Coronavirus preparations: What physician practices need to know

While the coronavirus (COVID-19) is a significant challenge for the entire healthcare system, physician practices face a unique set of issues themselves. They must balance between the acute needs of their patients, while also managing their staff through a major crisis.

It will not be easy, says Robert McLean, MD, an internist and president of the American College of Physicians.

“We face significant challenges,” said McLean is an e-mail interview. “No way to minimize it.”

Medical Economics asked McLean about the state of physician readiness for dealing with COVID-19. Here are his responses, with minor edits for clarity.

Medical Economics: What steps should physicians take to prepare their practice staff for the coronavirus?

McLean: Physicians need to ensure that we keep our staff, colleagues, and patients safe. Since there are such concerns over the contagious nature of COVID-19, physicians are steering patients with specific symptoms of fever and cough and concerns over possible COVID-19 infection to not come into the office. The practice staff need reassurance that the physicians are doing everything possible to ensure staff safety while trying to deliver appropriate care to patients.

Medical Economics: From an infection control standpoint, what steps should physicians be taking?

McLean: Personal Protective Equipment (PPE) is critical for the safety of our staff, but the challenge is that there are nationwide shortages of this equipment at this time. Clearly, physicians know from the Centers for Disease Control (CDC) that there are several specific recommendations around handwashing, protective face masks, hygiene in exam rooms that should be followed.

Medical Economics: Many patients will have questions about the virus. What should physicians tell them? Where should they direct them for accurate information? How do you answer questions about testing?

McLean: The CDC website is the definitive source of information, and it is suggested that patients follow advice from the CDC regarding travel, social distancing, how much to go in public.

As far as testing, with limited testing available, patients for whom there is concern about having COVID-19 are the highest priority for getting tested. As testing is more widely available, then there will be greater opportunity for broader testing of patients with much milder symptoms of respiratory illness, and that will give us a much greater sense of the extent of this viral epidemic.

Medical Economics: Many experts are touting the benefits of remote care via telemedicine, emailing with patients and patient portals. Setting up a program from scratch now may be daunting, but what’s one tips for physician practices to increase the number of patients they can treat remotely during this crisis?

McLean: Physicians have always provided different aspects of acute care and chronic disease management with phone calls. Physicians can manage many conditions and symptoms over the phone. There are actual billing codes for phone management, and we need to put pressure on our insurance and government payers to cover those phone call visit codes, in addition to the "telehealth" video-visit codes, which have been slowly expanding in recent years.

But too many physician offices and groups are not set-up or resourced to do these video-visits.

Medical Economics: What advise do you have for physician to manage staff concerns, anxieties, and requests for time off? How should they strike the balance between being there for patients and physician/staff safety?

McLean: Very big challenges will be faced by office practices as staff members have their own safety concerns. Provide appropriate PPE but also try to ensure that patients at higher risk of having COVID-19-with fever, cough, travel history-are triaged to NOT come into the office. But, now with so many schools closing, staff have childcare issues to worry about. Physicians and their staffs alike have a sense of professional responsibility to help care for our patients. That cannot be underestimated-that we all want to do the right thing and help people.