Greetings From Washington State!

This is part of a series looking at different practices of all sizes and locations, and how they are all dealing with issues during this pandemic. 

Jeff R. Peterson, MDBy Jeff R. Peterson, MD

Our clinic is a three doctor and one nurse practitioner practice that has been in operation for three years in the north end of Seattle. We are part of a multi-specialty independent physician organization meaning our clinic is independent, but we use some of the services of the parent organization such as billing and HR. We have a five chair infusion suite and a clinical research program.

The very first identified COVID-19 patient in the US was located about 6 miles north of us, and the very first deaths from COVID-19 were about 5 miles south of us. Needless to say, there was a lot of angst early on about what this would mean. Our staff was inundated by many phone calls from worried patients about immunosuppression and the risks. We put on our website that we wanted our patients to continue their medications and speak to us if they had concerns. We realized that our bread and butter is the infusion suite and that it is vital to make sure that the patients receive adequate treatments to control their diseases. And so, we endeavored to keep the infusion suite at full capacity if possible. We streamlined our days of infusion and were able to use just our full-time RN and our LPN working as a medical assistant crossover when needed.

Our front desk and the nursing staff called all of the patients to inform them that we needed to continue the IV medications and that we would separate them from each other and clean appropriately. Two of the three doctors and our nurse practitioner are working from home, and we have one physician in the office to cover infusion and injections. That gave us a few extra exam rooms that we could use for infusions. To date, we are down less than 10% on infusions.

We were early adopters of telemedicine starting about 1-2 weeks before our local compatriots and the rest of the country. We chose to use, which has been working very well for the most part. A few patients have bad connections, and then we will use telephone face time or worst-case scenario, a regular telephone call, but that is infrequent. Our front desk will call each patient a day in advance and send them in email with the login and instructions on how to get into the program and will walk them through it. Most everyone, including some of my 80+ year-old patients, are able to do this.

Currently, we are down about 20% on office visits. We recognize that this change in office procedures would necessitate some workflow adjustments, and we furloughed three front desk people, and our office manager is now helping out at the front desk. Our research coordinator found another job just as this was all coming about, and so a medical assistant is doubling as a research coordinator. Our third medical assistant is staying home and doing all prior authorizations as she is also caring for several small children who are home from school. We are still seeing a few patients in the office, mainly ones that need an exam or those who need injections. All patients who come into the office have their temperature checked on entry with a laser forehead reader and are given a face mask and gloves. All our staff are wearing facemasks throughout the day, and we do a deep clean in the morning and after each patient with Antiviral spray and alcohol. Fortunately, we were able to acquire enough gloves and mask’s to last several months.

Our financials from March, which included approximately two weeks of the above procedures, showed a small positive income. Adjustments for April include physicians taking one-half salary, and hopefully, given all of the above, we will still come out slightly ahead. I appreciate all the ideas that I have received from other members of United Rheumatology. It’s comforting to know that most of the policies that we have in place other United Rheumatology members have thought the same. There is strength in numbers. We will get through this.

Jeff R. Peterson, MD
Western Washington Arthritis Clinic  
Bothell, Washington

Clinical Associate Professor of Medicine University of Washington School of Medicine
President, Washington Rheumatology Alliance
Director, Northwest Rheumatism Society

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