By Timothy Howard, DO
I currently have a solo, private practice with several offices in Bucks and Montgomery Counties in Southeast PA, outside of Philadelphia. The area I am in is some of the hardest-hit areas in Pennsylvania with COVID-19 due to being in a metropolitan area as well as proximity to New Jersey and New York.
I have had very similar experiences to many other Rheumatology practices I believe and found the United Rheumatology Virtual Round Table Zoom meetings very helpful in reinforcing what I am doing as well as providing new ideas and strategies to maintain my practice during the pandemic.
Being a small practice I have a small payroll, with eight employees, I feel I have been fortunate to not have to lay off or furlough any office staff, and have reassured my office staff that I plan to maintain their positions and average hours/week worked for those on hourly wages, even if workdays are somewhat shorter. My daily office visit schedule is operating at about 50% of pre-COVID times. Infusions have continued to run relatively smoothly with only a slight drop off in schedule. I would say infusions are still running at about 85-90%. We have arranged the infusion schedule to attempt to maintain social distancing and have placed medical screens or curtains as barriers between infusion chairs. Prolia injections have been continued and I have offered patients a “drive-up” service, where a Medical Assistant will go out to their car and administer the injection. We had initially put off all non-urgent new patient visits back in March and continued that through April and most of May. Now that some restrictions are beginning to ease and the counties I serve look to be moving into the “Yellow” very soon we are starting to slowly schedule back in new patient consults.
We started early on the process phasing in telemedicine services, and most of my day’s appointments are either telemedicine or telephone check-ins for those who are unable to access telemedicine services. Patients are only seen in the office based on urgent needs. We use Healow which is the telemedicine service Eclinical Works offers. Although it has been immensely helpful to keep patient visits going during these times, I have found it to be a bit touch and go, as far as connectivity and patients being able to use the service. Much to my horror, twice I have entered a visit to find the patient on their phone, behind the wheel, and driving down the road! Another time a guy conducted the visit sitting in front of his chicken coop. Anecdotally, we have also found it quite comical that older patients are often more proficient and tech-savvy than younger patients at setting up telemed services. Overall, telemedicine has been an enlightening experience, however, I am not certain a lot of what we do can be captured in a telemedicine visit as we are so reliant on the clinical exam. The service has worked wonderfully for stable follow-ups, but often times when new problems arise, I am left with treating the patient empirically or deciding to kick the can down the road to the next visit in hopes we can meet in person.
Lastly, I would like to make a plug for The COVID-19 Global Rheumatology Alliance, which can be found at Rheum-covid.org or @Rheum_covid for those on Twitter. I have entered several of my patients in the registry who have informed me that they have tested positive. It is a quick and easy process. These unfamiliar times of COVID-19 have been challenging where so much in the medical literature is new and changing daily and at times, where hopes, hunches, and cavalier medical decision making have come to the forefront. I feel this type of registry will help guide and inform our patient care in these uncertain times while we await more formal clinical trial results.
Timothy Howard, DO
Stay safe, stay healthy, stay United.