at the AMA to engage physician and community via multiple surveys to collect their feedback on what’s happening on the ground with regards to the impact of COVID-19. 

And finally, we always continue to engage on the needs of physician practices at the practice advocacy level as well as advocacy at the federal and state level.  And just one great example, most recently our advocacy team at the AMA had a great win to delay repayments that were expected to come due to the Medicare Advance Payment Program that was released early on in the pandemic, so now physicians do not have to repay those advanced payments at this time. 

And finally, we continue to advocate for continued telehealth coverage during the pandemic.  The adoption of telehealth, as you know, has become an important lifeline for patients and physicians.  We have our telehealth quick guide to help them understand how to implement that, but as the pandemic wears on, we understand that physicians continue to need adequate coverage, as do patients, for availing themselves of this important tool. 

Dr. Caudle:
That’s really excellent.  Before we close, Carol, do you have any other thoughts you’d like to share with our audience? 

Ms. Vargo:
Well, first, let me say, Dr. Caudle, thanks to you and ReachMD for connecting us with the physicians that are listening today.  We at the AMA and my team and others across the AMA thank physicians for their service during these really difficult times, and we want to reiterate our support and our commitment to you, because without you we would not have come as far as we have, fortunately, with the advances in care and therapeutics for patients dealing with COVID-19. 

We also want to encourage you directly to reach out to us.  We have a “Share Your Story” button on the AMA’s COVID-19 webpage, which I mentioned to you before, so if you have a particular need that you feel like we are not yet covering or could be enhanced, please let us know.  And finally, I just want to encourage the physicians listening today and those that work in their practices to take a look at our keeping your practice open guide. Again, it is available and free to all, available on the AMA website, and you will also be able to find it on the ReachMD page for this episode.  

Dr. Caudle:
Wonderful.  Well, with that, I’d like to thank my guest, Miss Carol Vargo, for joining me to discuss a few of the resources available to help physicians keep their practices operating during the COVID-19 pandemic.  Carol, it was really great having you on the program.  

Ms. Vargo:
Thanks, Dr. Caudle.  It was a great opportunity, and I really enjoyed speaking with you today. 

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The preceding program was produced in partnership with the American Medical Association. To revisit any part of this discussion and to access other episodes in this series, visit ReachMD.com/AMA. Thank you for listening. This is ReachMD. Be Part of the Knowledge.