In the inaugural episode of the "Off the Chart with Medical Economics" podcast, family physician Kurt Stange, MD, PhD, discusses how doctors can establish meaningful relationships with patients whom they treat only episodically or virtually. Stange, a former  editor of Annals of Family Medicine, is a Distinguished University Professor and professor of medicine at the Case Western Reserve University School of Medicine.

Podcasts

As long-term doctor-patient relationships dwindle, how can doctors establish the trust and respect they need in order to provide patients with the best care? 

How doctors can form relationships with patients they treat episodically or remotely

For doctors, choosing the right malpractice insurance and insurance carrier are crucial decisions. They need coverage that is affordable, tailored to their specific requirements, and provided by a financially sound company whose judgment they trust.

Slideshows

Here are answers to some basic questions and answers about malpractice insurance. 

The ABCs of malpractice insurance

How common is physician burnout and why does it happen?

Why do doctors experience burnout? 

Chris Mazzolini is the editorial director of Medical Economics

The recent surge in COVID-19 cases in many states across the South and Western U.S. has clinical laboratories concerned they are close to testing capacity.

The American Clinical Laboratory Association (ACLA), which represents major laboratories such as Quest Diagnostics, LabCorp and others, 

 that COVID-19 testing capacity will be exceeded in recent weeks.

“ACLA member laboratories have seen a steady increase in the volume of COVID-19 test orders," the statement reads. "While our members are collectively performing hundreds of thousands of tests each day, the anticipated demand for COVID-19 testing over the coming weeks will likely exceed members’ testing capacities. This significant increase in demand could extend turnaround times for test results."

, saying "we have continued to experience surging demand for these services, with recent daily orders outpacing capacity. As a result, while our average turnaround time continues to be one day for priority 1 patients, it is now three to five days for all other populations."

The company said its ramping up its capacity to conduct more than 150,000 tests per day. The company is currently doing about 115,000 tests per day, according to the statement. 

"While we have the supplies to meet our current capacity target, we continue to work with our industry partners on platforms, reagent test kits and other supplies," the statement reads.

More than 31.5 million coronavirus tests have been conducted in the United States since the pandemic began, with as many as 500,000 to 600,000 tests per day in recent weeks, according to the 

Articles

Labs say the recent surge in COVID-19 tests and cases has them closely approaching testing capacity.

COVID-19 tests: Labs warn they are approaching capacity as demand surges

Across the United States, healthcare resources at all levels are being directed toward fighting the 

 pandemic. While this has resulted in encouraging progress, many non-coronavirus patients are finding it difficult to access care due to limited available resources, while others avoid seeking in-person medical treatment for fear of exposure to the virus.

This trend is especially concerning among patients in need of chronic care, who account for 

. For those with chronic diseases, failure to access care can lead to high-acuity care episodes, a situation that is dangerous and disruptive to patients, in addition to being costly for patients, payors, and providers alike.

To avoid these negative outcomes, and to preserve specialist availability and critical health care resources, health care organizations must find ways to provide safe access to primary care for patients with chronic conditions. One potential avenue for providing this care is through the use of 

With eConsults, PCPs can provide virtual access to specialist-guided care, replacing the need for face-to-face specialist visits over 70% of the time, and triaging cases to ensure only the highest-acuity patients are referred for in-person appointments. This means patients with chronic conditions can continue to receive care in a safe environment, improving patient outcomes and mitigating a backlog of more urgent care that becomes necessary when untreated conditions worsen.

Coronavirus is further interfering with access to care

The novel coronavirus pandemic has exacerbated several already significant barriers to accessing care. 

, health officer and internist Dave Chokshi, MD, states that, “Even before COVID-19, we knew there were patients we do not see, whether because of financial barriers, racism, fear related to immigration status, or social isolation. [...] But now, that is compounded by additional barriers to seeking care, which span physical and technological challenges as well as concern about becoming infected with COVID-19.”

Regarding patients hesitant to seek care due to fear of exposure to the virus, the data are striking: from 

 we see a sharp and significant drop in the number of ambulatory visits. From April this number begins to rise, but remains roughly one-third lower than what was seen before the pandemic.

In addition, many other barriers to specialist care—such as financial, childcare, and transportation—have been heightened due to job losses, school closures, and stay-at-home orders. On the provider side, many specialists are not taking patients during the pandemic. Meanwhile, others are overbooked even more than usual due to their critical role in combating the pandemic.

Chronic care needs still must be addressed

While stay-at-home orders are important for reducing infections, patients with chronic illnesses must still be able to receive care to avoid severe negative outcomes. According to AristaMD user Maria Barrell, DO, 

, “Patients with a chronic illness who do not continually make key wellness checks could see their disease states deteriorate, launching into an acute care crisis.” Such crises can be costly, risky, and even fatal to those with chronic diseases, and providing care for such patients is critical to their wellbeing.

Such care is also important if health systems are to avoid being overwhelmed. In 2014 

 found 60% of US adults had at least one chronic condition. On average, Americans with five or more chronic conditions spend 14 times more on health services than people with no chronic conditions.

Increased acute health crises due to chronic patients not receiving care could therefore result in subsequent surges in ED visits as a downstream effect, with these admissions both taking over critical hospital and healthcare setting capacity amidst COVID-19, as well as contributing to a significant backlog of patients seeking care as the healthcare system is met with a second surge of patients following the height of COVID-19.

“I am worried about hidden illness due to foregone care, and how this might contribute to a ‘second wave’ related to this pandemic,” Chokshi says.

eConsults support chronic care management for PCPs

eConsults are a powerful tool that can support PCPs in providing patients with access to high-quality specialist care within the primary care setting. They can replace the need for a face-to-face visit 

 for routine referrals, and telehealth technology easily provides support for routine chronic care management such as check-ins and medication adjustments. Further, eConsults offer a method of remotely triaging to confirm which patients are high-acuity and therefore need to see specialists in person. For health organizations and medical centers already leveraging telemedicine to see patients, eConsults enable PCPs to provide necessary specialty care entirely through virtual means.

Implementing an eConsult system results in several short-term benefits amid the COVID-19 pandemic. PCPs can provide quick access to proactive care, resulting in improved patient health and higher overall satisfaction. This is especially true for those with chronic conditions; it’s been 

 that proactive care, especially primary care, is effective in reducing the burden of chronic conditions and improving outcomes for such patients.

As a further benefit, providing access to treatment and chronic care management through telehealth mitigates the need for patients to resort to emergency care in settings that are likely impacted with COVID-19 patients, helping reduce the risk of chronic patients being exposed to the virus.

Finally, eConsults can help to optimize specialist appointment queues, reducing wait times following the pandemic when specialists begin taking patients once more and experience a surge of patients with unmet needs.

Even amidst this healthcare crisis, patients with chronic diseases cannot be ignored. This population continues to need proactive, accessible care if their conditions are to be well-managed, and failure to do so will only exacerbate future healthcare strain. eConsults are a promising tool demonstrating the value of telehealth for remote chronic care management, equipping primary care providers to see patients virtually, provide specialty patient care remotely, and to do all of this in a timely manner.

The COVID-19 pandemic is testing healthcare organizations at all levels, prodding at weak points and forcing decision-makers to answer difficult questions about the interaction between providers and patients and how to best equip health systems to respond to crises. While the answers to many of these questions are not quite clear, what does seem certain is that very little will remain the same in healthcare in the coming years—and organizations willing to adapt and remain on the cutting edge will be the ones driving the industry forward as we overcome this healthcare crisis.

eConsults are especially vital during the COVID-19 pandemic.

eConsults: An essential piece of telehealth for chronic care management

How many novel coronavirus (COVID-19) cases were announced today?

 is a volunteer effort to compile federal and state data in regards to new COVID-19 cases, including number of positive and negative tests.

Here’s the latest data, updated on June 30:

Data from the COVID tracking project on coronavirus cases, test results and more

How doctors can form relationships with patients they treat episodically or remotely

The ABCs of malpractice insurance

Why do doctors experience burnout?

COVID-19 tests: Labs warn they are approaching capacity as demand surges

eConsults: An essential piece of telehealth for chronic care management

Coronavirus case numbers in the United States: JUNE 30 update