tablishing 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. With
these safeguards in place, the use of telemedicine
greatly increased and has now become
a much larger component of the new norm in
many clinics.
“Telemedicine has been a great tool for us
this year,” commented Hunnicutt. “We were
fortunate to have been implementing telemedicine
in January before COVID hit our region,
so it put us in a good place to add scale rather
than starting a program from scratch. Aside
from a few technical glitches here and there,
patients, physicians and staff have embraced
this alternative to traditional care.”
M. Bruce Johnson,
MD, one of 12
physicians at GastroArkansas,
reflected
on his experience
with increased telemedicine.
“Telemedicine
has been
a positive. I see a
m. BRUCE JOHNSON, md continuing role for
this going forward
provided we don’t go back to all the onerous
pre-COVID regulations and provided it is adequately
reimbursed.”
Petet discussed further GastroArkansas’s
telemedicine experiences. “With all that’s happened,
we in health care have been able to educate
ourselves and implement a system across
all specialties within a week to two weeks that,
I think, otherwise could have taken us years,”
she said. “There’s so much focus on the negative,
but as part of the medical community, it’s
been good to see so many people come together
to quickly flip the switch on something that
we all had interest in using. The Medical Society
and the insurance payors have been great.
They removed barriers, and we were able to
find a portal and get access quickly.
“Sometimes, nothing can take the place of
an in-person visit; that said, telemedicine has become
part of our practice. We’re much better at
it than we were at the end of March, and for the
most part, patients have warmed to the idea.”
COVID-19 Testing Challenges Evolve
As clinics proceed through a pandemic that
shows no signs of going away, concerns remain
over the availability and efficiency of testing.
Dr. Johnson explained, “Ideally, testing everyone
before an elective procedure is a good
idea, but making that happen is problematic. We
need more testing sites with guaranteed turnaround
times, which seems to be unlikely given
limitations of supply. If someone that lives more
than an hour away has to make a pre-op trip
for testing and then another trip for the procedure,
they may choose to delay the procedure.
Although some testing like screening colons or
endoscopy for lesser indications are not urgent or
emergent, they shouldn’t be delayed indefinitely
as there will be resultant delays in cancer and other
diagnoses.”
Debra Morrison,
MD, also of GastroArkansas,
added, “We
typically advise our
patients to take the
second dose of their
preparation five to six
hours prior to their
procedure. When an
Debra Morrison, md
individual must wait
several hours longer for a procedure than expected
due to delayed result of their coronavirus test,
it potentially reduces the efficacy of the preparation
and adenoma detection.”
Testing has been no easy task, even for clinics
with on-site testing capabilities. According to
MANA Chief Operating Officer Paula Maxwell, several
MANA Clinics, including Dr. McGowan’s clinic
in Springdale, have provided drive-up COVID-19
testing. “It has been challenging due to the increased
demand for testing and testing supply
shortages,” she explained. “MANA is aligned with
the Northwest Arkansas health care community,
who released a statement on new testing priorities
on July 1. We are reserving tests for symptomatic
individuals, health care workers who have
been exposed, and individuals who are preparing
for a procedure.”
Update: As of July 9, 2020, one burden related
to some elective testing has been lifted. “We
learned today via a call to the Arkansas Department
of Health that we no longer have to screen
asymptomatic patients for COVID-19,” said Petet.
“This will significantly reduce the burden to patients
scheduled for screening colonoscopy and
other preventative yet elective procedures.”
James Bledsoe, MD, FACS, is ADH’s chief physician
specialist and medical director of EMS and
Trauma. He leads ADH efforts related to resuming
elective surgeries. While he confirmed Petet’s
statement, he went on to clarify it. “There are no
requirements to test asymptomatic patients preoperatively
for colonoscopy,” he explained. “There
is, however, a five-day window of preoperative testing
for most other elective surgery, including upper
endoscopy. The full directive for elective surgery is
posted on the Department of Health website.”
Staying the Course Through
Challenging Times
As physicians and health care workers continue
facing and solving COVID-19 challenges for the
benefit of patients, staying positive has been a key
to coping personally and professionally. That and
being willing to adapt, according to Dr. McGowan.
While the physicians in his practice bring
with them many years of shared experience, Dr.
McGowan is relatively new to the profession. This
hasn’t deterred his positivity or drive to help even
amid his great concern over COVID-19. “When I
chose to become a family medicine doctor, I did
not expect a global pandemic to happen within
two years of completing residency, but that’s the
reality of medicine. We can work on preventative
measures, but we still have to be adaptable. My
biggest concern is for the health of my patients
and community. We have heard about this virus
for so long now, but it has become a heavy reality
for our community over the past month or so. My
hope is that we can continue to practice preventative
measures to quell the recent uptick. The reality
is our relatives, friends, and neighbors’ lives
depend on it.
“This pandemic has certainly been stressful,
but if we continue to put the patient first I believe
we can achieve positive outcomes. The selflessness,
hard work, adaptability, and compassion
that our staff has shown over the past three plus
months has been inspiring. Each week seems to
present new challenges and obstacles, but with
their help we have been able to continue to care
for our patients. For that, I am very grateful.”
* (See the July Journal, pg. 4, to read about
how AMS stepped up to procure and distribute PPE
to clinics around the state – members and nonmembers
alike.)
56 • The Journal of the Arkansas Medical Society www.ArkMed.org