COVID 19: Moving forward in the community
April 24, 2020
Dear Community Pediatric Providers,
As we finish out the month of May, I thought it would be helpful to touch base. I hope that you and your families well.
First, I wanted to express my gratitude for the care you are providing to the children and families in our community. Being a primary care provider in this environment has not been easy to say the least. I have been able to witness your dedication in so many ways in my role over the last month – the stories of quickly adapting to provide safe, necessary care for patients; the willingness to share information; the thoughtful questions submitted to Grand Rounds; and the number of people calling in bright and early at 7 am on Mondays for the Global Cast call.
I also wanted to update you on plans moving forward. Our partnership with the CCHMC COVID-19 team faculty, Jeff Anderson, and Physician Outreach has been incredibly helpful. It has been a time of tremendous collaboration. The weekly calls, daily emails, and the external website page will continue to provide channels for sharing information as we begin to focus on transitioning to the next phase. Please continue to send questions and comments to help guide the information that will be shared. As noted in the daily email Friday, COVID-19 testing for pediatric patients will begin to be available next week. Please watch the emails for details. The ambulatory divisions of CCHMC are working on expanding in person availability carefully and we will share those plans as they are finalized. If you have a patient you are concerned about, please do not hesitate to use Priority Link. Finally, the surgery division will be beginning to schedule elective surgeries again soon.
On the primary care side, we recently held a virtual meeting with providers from the Community Practice Advisory Council and CCHMC General Pediatrics to discuss plans in primary care moving forward. The following is a synopsis of that discussion:
Infection Control – The consensus was that May will look like April in terms of infection control. Practices plan to continue separating sick and well appointments by time/location, universal masking, social distancing for appointments, cleaning protocols, screening employees and patients for illness symptoms, continuing telehealth, and working from home for some staff as able. Practices shared creative ways of socially distancing in person visits, such as completing registration and even the history portion of the visit while the patient waited in the car.
Well Visits – Practices are hopeful that they can gradually increase well visits. Most practices in the group continued to at least see well visits where immunizations were needed in the last month. Some kept appointments for well visits as scheduled. However, cancellation and no-show rates for WCC have been high for some practices. It was noted that national and Ohio AAP are providing messaging to encourage well visits for children.
The particular importance of well care for those needing vaccines was also discussed. The same evening of the meeting, data was shared in the Pediatric Management Institute webinar from a NYT article about declining vaccination rates during the pandemic. You can read the full NYT article here: https://www.nytimes.com/2020/04/23/health/coronavirus-measles-vaccines.html . The bottom line is that what we do matters and on-time well care for children is important for our entire community. If your practice is able, May might be a good time to use EHR reports to pull lists of patients due for vaccines at any age and prioritize them for active recalls as you expand well visits.
It was also acknowledged that each practice has unique factors to consider if expanding in person care including PPE supplies and the infection control processes that need to occur. The start of our checkup season will not look like it has in the past!
Telehealth - Most practices are continuing to use telehealth but noted that more in person ill and chronic care visits may need to be offered in May, especially for those whose care has been postponed or those with longer term or recurrent issues. It was noted that reimbursement may change over time and this will need to be monitored.
Insurance changes - Insurance coverage changes for existing patients may need to be discussed at each practice as some families may transition from commercial insurance to Medicaid. VFC vaccine supply may need to be reviewed.
Universal Masking - Several practices are asking patients and families to wear their own masks in to the office due to limited supplies in the office. The option of homemade masks for patients and families if needed in ambulatory clinics (not hospitals) was also mentioned in the KY governor’s address as part of the broader plan to gradually re-open KY healthcare facilities.
I hope this information is helpful. If you have comments or suggestions, please do not hesitate to reach out. My email is shelly.voet@cchmc.org.
Shelly F. Voet MD
Pediatric Associates PSC
Cincinnati Children’s Executive Community Physician Leader