Rheumatology in the Time of COVID-19: To Stay Open or To Close?

By Andrew L. Concoff, MD, FACR, CAQSM

Optimizing Telemedicine Approaches for Either Decision

I received word from a practice today, where a patient was heard saying, “I can’t believe you guys are still open, I had assumed that you had closed”.  This is not the first time that an agonizing Rheumatologist has reached out with this most basic and impactful choice that we will face during the pandemic:  Do I keep my clinic open or do I close?  As with so many of the dilemmas we face, there is no easy answer to this question. 

Some of our practices will decide that closing the clinic is the prudent thing to do.  It has been recommended by the Federal government to decrease the spread of the infection, that we congregate in no more than ten people at a time.  By closing our clinics, we may do our part in interrupting the chain of logarithmic expansion of the infection.  Further, we limit the exposure of our staff, and their loved ones, to the infection.  Even more significantly, however, if a staff member or one of us becomes infected, we risk passing that infection to the numerous patients we see whose immune systems are compromised by the very medicines we provide to treat them.  What’s worse, we now recognize that occult infection, wherein asymptomatic individuals can pass the virus to others, is not uncommon.  Thinking along these lines, emergencies rarely occur in or present to the Rheumatology clinic, so perhaps ours is among the specialties that might close.

Others will counter with several questions that serve as strong arguments for keeping our doors open.  To begin with, do we not owe it to our patients, staff, and our society to stay open? Can we turn our backs on our suffering patients and leave them to brave the overburdened primary care, urgent care, emergency room labyrinth, wherein we know for certain that the appropriateness of care they receive will be limited by the lack of our understanding and stewardship of their diseases?  And what of our loyal staff members?  And what of our income during the pandemic?  Even the President now estimates that the pandemic will not end until July or August.  Do we fire trusted and beloved clinic staff, sometimes after 10-20 years of faithful service?  The way each of us weighs these factors will determine our ultimate choice and will differ based upon several factors.

Among the factors to be considered is personal risk to the Rheumatologists, other providers, and staff.  If you, or your employees are over 60 years of age or have cardiac or pulmonary conditions or diabetes, the risk of serious complications from COVID-19 infection appears to be significantly higher than if you are not.  Similarly, the risk to you and your staff varies based upon the prevalence of the disease in your local community.  Obviously, your financial circumstances are a consideration.  Can you, and your family, survive with reduced, or no significant income for the 6-12-month period over which this pandemic may last?  Will your patients even attend clinic visits, given the recommendations to limit social contact?  There is no right or wrong choice, and the decision is not absolute, as an office may choose to close temporarily and then reopen if circumstances allow.  Let us know how you are approaching this issue so that we can share these insights.  Misery may love company, but insight deserves it. 

No matter what you choose, UR will attempt to limit the fall-out and the burden imposed by these uncertain times.  Certain approaches, including Telerheumatology, present important considerations, and opportunities in either case.  Specifically, if you choose to close your clinic, the development of a robust Telerheumatology practice may ease the burden on your patients and on your pocketbook, by allowing remote, billable visits to occur.  Such visits may provide revenue that may also allow you to retain at least a few of your administrative staff.  On the other hand, if you choose to keep your doors open, leveraging Telerheumatology can minimize the risk of COVID infection among you and your staff by allowing an approach to interacting remotely with patients that have symptoms consistent with COVID-19, have tested positive for COVID-19, or have chosen not to follow-up out of these or other concerns. 

CMS has recently relaxed specific regulations, including those regarding interstate licensing requirements for Telemedicine.  United Rheumatology is negotiating on your behalf with certain Telerheumatology vendors and payers and will soon present options as to how our practices may move forward.  Thus, these trying times present a significant opportunity for UR members to partner with payers on a national basis to step into the void created by practice closures across the country.  We recognize that our practices are at various stages of adoption of these approaches and that certain changes to workflows are required to adopt and optimize Telerheumatology.  The following are some details that may help with billing and coding in the adoption of Telerheumatology. https://unitedrheumatology.com/the-latest-developments-about-cms-telemedicine/

Meanwhile, if you have already adopted Telerheumatology, let us know how you have adapted your practice and what key tips, learning points, or pitfalls you have encountered as you have done so, so that we may share your advice.  Similarly, if you have questions about implementing Telerheumatology, contact us so that we can answer or seek answers to your questions.

The advent of the COVID-19 pandemic has fundamentally changed the practice of Rheumatology. One way that we can face such uncertainty and confront these challenges is band together virtually, by sharing our thoughts and approaches.  Please send your concerns, solutions, thoughts, and novel approaches to info@unitedrheumatology.com.

Stay safe, stay healthy, stay United. 

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