Today's blog is a Guest Blog by Charlotte dentist Dr. Charles Payet. Since 1999, Dr. Payet has been the sole dentist & owner of Smiles by Payet Dentistry at the corner of Park Rd. & Abbey Place in Charlotte. He earned a dual B.A. in Biology & German at UNC Chapel Hill in 1994 and his DDS at the UNC Chapel Hill School of Dentistry in 1998. He and his wife, Fara (who runs the office most capably) met in Charlotte in 2005 and married here in 2006. They have 2 daughters, 2 dogs, and live in south Charlotte. You can follow Dr. Payet and his practice on Twitter and Facebook.
Dentist-ing in the Age of Covid-19
Let’s see…what day is today? Monday? Friday? Sat-wed-sun-day? Oh hell, it doesn’t matter, because without getting to work on patients, they all blend together. Not because of alcohol, but as a dentist, who doesn’t bear the responsibility for the business side of my practice, I don’t have a way to tell the difference. My wife handles all that stuff. Normally it’s a great division of labor, but not so much at the moment.
We closed our office just after lunchtime on Monday, March 16th. I’d followed the news from Italy closely over that weekend and could see what was coming to the US. It was a hard decision, because as a small business, neither our employees nor we get paid if we aren’t working. No patients = no revenue, so how would we pay the rent, our office and equipment loans, and accounts payable already incurred the previous month? What would our employees do? What could we do for them? There was (and even now still is) so much uncertainty surrounding the supplemental unemployment insurance for them, the loan possibilities for the office, etc. Would our mortgage lender let us defer payments? Online applications frequently crashed; my wife was on hold for hours trying to reach our lenders and vendors about deferments and extending/increasing lines of credit, only to be suddenly cut off.
We’re still waiting for the $10,000 EIDL loan to arrive to our account. The Paycheck Protection Program though? Well, we decided to wait on applying for that, as we didn’t want to be forced to hire our team back, if we still don’t know when we can open. As of Thursday, April 17th, that fund has been fully used up, and Congress is in recess, so no one knows what will happen next for small businesses like ours, which hadn’t yet applied for, or received, any money.
I’ve seen 5-6 patients in the last month, and it’s frustrating. I love dentistry and helping people, but I can’t do that now. Like many dentists, I’m moderately Type A and thrive on the pressure of a full schedule of patients. I’m a general dentist, but with more than 1,800 hours of advanced training since graduation, I provide a variety of advanced surgical and prosthetic services, along with fillings, check-ups, cleanings, etc. At the moment, because we are unable to source adequate PPE for our team, and because of the unknowns surrounding COVID-19 transmission, we’re limited to life-threatening emergencies and writing prescriptions.
Relatively speaking, we have no right to complain about our situation. Thanks to my wife’s financial savvy, our personal financial situation is solid, even if we stay shut down for 5-6 months. We live in a beautiful home in a beautiful neighborhood, we’re all healthy, we have plenty of ways to entertain ourselves. This includes our newly adopted American English Coonhound, Hershey, whose youthful energy keeps us moving. We are admittedly privileged. Because of that, we’ve doubled our charitable donations to both local and national non-profits, focusing on groups that support those most in need.
One of the most frustrating feelings right now though, is the feeling of being useless and unable to help our physician colleagues. We dentists often get irritated by people calling us “not a real doctor.” After all, we do have to study most of the same basic medical subjects for the first 2 years of dental school. It doesn’t diverge greatly from medical school until year 3, when we begin caring for patients and start our rotations. But in following so many physicians on Twitter, and having joined a few COVID-19 related FB groups, I’ve realized just how little we do know of medicine. The terminology, diagnostic criteria, etc. are all radically different, especially when colleagues talk to each other. We all have to use layman’s language when speaking with patients, but when physicians talk among themselves, it’s all Greek to me. And even though I wish I could go volunteer at a hospital, I realize how useless I’d be. There’s not much worse for any type of doctor than the feeling of being useless and helpless.
So I do what I (and my family) can do: we stay home so we don’t get sick and burden the doctors and nurses of Charlotte’s hospitals even more. I do try to help counter misinformation online, but I get so frustrated by the ignorance that I lose my cool. That doesn’t help anyone.
So we play games, read books, read too much on Twitter & Facebook, walk our dogs and exercise, and try to maintain a semblance of normal sleep.
At least the setting and rising of the sun makes it easy to tell when one day ends and another day begins. Even if I still don’t know what day it is.
As I work closely with many healthcare professionals, I am hearing all the latest and greatest (and usually false) rumors about Covid-19.
The latest one is of special importance to independent healthcare providers, many of whom are turning to telehealth sessions during shutdowns to help enforce social distancing. There is a rumor going around, especially on social media, that the government has essentially suspended all HIPAA privacy rules and is allowing all forms of communication for telehealth sessions. This is simply untrue. To read the full, official statement, please click here (link to HHS.gov article).
In a nutshell, it says this: yes, as of this past week, the government will be temporarily suspending enforcement and fines for some non-compliant platforms, but not all of them, including FB Live, Twitch, and other public platforms.
However, we are advising clients, prospects, and all providers we know to be careful about employing non-compliant platforms, even in light of the new, temporary waivers. We have four main reasons for issuing this advice:
1) Privacy rules are in place to protect patients, and our ethical duty to do that does not end just because we (temporarily) cannot be fined for failing to do so. Applications like Facebook Messenger, consumer-edition Skype, and FaceTime are not subject to BAAs and you (and by extension your patients) are therefore not protected in case of breach. Indeed, the HHS statement underscores your responsibility as a provider to protect your patients' privacy even in the temporary absence of enforcement. And you must be cautious of even HIPAA-compliant teleconferencing applications that are not telehealth-specific, as the security nightmare with Zoom has shown us.
2) From an operational point of view, consumer applications like FaceTime are not optimal, since they are not integrated into a practice's workflows and have no functionality to help with things like scheduling. A robust telehealth platform like EMRx's, by contrast, is simply another feature in an overall patient portal that allows you and your patients to manage the entire interaction, from setting the appointment to holding the secure, HIPAA-compliant telehealth session, to having the patients pay their co-pay/fees, to following up with messaging/labs/notes/prescribing (as applicable). Burnout among healthcare professionals was already high before this crisis; let's not make it even worse by forcing staff to jump through extra hoops by using applications that sit entirely outside their workflows.
However, we understand that in the middle of a crisis, practices that do not already have an EMR with telehealth may not have the time and resources to make that switch. That's why we also offer a standalone telehealth application that is true telemedicine, not simply a video chat tool. Our platform- and vendor-agnostic Blum Telehealth is the first Bluetooth-enabled telemedicine app, allowing physicians to monitor vital signs such as temperature and blood pressure, and even to look into patients' eyes and ears.
3) From a best-practice point of view, we do not recommend that practices get in the habit of using non-compliant platforms. Sooner or later (and quite likely sooner), HHS will rescind the enforcement waiver. So we recommend asking yourself this: were you aware of the HHS article above? Possibly. Also quite likely you were not, given how chaotic everything has been. So will you be equally unaware when the rescission of the waivers is published? HIPAA fines range anywhere from $100 to $50,000 per violation. That's a lot of long-term downside risk to save very little money in the short term.
4) We all need to start thinking about the "New Normal." Practices of almost every kind are under tremendous financial strain thanks to this crisis. And let's face it, with all the rules, regulations, bureaucracy, paperwork, bad technology, and the constant insurance company push-back on claims, it was already a challenge to be an independent provider to begin with. For example, on average, the insurance companies make practices resubmit one out of every three claims at least once, with an average re-work/re-submission cost of $25 a claim. We are projecting those rejection rates to climb in the months to come as insurance companies scramble to cut their losses from Covid-19 coverage. (That's a polite way of saying they are going to try and claw back as much as possible from you, the healthcare providers.) We broach this in the context of these temporary enforcement waivers because we are concerned that the waivers represent a bad opportunity for many independent practices to delay making the changes they already needed to make to stay financially viable in the long term. Practices that fail to adapt to the New Normal, practices that were already under pressure to begin with, are going to struggle to stay afloat if they do not act now.
In summary, please be careful about the decisions you make regarding telehealth, and be sure to consider those decisions in the larger context of your practice's long-term health. Reach out to us today and we can get you up and running on a safe, fully compliant teleheatlh platform at a reasonable cost and in a very short time frame. And if you need the standalone application, we are pleased to offer that free of charge until September 13, 2020, or the end of the pandemic, whichever comes first. (For other ways we are helping out with the Covid Pandemic, please see our official response statement.)
In closing, a heartfelt thank-you to everyone in the medical and mental health community. Your dedication during this dark time for our country is an inspiration and gives us all hope. Please stay safe!
Covid-19, the deadly and highly contagious disease caused by the novel coronavirus that was first reported late last year, has already tested our country’s healthcare delivery system, and it is almost certainly not even close to peaking yet as of this writing. Here at Fast Layne Solutions, we are, as always, focused on how to help small- to medium-sized independent medical practices, so this blog post outlines our response, including our advice and the steps we intend to take to help our clients and our country. It will be updated as events unfold and as we add more measures.
Let’s start with social distancing. It is absolutely vital that we minimize human-to-human contact to stem the spread of the virus. For any medical procedure that does not require in-person consultation, we strongly recommend e-visits, aka telehealth. If your office is not already equipped to do telehealth visits, please contact us. For the duration of the Covid-19 pandemic, we are waiving much of the implementation cost for our clients and, for qualifying practices, will amortize the rest over one year. We can get practices set up on telehealth extremely quickly and we have two versions: one is embedded into the patient portal that we provide with our EMRx and Revenue Cycle Management offering (see iClaim below), while the other is a standalone app that is Bluetooth-enabled and vendor/platform-agnostic and can be rolled out in a matter of days. In either case, with just a few clicks, you can be seeing a patient anywhere in a secure, HIPAA-compliant environment. (Because Apple will not sign a BAA, FaceTime, for example, is not compliant. Do not make that risky and potentially expensive mistake. Please see our statement on the HIPAA telehealth enforcement waivers for more information.) In the embedded version, in the same portal where you hold the telehealth session, your patients can make appointments and even pay for their visits, as well as message your office, review their records, and check lab results.
Another way your office can facilitate social distancing is to get rid of the old practice of having patients arrive early to fill out paperwork. Using our portal, patients fill in their paperwork online in advance, and your office staff see it as highlighted entries ready for them to check and confirm before making them permanent entries into the patients’ records. As noted above, that same portal can also minimize face-to-face interactions by facilitating online payments, scheduling, records and results retrievals, and messaging.
Now we need to discuss an unpleasant topic, doctors and practice administrators. The insurance companies have waived certain co-pays related directly to testing, but this will not impact any other costs to patients, including actual treatment. Independent doctors already struggle with denials, claim rejections, and outstanding patient debt even at the best of times. During this crisis, those problems will only grow. So let’s look at how we can use technology to minimize the impact on your practice so that you can continue serving your patients:
Technology has an important role to play in this crisis, and we are ready to help you implement it quickly and efficiently to minimize negative outcomes for both you and your patients. And to help even more, we will be offering all the basic features of our standalone telehealth app free of charge until the pandemic is over or until September 13 2020, whichever comes first.
To further assist doctors and their patients at this difficult time, Fast Layne Solutions is also offering a monthly 5% rebate to any of our clients who are in a position to offer medical care to uninsured patients, in order to help them defray those costs. This offer remains in effect until the pandemic is declared over in the United States.
For the duration of the crisis, we will also be donating 5% of our clients’ monthly invoices to the Center for Disaster Philanthropy’s Covid-19 Response Fund. We will also be earmarking 5% of all 2020 corporate profits for Covid-19 relief.
We want to close by thanking our tireless and brave healthcare workers who will be on the front line in the battle against Covid-19. You are our heroes and America’s best hope.