The COVID-19 pandemic has tragically taken the lives of more than 100,000 Americans, and with the crisis progressing into its next phase with care delivery systems reopening, healthcare leaders across the country now have the additional concern of the potential long-term health implications of patients who have put off their general medical appointments and procedures.
For instance, could there be future health crisis as a result of missed routine cancer screenings or delayed testing for chronic conditions such as diabetes and high blood pressure? One healthcare leader, Scott Hayworth, M.D., president and CEO of New York-based CareMount Medical, worries that over the next couple of years the country could see a spike in preventable disease and death because of missed or delayed screening for skin cancer, gynecological issues, and other health conditions. To reduce the public health risks, CareMount Medical, the largest independent multispecialty medical group in New York State, has initiated a communication outreach program to encourage patients and the community to remain in contact with their doctors and discuss ongoing care options.
A frontline physician and medical group leader in one of the country’s earliest COVID-19 hot spots, Hayworth recently discussed with Managing Editor Rajiv Leventhal these longer-term patient care concerns, how CareMount has handled the crisis, the future outlook for medical practices, and more. Below are excerpts of that interview.
As the pandemic began and progressed, how did you handle the issue of patients not wanting to or not being able to come into the office for care and treatment? What were your core strategies here?
Here in New York, we were obviously right in the middle of the pandemic. It all started with communication, which was very important for both our providers and patients. We did an excellent job of communicating to the patient the importance of not losing sight of other issues, such as high blood pressure or diabetes. Some [services] were restricted, such as cancer screenings. We could do urgent electives—meaning if there was a clinical problem—but we couldn’t do screenings. For a lot of [conditions], we did virtual exams as well as in-person ones, and the important thing was that we didn’t want to save everyone from COVID-19 and then God forbid lose people to out-of-control diabetes and hypertension.
So it all starts with great communication—if you aren’t communicating to the patient you can’t encourage them and have them feel safe. We did name a chief safety officer whose job was specifically to make sure patients felt safe in the office, and that we had up-to-date protocols in place. We [enacted] [procedures] such as patients waiting in their cars; and they still can. We made sure we had enough PPE for our employees, as well as masks for patients. Essentially, we did whatever it took to make sure it was safe environment, while communicating that [message] to our patients.
From a physician’s perspective, could you further describe the health impact that missed or delayed screenings could have in both the near- and long-term?
That impact could be huge. We have a backlog of patients who need colonoscopy screenings. You have to [consider] that whenever someone has a colonoscopy, they find polyps [that could lead to] early Cancer. Well, if you delay that by four or five months because the patient has put it off, or now is unemployed and doesn’t have insurance, it’s a real health crisis. Polyps can be detected in colonoscopies before they turn into a cancer. So now maybe someone has gone from a polyp, which could have been removed, but has [grown] into an invasive colon cancer. That’s just one example. We will find that in three to six months down the road and into next year, we will see a bump of [problems] that were neglected, and that minor issues have turned into major ones.
What have you done in the realm of telehealth?
We already had a platform ahead of the pandemic, so we were fortunate, but we were doing very few visits—just a few post-operative visits and some urgent care. We quickly employed a team, and got up to 1,500 telehealth visits per day. Before COVID we were doing about 6,000 visits per day total—[encompassing] in-person and virtual, but just 25 of those were telehealth. We moved to 1,500 virtual visits [alone] at the peak of COVID. At our lowest numbers [during COVID], we were doing 1,500 to 2,000 sick visits per day as well, so our visit volume was at about 40 to 50 percent [of what it was pre-COVID]. Ramping up to those 1,500 visits per day, we took a project that in a normal environment would have taken three to six months to roll out, and did it in two weeks. We had a help line for patients who needed assistance in downloading the app, and we had to train the physicians and staff [on the telehealth platform]. Today, we’re at about 90 percent of our pre-COVID visit volume.
If you could go back in time, what advice would you give medical practice leaders to ensure that patients received the preventative care and screening they needed?
Patients need to feel safe that they can come to the office and be taken care of. Also, you need to load up on PPE. Fortunately for us, we had [employees] who were smart enough to put away PPE a few years ago in case something like this happened. That made a big difference; a lot of medical practices had to close down because they lacked the necessary PPE. We have also spent a lot of money on PPE during the pandemic, to the point where it was costing us $125,000 a week to just provide [the equipment] for physicians and staff. But it was necessary to keep people healthy. We have 650 providers; we’re the largest independent medical group in the New York State, and we take care 665,000 patients. So we feel a large obligation to take care of the community.
There are also staffing issues to [work through], such as understanding where you need your staff, how to deploy your staff, how to move them around to where they’re needed, and giving people new roles they didn’t previously have. Doctors need to be flexible; we have them in different offices working with different staff from what they were used to. They really stepped up to the plate; they rolled with the punches and did whatever [necessary] to take care of patients.
There’s been lots of concern around the financial viability of some medical practices, especially those not connected with a larger system. What have you been hearing on this front?
It’s a real concern. The government unfortunately thinks that if you take care of hospitals, you’re taking care of doctors and nurses. But you are taking care of those in the hospital, not in the offices. Most care in the U.S. is delivered by outpatient offices and facilities. The federal programs didn’t come close to making up for the lack of money that outpatient offices need to stay open. Our physicians took a large salary reduction, as did many across the country. We were fortunate we were still able to pay people at a reduced level. Some practices couldn’t pay physicians at all. We have to make sure that when we come out of this, the providers will still be in practice. It’s up to Congress to make sure the funds are there to support the outpatient facilities.
We received our first [relief] check from the government and are apparently in line for the second one. But it’s a fraction [of what we need]. You are basically getting about 10 percent of the money you lost, meaning 90 percent of the money will be made up for off the backs of the physicians. That’s really substantial.
