April 30, 2020

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The COVID pandemic has disrupted many norms, including the need to temporarily close the traditional front door to primary care. However, the long-running, firmly established relationship of trust between patient and primary care physician remains strong and may be more important than ever.
                   
For decades primary care has been positioned as the front door to local and regional health systems. Crafted over time and shaped by human connection, these trusting relationships were forged at the bedside. Many providers have believed that the integrity of this relationship resides exclusively in this space. As such, the adoption of technology solutions for direct patient care has been met by skepticism.
 
Novel COVID-19, though, is a disruptive innovator. The threat to primary care is perilous, creating serious short-term, and potentially long-term, consequences for patients and providers. Quarantine is the best solution to protect those with chronic disease in the short term, yet it may prove lethal if we don’t offer a lifeline of support through a new, virtual front door.
 
Teams must move swiftly, integrating innovative virtual delivery approaches that save patients and practice revenues. Primary care practices know that many patients are afraid of contracting COVID at physicians’ offices, so they simply aren’t coming in for appointments. The message many have heard is “Don’t go to the doctor’s office, it’s not safe.”

The critical question now: What have you done to let your patients know you are still there for them, even if the physical building may be temporarily closed?

Primary care must continue to serve patients during periods of social distancing for the foreseeable future. For vulnerable patients, the repercussions of going without care cannot be ignored. Left unaddressed, chronic conditions will likely worsen, resulting in hospitalizations, which could make the second and possibly third wave of COVID even more deadly.

Comprehensive Virtual Care Paths include:
  • An orientation to the “new front door” to care via telephone, text, or email
  • An easy and meaningful virtual experience for patients
  • Consistent marketing across all the clinical domains in a health system
  • IT support for providers and patients
While draconian reimbursement systems have made patients and providers   
accustomed to the in-person visit, the Centers for Medicare and Medicaid Services recently recognized the risk this poses. CMS has enacted significant policy changes that will dramatically alter how patients access care.  
 
The best option by far is telehealth services. Successful implementation of telehealth, though, begins with a reliable roadmap that features shifting our perspectives and proactive outreach.
 
Patients – especially older patients – need to be reassured that telehealth is a safe way to connect with providers and will allow for meaningful support during prolonged periods of isolation. If telehealth is not an option, a virtual check-in or telephone E&M with the provider, or a nurse led between visit Chronic Care Coordination (CCM) service, are still valuable ways to ensure patients are getting what they need. If necessary, home health or other options could be explored as well.
 
For telehealth outreach, a key first step is to have practice teams welcome and orient patients to virtual care, showing them the “new front door” to access care. This means proactive outreach via phone, text, or email, that introduces patients to virtual options and the technical path to finding and using the system.
 
It may be a difficult transition for patients who have known good care as seeing their doctors in person. That’s been a challenge for physicians too. While telehealth will never replace the art of in-person care and human touch, primary care’s origins began in patients’ homes. This is an opportunity to go back to those roots and make it easier to meet patients where they are most comfortable.
 
Stories abound of a palpable sense of relief on patients’ faces once they see their doctor’s familiar face on the video screen. This simple connection has the capacity to comfort and console patients during these times. It also has the capacity to give us insight into the patient as telehealth affords the provider a new lens into the patient’s life that is lost in the sterile world of office-based medicine. The words of Dr. Francis Peabody from 100 years ago still ring true, “What is spoken of as a ‘clinical picture’ is not just a photograph of a man sick in bed; it is an impressionistic painting of the patient surrounded by his home, his work, his relations, his friends, his joys, sorrows, hopes and fears.” One could easily argue that connecting with a patient periodically in their home is a step toward more comprehensive and patient centered care.  
 
For guidance on performing a physical exam via telehealth, see our helpful infographic.

Practices and patients cannot wait for a return to “normal.” The fact that 20 percent or more of COVID cases are asymptomatic means that although patients need care, they increase their COVID risk by venturing out. There is a growing body of evidence noting a clear correlation with adverse events in those with highly prevalent conditions such as hypertension, diabetes, and obesity. Patients need primary care at home and primary care needs to survive. Virtual care is best practice care. Most agree that it needs to be woven into the fabric of primary care delivery, becoming part of its post COVID ethos.
 
Primary care providers have been reluctant to offer telehealth because barriers to entry were high—cost prohibitive platforms and high patient copays. Now, the biggest barriers have been removed during the COVID health crisis. Although payment solutions are not yet perfect, this is an opportunity to reinvent primary care for current and long-term sustainability. The only real barrier that exists is provider willingness to widely adopt and actively endorse its value. It is time for this change.
 
The COVID-19 pandemic caught our health system by surprise and cast a light on our vulnerabilities. As business leader Jack Welch said, “If the rate of change on the outside exceeds the rate of change on the inside, the end is near.” We have a choice to approach this moment in time as an opportunity not an obstacle.
 
Primary care is still the front door to health systems in virtually every community in America. Our role as trusted advisor is of paramount importance during these unprecedented times. Although patients may be waiting for this storm to pass, it is inevitable that needs will arise. If we don’t proactively reach out, connect with, and create a clear pathway to care, unlimited by geography, patients will likely be forced to seek care elsewhere or end up in high risk environments like emergency departments or urgent care. How visible is your new virtual front door?

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