Back 3 Ways COVID-19 Is Affecting Pediatrics and Family Practice

3 Ways COVID-19 Is Affecting Pediatrics and Family Practice

By Melissa Wirkus Hagstrom, contributor

As many businesses and services begin to reopen in the wake of COVID-19, medical groups including family medicine and pediatrics are determining how to move forward in this new environment. 

Physicians and their practices across the country have been impacted by the coronavirus pandemic, which kept many patients from seeking routine care. Some medical groups have experienced financial losses and face an uncertain future; most have had to rethink how they deliver care. 

As practices begin to welcome back more patients for routine visits such as health screenings, preventative care and chronic disease management, we are starting to see the effects of the coronavirus on these medical groups. 

Michael Villadelgado, MD, of Orange County Children's Medical Group, said that the pandemic has impacted his practice in many areas--some impacts have been positive, and some negative.

Increased use of technology and telemedicine visits

“On the positive side, we are shifting our practice to have our electronic health records hosted in the cloud. This will allow us to efficiently implement the safety measures that were put in place due to COVID-19,” Villadelgado said. “Furthermore, we have adapted telehealth within the scope of our practice to allow continued communication with our patients in order to provide ongoing medical care at a distance, especially for those afraid to come into our office.”  

Like many other clinicians in pediatrics and family medicine, Villadelgado anticipates that communicating via telemedicine is not going away, even when the pandemic ends. 

In fact, beginning in March, the Centers for Medicare & Medicaid Services (CMS) announced that they will temporarily pay clinicians to provide expanded telehealth services for Medicare beneficiaries residing across the entire country. Telehealth payments used to be reserved for remote areas with specific audio or visual requirements; now that those stipulations are removed, providers can provide telehealth to a wider patient base and receive the appropriate payments. 

In addition to telehealth, OC Children’s Medical Group is also offering a remote check-in process that virtually eliminates the need for a waiting room. 

“Furthermore, once fully transitioned to the cloud, our EHR will allow us to continue curbside check-in, where we have patients check-in via an app on the cellphone, while sitting in the car, and us responding to come into our office, once we are ready to room the child,” Villadelgado explained. “This prevents families from sitting in our waiting room, helps minimize contact with other people, and keeps social distancing.”

More PPE, safety and cleanliness measures

From temperature screenings at the front door to sanitation stations in every room, and the requirement to wear face masks, patients will note that going to the doctor’s office looks a bit different these days. 

“Other safety measures we have adopted to prevent the spread of infections, and COVID-19 in particular, include wiping down exam rooms between patients with the use of sterilizing wipes and/or sprays; running HEPA filters in the office throughout the day; use of PPE by staff; more frequent sanitizing of common areas; required use of masks for any visitors to our office over the age of 4 years old; not allowing more than one chaperone/parent with the child in the exam room, excluding siblings who are not being seen, in the office and exam rooms,” explained Villadelgado.

His medical group has also converted one office location into a "well only” office, while having another location see "well" patients seen in the morning and "sick" patients in the afternoon. They have also removed all toys, books and magazines from waiting and exam rooms.

The American Association of Family Physicians (AAFP) is providing a variety of COVID-19 resources and information to support practices and their patients with the latest updates on coronavirus. They have created a Checklist to Support Reopening and Promote Safety that includes guidelines and best practices. The checklist covers social distancing, PPE, screenings, triaging, telehealth and other protocols that physicians and their staff can implement to ensure the highest levels of safety, cleanliness and quality medical care. 

But getting some of these supplies can still be difficult, even with recent improvements to supply chains around the world. 

“Similar to many stories heard, we also have had difficulty getting many supplies that we need, such as disinfecting sprays, N-95 masks and gowns, along with COVID-19 testing kits. While the situation has improved considerably, many supplies still are not readily available like before the pandemic,” Villadelgado said. 

Decreased patient volume

Both pediatrics and family medicine practices have been impacted by the coronavirus pandemic due to a variety of factors, including the stay-at-home orders, fears of contracting the virus and other mandates. Elderly patients and other age groups who have underlying medical conditions that make them prone to complications from the virus have been especially scarce.

“On the downside, we have seen a reduction in the number of patients seen at our office, mainly due to parental fear of ‘catching’ COVID-19 while visiting us,” Villadelgado said. “While improving since the beginning of the pandemic, we are still not at our previous volume before this all started.”

This decrease in patient volume can have a major impact on small and large practices. There is some relief for practices truly struggling, thanks to the Coronavirus Aid, Relief and Economic Security (CARES) Act.

According to the AAFP, The CARES Act includes several provisions that are important for family medicine:

  • Financial relief for small businesses, including private family practices
  • Addressing supply shortages
  • Coverage for COVID-19 testing and medical services and provisions for Medicare and Medicaid
  • Health care workforce support, including primary care extensions
  • Telehealth benefits for a variety of health care services beyond COVID-19 support

  • Villadelgado said that initially patients had an apprehension about coming into the office, but those fears have seemed to wane recently.

    “Once patients/parents know what we are doing to mitigate their risk, many feel more comfortable scheduling appointments,” he said. 

    Related:
    ‘Is it safe?’ How to Put Patients at Ease Post-COVID-19

    Practice Reopening Guidance
    – AAFP

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