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What Are New Patient Realities During COVID-19?

By Debra Wood, RN, contributor

Health systems and physician practices have noted a significant decline in patient volume as the COVID-19 pandemic altered their practices and changed life throughout wide swarths of the country. 

How will practices attract new patients, many fearful of in-person care, and how will those visits seem different than in the past?

“A return to regular operations does not happen overnight,” said John Haupert, CEO, Grady Health System in Atlanta, during an American Hospital Association (AHA) press conference.

AHA reports health systems have experienced a dramatic decline in revenue, said Ken Kaufman, managing director and chair of the research firm Kaufman, Hall & Associates in Chicago, during a press conference. He also estimates people will return to in-person care at 90 percent to 95 percent of prior volume—but that still will leave some health systems millions of dollars short, “with no clear way how they can make up that gap.”

Understanding the issues

How significant is the problem? The Commonwealth Fund reported in April 2020 a nearly 60 percent decline in ambulatory care practices, and in May 2020, in-person visits were off about 30 percent. These are the new COVID patient realities. 

A study in July 2020 by the Larry A. Green Center, in collaboration with the Primary Care Collaborative and 3rd Conversation, determined 61 percent of primary care practices have experienced a decline in in-person visits, reporting a drop of 30 percent to 50 percent. It also learned that 56 percent of clinicians say patients have experienced exacerbations of health conditions related to limited access. 

A paper in Health Affairs, published early for the September 2020 issue, estimated that the nation’s primary care practices will lose $15 billion due to COVID-19, or more than $65,000 on average for each full-time physician.

“Primary care is holding on by a thread as our country faces a surge in COVID-19 cases,” said Christine Bechtel, patient advocate and co-founder of 3rd Conversation, in a statement. “Anyone – whether a policy maker, an insurer or patient – should be totally alarmed.”

The primary care study also found more than 35 percent of primary care clinicians say they are not ready to address the needs of COVID-19 patients during this summer surge, with nearly half of practices lacking sufficient personal protective (PPE), and 25 percent reporting local labs struggling to keep up with COVID-19 testing. 

However, there may be regional differences. 

David Miller, founding partner of HSG, a health care consulting firm in Louisville, Kentucky, said that his personal physician was back to normal operations.

But in a hot spot, like Florida, people are still fearful of seeking medical care and are being advised by their physicians to avoid their offices unless an in-person visit is essential.

Educating patients

Without access to physicians and other providers, many patients’ health is likely to continue to decline. But how can practices safely bring in new patients, or have patients return, with COVID-19 raging uncontrolled in some areas of the country?

“Health systems need to be communicating to the public at large that the environment is safe for care,” Miller said. “I see some health systems doing this and some ignoring it.”

For instance, in Orlando, Florida, AdventHealth runs advertisements on television, demonstrating how it is ready to care for patients in person, while Orlando Health has taken a more targeted approach, sending messages to established patients. 

“Physician practices need to communicate with their patients about precautions individual practices have in place,” Miller continued. “Some practices are putting stuff on their website and assuming that is adequate.”

However, he said, patients may need a more personal approach, with staff explaining to patients the steps that are being taken to keep them safe.

Additionally, Miller suggested, “If the provider can get the patient scheduled for a virtual visit, then [he or she] can coach patients through the need to meet face to face.”

Mitigating risks

What are the new patient realities? The COVID-19 patient realities include dealing with ways practices have changed to make in-person visits safer. 

A number of organizations have created checklists designed to help safely reopen practices, including The Doctors Company, a medical liability provider in Napa, California, the American Medical Association and the American Academy of Family Physicians

Their recommendations include:

  • Following Centers for Disease Control and Prevention guidelines
  • Physically distancing
  • Screening patients for COVID-19 symptoms
  • Closing waiting rooms and other common areas
  • Practicing good hand hygiene
  • Sanitizing exam rooms
  • Limiting non-patient visitors, and
  • Screening staff members daily before work

  • Miller recommended leaving extra time in the schedule to allow for additional cleaning of rooms. 

    A commentary article in a May 2020 issue of The New England Journal of Medicine suggested physically distancing patients with respiratory symptoms from those without. 

    Miller does not find this practical for many practices, because most have not been built to have separate waiting rooms. Many practices are having patients waiting in their cars until the doctor is ready to see the person. 

    But Miller is convinced patients will come back as needs for medical care increase.

    “Patients are getting sick and needing doctors,” Miller said. 

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