“We immediately pulled a list of patients 60
and older [and] patients who had diabetes,
CHF, Asthma, and other co-morbid conditions
and began calling to reassure them and get a
head start on medication refills and preventative
care.
“We’ve been doing telemedicine for about
two years, but it was mostly Dr. Walker. When
this happened, we immediately adjusted his
schedule to include more telemedicine and
we carved out a couple of hours a day where
our nurse practitioners are doing nothing but
home visits and telemedicine. It’s been extremely
successful. Patients are appreciative
and excited that they don’t have to come into
the office. They can do a lot of things online.
We went from five to 10 telemedicine visits per
month to 25 a day.”
The clinic has continued to see patients as
well, after first screening them first by phone.
If patients need to come in who have COVID-19
signs or symptoms, they go into a separate,
dedicated area of the clinic.
Angie expects the clinic to emerge with
some improvements in place. “For instance,
the swap to telehealth has been a help to Dr.
Walker,” she said. “We’ve been doing half-day
of in-person visits and half-day of telemedicine,
and on Wednesdays, it’s all telemedicine.
I think that alone took some stress off him. We
added one more nurse practitioner a few weeks
ago, which reduced his burden even more.
Also, he was used to rounding in nursing homes
every Thursday, but since they went into lockdown,
we’ve gone to iPads and Facetime, so we
are seeing those patients from a distance.”
To help patients through this process, the
clinic has been all about “meeting patients
where they are,” stressed Dr. Walker. “Patient
outreach now is key because they’re scared to
come in, they’re scared to go to the ER, they’re
scared to call the ambulance, so the more that
you can explain to them up front the better,”
he said. “Like, with us having a split area in
the clinic, patients can absolutely come into
the clinic. We also set up a tent area up front
so that patients can have scheduled labs. We
don’t want to miss out on the work they’ve
been doing on A1Cs and cholesterols. They can
pull up and call us, and we can send out a nurse
to draw their labs. We’re also doing home visits
for patients who maybe would not meet the
criteria for being homebound, but it’s where
they’re comfortable.
“We purchased a couple of iPads so that
if we have patients who simply can’t navigate
our system, we’ll send a nurse out with an iPad.
She’s there with the patient in the home, doing
what I need done and relaying that back to me,
or sometimes just teaching patients how to use
their own technology to access our system. I was
surprised at the amount of people that we have
over 65 that have been able to navigate this and
love it. They’re used to Facetime chat with their
grandkids and such, and this is one more related
thing. It was funny, the other day I had a patient
who joked, ‘this is the closest I’ve ever been to
Dr. Walker. He was one inch from my screen.’ ”
That’s not to say that the clinic hasn’t taken
a loss or suffered some burnout. They have
seen reimbursement decreases and an overall
revenue decrease, according to Angie, “We
are not willing to furlough staff, though we did
have to bring some outsourcing in-house to
make up the difference.”
To guard against burnout, the clinic enacted
small supports for the staff. “On the first of
March, we started catering all food in so that
our staff doesn’t have a financial burden to go
out for lunch, but they also don’t have to be out
in public in scrubs. It allows them to go into the
kitchen or out back and just take a breather,”
said Angie. “We’ve sent some staff members
home with pay just because there was a day
there when it was clear that some were worn
out. You’ve got employees that are giving
150%, and they’re just wearing out. You send
them home for a day with pay and sometimes
that’s all it takes.”
AMS Steps Up to Support Physicians
As COVID-19 began to take hold in Arkansas,
the Arkansas Medical Society began working
to enable the state’s physicians and
other health care workers to continue
safely caring for patients. From developing
a COVID-19 update on an almost
daily basis to protecting past telemedicine
legislative efforts, the AMS
staff has worked in many
areas to provide for the
needs of members and
non-members alike.
AMS efforts
as a liaison to Arkansas
Governor
Asa Hutchinson
kept past telemedicine
safeguards in place even as restrictions were
relaxed on requirements for establishing professional
relationships. And as telephone-only
visits were opened with certain restrictions for
the good of the patients, AMS was instrumental
in ensuring reimbursement for those visits from
insurance carriers. “If we’re opening the door
to telephone-only visits, then we have a problem
because our telemedicine statute does not
require insurance carriers to pay for audio-only
telephone,” explained AMS Executive Vice President
David Wroten. “So, we reached out to the
state’s carriers, and within 10 days, all of them
agreed to pay for telephone-only visits at the
same rate as in-person visits. We did this so that
– particularly during the early days of this pandemic
– established patients wouldn’t have to
come to the office … the governor’s office was
encouraging people to stay home. This was an
important thing to the clinics. It was like you
turned on a light switch and patients stopped
going to their doctor and began putting off care
that they needed. This helped patients and it
helped physicians to keep their doors open.”
Perhaps the biggest thing that AMS has been
involved in during the pandemic has been filling
a need for personal protective equipment. Between
March and May, the Society distributed
over 600,000 pieces of PPE to clinics around the
state who could not order it themselves because
it wasn’t available. (For photos and videos of the
PPE road show, visit the AMS Facebook page - @
arkmedsoc.)
“I can’t begin to describe how proud I am
of our medical society staff for the hard work
and dedication they’ve exhibited during these
past couple of month,” said Wroten. “That said,
the ones we really must be bragging on are the
health care workers of our state. The Arkansas
Medical Society is so grateful to those
working the front lines. Listen to hearts.
They’re risking their health to preserve
ours. To everyone who works in our
state’s clinics and hospitals, thank you
doesn’t say enough. Then again, it says
everything.’”
For more on The Society’s response
to COVID-19 for the benefit
of members and non-member
health care professionals
around the state, see David
Wroten’s commentary, page 4.
Randy Walker, MD
14 • The Journal of the Arkansas Medical Society www.ArkMed.org