Practicing in a COVID-19 World: Lessons Learned

We have heard day in and day out about the impact COVID-19 has had on the day-to-day operations of primary care clinics and patient care. We wanted to get answers right from the horse’s mouth so to speak, and hear how family physicians have adapted their practices throughout the pandemic. To that end we recently brought together three primary care doctors – Dr. David Price, Dr. Sofia Nastis, and Dr. Andrew Vellathottam –  for a panel discussion to share their learnings and experiences. We captured some highlights here.

Expanding the role of technology in virtual vs. in-clinic visits during COVID-19.

According to Dr. Price, when the pandemic hit in March, in-person primary care visits dropped significantly, going from 800,000 visits per week to only 30% of visits in person. There was certainly a rapid increase in virtual care. By the end of September, visits were split about 50% virtual and 50% in person. 

For Dr. Vellathottam, his early adoption of OTN meant his practice had the infrastructure set up to manage the rapid transition of in-patient to telephone visits and embracing more technology has helped him to smooth out the transition. He commented “We’re just trying to sort out and trying to educate our patients on how to use secure messaging. And the other aspect we brought in was the online appointment booking and getting those patients who are capable of doing that to start using it, to flip to that so that the burden on our staff isn’t as high.”

Dr. Nastis took advantage of the Primary Care Expansion Program, a pilot for virtual care as well as made a concerted effort to educate her patients that she was accessible not only over the phone but also through virtual care booking services. She stressed the importance of being open-minded about the population who will embrace the technology. While it’s true that in her practice the platform has largely been adopted by a younger demographic, she also shared that a surprising number of her senior patients were using the virtual care platform. 

Challenges of the upcoming URI season.

Dr. Nastis pointed out that many physicians are worried about how to manage and triage common infectious presentations, who comes in the office, and when to bring them in (sooner rather than later). As Dr. Vellathottam pointed out, physicians have to gauge the patient and weigh the risk-benefits of an in-clinic visit and spend some time educating the patient on prescriptions, and when to seek care. Dr. Nastis shared the resource The Cold Standard: Choosing Wisely as a helpful handout to help with diagnostic dilemmas of worrying about bringing these patients in now versus waiting versus letting them ride things out at home. Dr. Price emphasized the importance of having provincial information communicated out. While there’s virtually no influenza in Ontario and/or Canada, there is certainly a lot of rhinovirus out there and significant challenges with that. 

Preventative care is more important than ever.

Many primary care physicians are now trying to deal with the challenge of clearing a backlog of preventative care screenings and vaccinations that has increased as a result of the pandemic. Dr. Nastis and her partner are focused on prioritizing getting patients in who are overdue for anything such as PAPs and mammograms and ensuring patients know the office is open and the importance of staying current.  Dr. Vellathottam stressed the importance of immunization and being proactive in identifying patients who need to get vaccinations up-to-date and especially encouraging parents that the office is safe so that childhood immunizations are kept up to date. 

Shifting the business to adapt to virtual and maximize revenue. 

One of the big changes for doctors in the pandemic, with a switch over to more virtual visits, is maximizing revenue and understanding the billing code structure. When it comes to the PEM models and FHOs in particular, the out-of-basket codes have been probably seen the biggest hit from a financial perspective, and especially so with diabetes management. Using the KO81 equivalent as a KO30 enables the ability to get the Q code bonus. Dr. Vellathottam stressed the importance of having OTN set up to start to access some of the virtual out-of-basket codes. He also pointed to a re-thinking of his physical space. With staggered in-person visits, doctors working virtually, there may be an opportunity to reduce space and potentially reduce expenses. With there being no question that things are going to evolve over the next couple of years to be supporting virtual care, Dr. Price pointed to a virtual care working group that the Ministry and the OMA have put together to look at how to bill and how to be able to organize things a little bit differently. 

Self-care is equally important as patient care during COVID-19.

Dr. Price shared his experience hearing from a lot of colleagues across the province is that a bit of the joy of family medicine has left because there hasn’t been the same patient interaction or physician-to-physician interaction. Dr. Nastis encourages physicians to keep up-to-date and see what other colleagues are doing and has joined the COVID-19 community of practice through the OCFP to get information to apply to her practice. 

Additional Resources:

The Cold Standard Toolkit 

COVID-19 Community of Practice Webinars

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