Tips for re-opening your medical practice

Geeta Nayyar, MD, chief medical officer for Greenway, discusses how physicians can re-open their practices safely and efficiently in the midst of the COVID-19 pandemic.

The following transcript has been edited for length and clarity.

Medical Economics: What should physicians consider before we opening their practice? Specifically, what criteria should they use to make the decision?

Nayyar: Sure, well, the first thing is knowing what's going on in their particular region and locality. Right. So there's definitely regional advice. I would first and foremost, be looking at that and be following CDC as well as local guidelines. But secondly, it's really about how to get your patients and staff back to the office safely. How to maintain that safety and again, As you can imagine the volume of sort of the backlog so it's how do you recover in a way that is also the most valuable for your patients and the patients that are the most sick, the patients that have an acute issue? And then also just keeping in mind, how do you take care of the patients that don't want to come in? So again, a lot of folks have overnight developed an affection for telemedicine, right, so how are you doing telemedicine? Plus the old brick and mortar practice and how do you manage that are really the things folks need to consider right now.

Medical Economics: What new safety protocols are needed for practices?

Nayyar: The first thing is, again, the same guidelines that we have in society, so keeping people six feet apart, wearing masks, making sure surfaces and there's no contact and making sure that you know once a patient has been seen, that the room is able to be completely disinfected and wiped down. And when we think about PPE, it's now not just PPE for the staff, but it's also PPE for your patients. Are they coming in with gloves? A mask? Are you providing them? Or are they, and is it mandatory that they do this themselves?

We've never had to do this before. So this is really a new world. And you'll see a lot of folks also making patients wait in their virtual waiting room, which is their car most of the time, or one person in the waiting room to keep that gap and ensure that distance. If anyone in the office turns out to be COVID-19 positive, staff or patient, there's a whole protocol you have to follow in terms of making sure anyone that was around that individual self-quarantines.

Medical Economics: What are some of the best practices in terms of managing your staff? Should they be taking their temperature every day? What are just some basic guidelines practices need to follow?

Nayyar: It's safety first. So again, just treating everyone as you would like to be treated, or I would say, the mom test: What would you want to do for your mom? So number one, it's a bit of the honor system. If you're not feeling well, you need to stay home. Certainly, if you have a temperature you need to stay home. The problem with taking temperatures, as you know, is most of the cases are asymptomatic. And most of the time that you're actually shedding and the most infectious is right around the time when you do not have a fever. So this concept of taking temperatures is really I think to make some of us feel better. But the truth is 40% of transmissions are happening in asymptomatic people. So I'm not really sure there's much to do there. So it's really about prevention. This virus is all about not getting it and following all the protocols that we've established to prevent it from spreading.

Medical Economics: Let's talk about PPE. Obviously, it's been a huge story in the last few months about a lack of PPE or PPE not being distributed to where it's needed. What do practices need to do to ensure that they have enough and that they can stay open?

Nayyar: A lot of inventory management, it's being in touch with your local regional medical association, your state association, they're doing a lot to help physicians. Your public health department. And look, if you run out, you run out. This becomes the rate limiting factor. But you see people getting very creative about how long a N95 mask will last. Traditionally 24 hours and you had to dispose of your mask, now the hospitals are saying one week. I think you've just got to use good sound judgment at this point. And again, I think to the extent we're all helping each other and moving supplies, you see the different manufacturing efforts that are out there. My hope is that we're better prepared this time around. But it at this moment, we just can never have enough supplies.

Medical Economics: A lot of physician practices have taken a huge financial hit. How should they effectively balance between the eagerness to re-open and also making sure that you're opening in a safe time in your area? What are some of the things that should be on your checklist?

Nayyar: Again, safety first, and knowing what is going on in your particular region and locality. Are you allowed to open? Is the hospital in your area re-opening? Take an inventory of your staff. Who wants to come back? Who's comfortable coming back? Who's not? What is your inventory look like when it comes to PPE? What's your process and procedure to disinfect rooms? What is your new process of communicating to patients? There's a whole kind of wraparound communication that’s need, and patient engagement couldn't be more front and center right now.

How do you get patients in and out? The key is in and out. And patients also, for the first time, they want to come in and out. So you know, being very efficient in what has to be done in-person and what are the things that don't have to be done in-person and can be done virtually. What are the things you can do ahead of time? Your co-pay, getting all those forms done, any screeners, any paperwork? All of that does not need to be done in person.

Adapting to new technologies is crucial. Now is actually the time because a lot of this existed, but we've didn't really have that patient readiness, but now we do. Everything has really flipped on a dime.

And I would say the same thing with the discharge process. As soon as the actual clinical visit is done, what is the discharge process that can be done outside of the four walls of the office? Is there prescriptions that need to be picked up? Patient education? Follow up visits? Scheduling your next appointment? None of that needs to be done in the confines of the office. So moving forward, what needs to be truly done in the office?

Medical Economics: How do you think telemedicine has performed during the pandemic?

Nayyar: I think it's an exciting time for adoption of tech. We're finally realizing the future is here. It's been here all along, just the reimbursement and the regulations didn't really allow us to open the flood gates. So I think it's extraordinary what's happened with telemedicine, it speaks volumes to the work, workforce shortage that we have now. And we will have even more shortage going forward given all the things that we've seen with this pandemic. So I think the opportunity here to really meet the patient where they're at. It’s about the right care at the right time. That's what keeps people from going to the emergency room, their own doctor's office, urgent care, etc. So the opportunity is tremendous. We've seen amazing adoption and I think it's very exciting.

We're also seeing the limitations. We're having to figure out what is the value of the visit that can be done virtually versus not? And I would just encourage people to say it is a new paradigm and to the extent physicians are anxious, patients are anxious, you want to keep that good, I call it good website manner, instead of bedside manner. There are things we've never had to think about but they have a lot to do with the interaction and making the patient comfortable. I think what we've also found is that people have more eye contact, when they're on a screen, , so many of the patients are used to the doctor not looking at them and typing in the EHR. And now, everyone's sort of forced to say: ‘How are you? How is it going? Talk to me about your pain levels?’ And that's really nice. But certainly, there are limitations and we'll have to navigate those as we go forward.

Medical Economics: What are the best ways to integrate these different types of visits?

Nayyar: So I think you've got to first take stock of your own practice and your own patient population. How successful have you been with this, or not? And how successful is your staff at adopting this, or not? So every office is going to be different. So I don't think there's one right approach. I think it depends on your practice, your population and what your workflows and efficiencies tell you, because I think also people are going to realize what is truly more efficient versus not.

Um, another question about staff. Obviously, it's a difficult time for everybody. And I'm wondering what physicians as sort of leaders of their care team need to do to sort of keep morale up, help deal with burnout, all those sort of staff morale issues that may crop up but as a result of the pandemic, and just sort of the strange situation we're in right now.

Medical Economics: Is there anything that we haven't discussed that you think it's important for physicians to consider as they re-open their practice?

Nayyar: Communication, communication, communication. Traditionally the doctor's officeis the  worst place to communicate. You call, you're on hold, you leave a message. The more you're communicating with your patients right now, the more you're investing in things like patient engagement. Again, it doesn't have to be high tech, necessarily, but they want to know: Are you open? Are you closing? What are your process and procedures? And how do they get a message to you during office hours? After office hours? What's the health of your staff? So I would say basic kind of common sense consumer practices that we've just not had to think about in medicine. Communication is key.

Watch more Medical Economics Pulse videos on topics, including:

• Make telehealth work for your practice-even after you re-open

• Your telehealth reimbursement questions, answered

• How to save medical practices from COVID-19