Medical practices rely on virtual visits as they lose patients and revenue

The Enterprise — Melissa Hale-Spencer

ALBANY COUNTY — Businesses across the region are experiencing heavy losses in revenue as the coronavirus continues to force people indoors and away from each other, and medical practices are no different.

“Unfortunately, like many other small businesses, we are suffering financially with this pandemic,” Family Nurse Practitioner Jill Martin, who founded Hilltown Healthcare last year, told The Enterprise in an email. “Prior to this, Hilltown Healthcare had been growing quickly and by March 1st, we welcomed nearly 750 patients to our practice.

“However, since mid-March our number of daily visits have decreased by 50-75%,” Martin said. “This sudden drop in our revenue resulted in furloughing our [part-time] nurse and cutting hours for the remaining staff by 25% …. Unfortunately, although we had been hitting our financial goals up until March, we simply did not have time to build up a financial cushion for such an economic disaster.”

Martin added that, because her practice is less than a year old, it does not qualify for many of the small-business disaster loans that are available.

“However,” she said, “we did apply for the payroll protection loan and are awaiting approval. Although we realize it will be a financial struggle for the next few months, our priority remains the same: to provide exceptional healthcare to the residents of the Hilltowns.”

Community Care Physicians’ Chief Operating Officer Joan Hayner told The Enterprise that the dire economic situation is not unique to any one region or specialty, and that the industry is impacted by the virus across the board.

CCP, which once ran a practice in Berne at the site where Martin now operates but withdrew last year, has also seen a decline in revenue due to the necessary cancellation of appointments that were deemed nonessential. 

“This has been a very challenging time for all businesses …” said Hayner. “The decline in revenue due to canceled or postponed visits will probably not be a timing issue,” meaning that it’s not simply a matter of waiting until the restrictions on social distancing lift, and that the money is likely gone for good. 

“We are bridging this time with telemedicine,” Hayner added, and said that telemedicine options are available at Community Care Physicians’ 63 practices across the region. 

Community Care Physicians has 360,000 attributed patients, Hayner said, and is able to accept more from any practices that may close, whether that be from a lack of economic sustainability or an inability to adapt to tech-centered remote care. Critical to that, she said, is an easing of telemedicine restrictions since the pandemic hit the country.

On March 30, the Centers for Medicare & Medicaid Services issued regulations to implement telehealth provisions in the Coronavirus Aid, Relief, and Economic Security (CARES) Act that expanded patients’ access to telehealth services. Vulnerable populations, including terminally ill patients, can seek care from their homes while allowing quarantined doctors to safely deliver care.

CMS will now pay for more than 80 additional Medicare services — ranging from emergency-room visits to home visits — when furnished through telehealth. Providers can evaluate Medicare beneficiaries, who have old-style telephones rather than cell phones.

Licensed clinical social worker services, clinical psychologist services, physical therapy services, occupational therapist services, and speech language pathology services can receive payment for Medicare telehealth services.

And licensed practitioners, such as nurse practitioners and physician assistants, are allowed to order Medicaid home health services during the public-health emergency for the COVID-19 pandemic.  

“Prior to the COVID crisis, new-patient visits were not allowed via telehealth,” Hayner said. Now, new patients will be able to meet their doctors and nurses for the first time through their computers or smartphones.

Further impacting the organization’s bottom line is the operation of drive-through testing for the coronavirus, a hit that Hayner said Community Care Physicians was happy to take for the wellbeing of its employees and the community at large. 

The drive-through testing provided by Community Care Physicians has been up and running for about two weeks, and Hayner says that its testing site in Latham is issuing approximately 140 tests per day and can go higher. 

“We don’t get reimbursed for that testing,” Hayner said, adding that there “needed to be a place for our patients and healthcare workers to get tests” given the general lack of testing available in the region. 

On Monday, April 6, the state opened a drive-through facility at the University at Albany campus, serving the Capital Region.

On the other hand, Myria Emeny, M.D., told The Enterprise that her Westerlo micropractice is seeing roughly the same number of patients now that she did before the virus, but did not want to disclose specifics. 

“Some of my colleagues have told me that they’ve seen a decline in patients,” she said, “but I’m not in that situation yet.”

Loss of patients and therefore revenue is happening in spite of extraordinary measures taken by practices to make themselves available to patients while ensuring everyone’s safety inside the offices.

“[Hilltown Healthcare has] implemented Telemedicine options, so patients who are concerned with exposure or having symptoms can call and receive both advice and treatment,” said Martin.

Martin added that remote treatment is also available for mental-health concerns.

“During increased times of stress and isolation, we have seen a jump in anxiety and depression,” she said. “We encourage those who are suffering to reach out either by scheduling a well-visit or telephone visit for counseling and/or medication management.” 

In the office, Martin said that her staff is disinfecting all rooms between patients, designating “well rooms” and “sick rooms” to avoid exposure, scheduling routine visits during the day and “sick” visits after-hours, and using gloves and masks while interacting with patients.

Martin says that calls are being triaged, or prioritized based on need, to ensure that emergencies of any nature are addressed in a timely manner and by the proper authority. 

Emeny told The Enterprise that she is taking many of the same precautions in her office. Her patients are answering screening questions, she said, and any patient displaying symptoms of any kind is admitted into the office through a seperate door, and the sick and healthy patients are kept completely separate.

“We’re doing a lot of telemedicine,” Emeny added.

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