Originally live-streamed on Thursday, March 19, Dr. Philip Eskew took some time away from treating patients to answer some of your questions about how to flatten the curve of COVID-19 infection in our communities.
Watch for Yourself
Before the question and answer portion of the webinar, Dr. Eskew cautioned all DPC physicians and staff to “take very seriously” the threat of the coronavirus, even if they are not experiencing pandemic-level numbers in their communities. He advised: “Social distancing is important no matter where you are because we’re all connected.”
Q: What can DPC practices do with regard to testing given the lack of resources across the nation?
A: Right now, companies are trying desperately to produce home testing kits. Ideally, such companies would be able to mail out kits and, combining these results with DPC care, we could get a much better hold on this situation. Unfortunately, testing kits aren’t available yet, so all DPC practices can do is practice caution and try to rule out COVID-19 by testing for other maladies.
Q: What kind of information about the virus should DPC practices be sending out to patients?
A: The more information the better. People fear what they don’t understand. Get educated by reading the latest news and studies on COVID-19 and incorporate this information into your practice’s messaging. Provide airborne precautions, hand-washing directions, screening information, details about symptoms, risk factors... Learn as much as you possibly can, and pass it on.
Q: Should practices keep their doors open to see “healthy patients”?
A: Since every DPC practice is unique, it’s tough to give an answer that works for everyone. Many clinics are suspending “in-person” visits in favor of all-virtual care in order to protect doctors, teams, and their patients. If your DPC clinic needs to stay open, only do so in a way that makes sense to you. In other words, if you can isolate people to a certain area if they have symptoms, then seeing patients in-person may still be feasible.
Or, if you operate a smaller clinic, you could lock your door and allow patients with appointments in at will. This helps you avoid waiting room contamination if an infected patient shows up for a walk-in visit. The bottom line: If you’re going to stay open, be careful how you bring people into the facility and manage your operations with the utmost precaution.
Q: Can you comment on the new Telemedicine law and how it affects non-hybrid DPC practices?
A: Due to the new HIPAA rule waiver, you can use Spruce or Hint to provide free Telemedicine appointments online. If you have a hybrid or traditional practice, Medicare has now confirmed that they will pay for visits just like they would a regular in-office visit, which we know wasn’t previously the case. Essentially, Medicare promptly removed the stipulations that surrounded Telemedicine visits before COVID-19, so you are able to provide these Telemedicine visits for more patients.
Q: Are DPC practices able to treat Medicare patients if they have not “opted out”?
A: If you’re not opted out and you want to take advantage of offering Telemedicine services to even more patients, Medicare will allow you to waive the copay and take Medicare payment for those calls. Depending on where you practice and where you’re licensed, you may also be granted permission to practice in other states for the time being.
Q: Aside from HIPAA documentation, is there any other legal documentation that a DPC practice should collect?
A: At a time like this, it’s wise to have some sort of member agreement in place for all new patients, even though this may be overlooked during a pandemic. Ideally, you could have some sort of click-through agreement in place to briefly describe what you’re doing to treat the patient and what efforts you’re taking to be secure.
Q: Should DPC practices expect medical malpractice carriers to have issues with physicians practicing outside of their state of licensure?
A: Medical malpractice carriers would only have a problem with physicians practicing medicine in a place where they’re not allowed to do so. However, in a time like this, when states are openly asking physicians to cross state lines, answering the call will not create a malpractice issue.
Q: What legal pitfalls would you advise us to be wary of in the midst of this crisis?
A: The biggest legal pitfall is a medical one: that you’d miss a case of the virus and tell someone that they’re clear, only to have them come back and hold you liable.
When it comes to legal pitfalls for employers, if somebody can work from home, they need to work from home. If COVID-19 gets passed around the office and it turns out that the infected staff could have been home, the company is liable. The safety of each person matters, so if remote work is possible, be sure to implement that as soon as possible.
Q: If doctors in ERs and hospitals get sick and can no longer work, what is the likelihood that DPC physicians will be recruited to help?
A: As the need for more medically trained professionals rises, DPC doctors could receive an “open invitation” to help in the FFS world, but each individual physician will have to decide if he or she feels comfortable working in that environment. It is definitely possible, though, that the medical workforce could be knocked out due to frequent exposure to the virus.
Q: Would it be possible for a person with probable COVID-19 to obtain their own test sample or to have a family member or close contact obtain the sample?
A: It’s a good idea, but it would be tough to implement. Right now, it might be difficult to trust someone without a medical background to perform a test and get accurate results, despite their willingness to do so. However, if the option is to do nothing or to expose even more people to the virus in order to test, it’s “better than nothing.” However, if this ends up being a viable option, you would need to make sure that the family member administering the test understands the risks. They should conduct the test in an open air setting, and stand as far back as possible as patients tend to sneeze when being tested.
If the test is positive, the family member should keep those who are infected in the same room and give them frequent access to fresh air.
Q: Do you think patients will be able to conduct a proper nasopharyngeal swab on themselves without false negative results?
A: There is a high chance that a patient administering a self NP test would get incorrect results. The test is uncomfortable and invasive, and it’s hard to administer correctly even by trained professionals. Plus, the patient could get that false reassurance that they’re negative for COVID-19, when in fact they’re positive. This could lead to subsequent infection of others surrounding the patient.
Q: How can small independent DPC practices get PPE and testing materials?
A: If you don’t have the proper protective equipment for your staff, all the more reason to do 100% telemedicine for your patients. Over time, you may be able to access the PPE that you need, but unfortunately, there aren’t answers for that yet. It isn’t wise to expose staff to this without proper protective equipment because “if you knock yourself out, that’s one less troop in the army to battle this.”
Q: Do you think a negative COVID-19 test could give patients false reassurance? If the results of an initial test are negative, can the patient test positive later?
A: Here’s how to manage this with patients if they are eventually able to test themselves at home: everyone with symptoms needs to assume they’re positive for COVID-19, even if they haven’t had testing at all or if they’ve received a negative result. Stop shaking hands, stop hugging, cover your mouth, always be mindful of your symptoms, and isolate immediately. One negative result is brief reassurance. Ideally, COVID-19 tests would be $1 a piece and a patient could do a finger stick every morning to make sure he or she is still negative, but we don’t have those resources yet.
Q: How can DPC practices allow staff the time off that they may require without assuming risk or liability?
A: Employers need to be careful about liability when dealing with staff leave. For example, if you have staff that are looking to take time off and they have any kind of PTO available, you have to give it to them. Also, FMLA still applies, so your staff members could take 12 weeks of unpaid time off if needed. Lastly, If your staff member is symptomatic or tests positive for COVID-19, he or she can access temporary disability under ADA rules.
Q: Would a DPC practice be held liable for using a N95 from Lowe’s that hasn’t been fit-tested with staff?
A: This option is better than the alternative of no coverage, but you would have to convey the risks to staff up front and give them the option to work under these circumstances or stay home. Of course, you’ll want to mitigate as much risk as possible, but if any of your staff is not comfortable with that, let them stay home.
Q: How can we sanitize testing areas in a practice with limited space?
A: If a patient tests positive, leave and close off the testing area and wait for more than three hours. Then, put on protective equipment and sanitize the area.
Q: Is there any preliminary data about how COVID-19 will affect prisons? Are they prepared to properly quarantine?
A: This is a difficult subject. Iran, for example, released 40,000 inmates because the prisons couldn’t effectively quarantine them. You can lock a facility down, limit visitations, allow more phone calls, and cohort vulnerable patients in a place that is better ventilated or more secluded, but it’s still a difficult issue because the prisoners use all of the same common areas, thereby making it difficult to effectively separate them from one another.
Q: What about masks from China that are being sold on Amazon? What, if any, are the dangers of purchasing such masks?
A: There are all kinds of fraudulent masks out there. Amazon, EBay, and others are trying to police these issues, but they can’t prove quality. In fact, there is currently no way of certifying that the masks you purchase are safe. The only option you have is to make sure you know and trust the company from which you purchase your masks.
Have more questions about COVID-19?
Based on CDC recommendations and his own research, Dr. Eskew has created resources to help you and your staff deal with COVID-19 safely and effectively. Find these valuable resources by clicking here.