Today I spoke to Dr. Louis Wilson from Wichita Falls Gastroenterology. He’s the ACG Practice Management Chairman and also the President-Elect of The Texas Society for Gastroenterology and Endoscopy. He just published an excellent and practical article on the 10 specific actions GI practices should be taking now.
DOWNLOAD the exact tools that Dr. Wilson used when he pitched to his hospital and presented to all GI stakeholders in their community.
Watch this insightful interview with Dr. Wilson. Highlights:
• How Wichita Falls Gastroenterology, a 7 MD group is handing the COVID-19 crisis
• What to do with patients whose GI symptoms aren’t going to go away
• Petition your hospital regarding PSA
• Supporting your staff
• Infection control plan
• Holding structured meetings with your partners
Most experts are saying this is going to be a marathon and not a sprint. We will do our best to support you through this journey.
The Transcribed Interview:
Praveen Suthrum: Hi Dr. Wilson, thank you so much for taking the time for this interview. I broadly have two questions and then we’ll get right into it. The first is about what the situation is on the ground… on your end in Wichita Falls, Texas and the second is about the article that you put out there, was it yesterday?
Dr. Wilson: Yeah
Praveen Suthrum: Yeah so, you outlined 10 action items that GI practices can take, and endoscopy centers can take now so, I wanted to talk to you about these two questions. But first, how are you? And how are things where you are?
Dr. Wilson: Of course, everything is different like everybody else, we’re under the strain and stress of preparing for and dealing with the pandemic. We’re in a small community Wichita Falls, North Texas. We are a gastroenterology group with seven doctors, we have an ambulatory surgery center. We participate very closely with our regional hospital. We’re right across the street from them. Our ASC is right across the street from them and we are the only GI group that covers hospital call for gastroenterology 24/7 365 days a year. So, we have a very close relationship with our hospital. The epidemiology predictions for our community… we have been watching those very closely and in fact it’s shocking how closely our rate of rise of this infection has matched those predictions. Today we have 38 people in Wichita County, Wichita County has 135.000 people. We have 38 people tested positive. About 1000 people have been tested but only 38 have been positive about 300 are pending. 90% of the test or more that have been done for patients of interest have been done are negative, which is great. We currently have four intensive care patients here that our patients under investigation one is COVID-19 positive. Everything is different. The volume in our practice is greatly reduced and is hampered by you know, shelter in place restrictions for our community. The community is sticking together for shelter in place and everybody is encouraging that. I think it’s going well here. You know, social distancing affects everything we do. The volume at our ambulatory surgery center, our ASC is still open. We keep one room open four days a week right now that is all as compared to three rooms five days a week before. And we’re doing only urgent outpatient endoscopy for urgent indications. We continue to have clinic, both face–to–face and telemedicine. Today, my clinic is around 50-50. I’ll have half of my patients via telemedicine today and about half will be face-to-face. New patients mostly we’re seeing face-to-face. Some of them we’re not. But physical exam… our policy has still been to see and examine our patients when they’re new sometimes we offer telemedicine even for new patients and sometimes patients are choosing that option which is fine. And then we have to follow up with them for physical exam at a later time. So, that’s what is going on here. I’m healthy, all of our staff has been healthy. We have not had any patients or people under investigation in any of our organizations so far thank God.
Praveen Suthrum: Thank you. And what kind of steps have you been taking to protect yourself and your staff and other colleagues?
Dr. Wilson: We’ve had an infection control policy in place for number of years now and our infection control policy applies to this infection as well. Now we have prohibited people from the building. Visitors are not allowed into any of our buildings… only the patients. They are tested for fever and they are pre-screened by telephone on the day before and upon arrival at any of our facilities. Infact we like to pre-screen patients two or three days before for the appropriate questions of risk factors anybody with respiratory symptoms or fever or exposure to people in their household from the symptoms is going to be excluded from the building until they’ve been tested for COVID-19 or until they have been quarantined for 14 days. So, that’s currently our situation at the clinic. You know, I’m encouraging and walking through the building all the time, our waiting rooms are empty both at the ASC and at the clinic. Social distancing is encouraged and maintained in the staff areas as well. Most of our meetings now are teleconferencing meetings or strictly following the limitation of size and following social distancing. So, we’re doing all those things. So, PPE… patients who are considered low risk, who have screened negative, we are using standard PPE – face shields, surgical masks, water-proof gowns, gloves, hand washing etc., and we are not doing patients with high risk. If they have respiratory symptoms or exposures, then they are not being done. If those patients need to be done in the hospital, then they’re being done within N-95 masks and full PPE’s.
Praveen Suthrum: I’m curious. You know, all these patients who are getting their surgeries rescheduled or you know the GI symptoms don’t go away but now you know COVID 19 takes precedence so, what happens after you know hopefully we flatten the curve and we don’t pass this phase… you know these patients with GI symptoms wouldn’t they be worse off?
Dr. Wilson: Well, I’ll tell you what… this is not a two week or three-week social distancing, shelter-in-place kind of thing for us. We have to be planned for the long term. This is a marathon not a sprint. That means those patients with urgent elective indications – trouble swallowing, persistent diarrhea, persistent abdominal, colitis etc., bleeding, GI bleeding, those patients are not going to be able to wait two, three, or four months. So, we’re trying everything possible to put those patients off. Now, we’re watching our epidemiology curve, if things continue as they are, we will have a patient surge here that fills our ICUs and our hospital about the third week of April and that’s what we’re preparing for. However, we’re not anticipating being able to lift the prohibition on elective procedures until perhaps mid-June. So, right now June… and our ambulatory surgery center is already filling up because we’re still seeing patients and right now we have hundreds maybe 400 patients already scheduled for June patients that normally would be of schedule probably next month July is also starting to fill out. So, it’s important in my opinion it’s critical that we plan for the continuity of our practices, right? We have to stay… we have to protect our staff and the infrastructure of our practices and our ASCs. I think that’s a public health concern because those indications are not going to go away. So, patients with more urgent indications we’re going ahead and doing those procedures in our ASC now. I don’t think this is the right time to push those patients off to the hospital and we’re working very closely and with full support of our hospital. We have at our ASC a full supply of N-95 masks. The hospital has offered those to our ASC if necessary. We’re working closely with the hospital the emergency room, the clinical decision unit, the Transfer Center and the GI team on call to try to avoid using the hospital for low-risk patients, COVID screened negative patients… we don’t need to do those in the hospital setting unless it’s a true emergency.
Praveen Suthrum: Okay. Thank you. So, let’s get to the article that you published and all these resources that you’ve been sharing… you talked about 10 specific action items the GI practices and hospital centers can take right now. Could you share a few of those? And then with this video I’d like to… you know share the article.
Dr. Wilson: Okay. Well they are of course my opinion and things that are working for us here locally. First of all, I petitioned our hospital for an emergency expansion of our PSA our professional service agreement immediately. And they were very cooperative. So, we have expanded our normal PSA on call, financial support paper call etc., we’ve dramatically expanded that that support from the hospital. Why is that? Because they share our goals… they are very stressed, they need specialists to help and support hospitalists, intensivists, people in the hospital as the volume of patients rises, so will the number of gastroenterology issues that will rise. As you said those problems are not going away. Liver disease, GI bleeding, abdominal pain, whatever. Those patients will need to be served and done so with rapid short hospital stays, rapid discharge, rapid endoscopy or care coordination. As an outpatient we can help with them with that. So, what they’ve agreed to do is give us full support for a second gastroenterologist on-call… we call that person G2 we are then so the expansion of the PSA with your hospital. I urge practices to approach their hospitals immediately for that. I think they should be cooperative… you share their goals. Here we are maintaining… number two… we’re maintaining outpatient endoscopy capacity. Even if it is much less than before we’re going to try to not push those procedures off to the hospital. The anesthesia serve is going to be very important part of expanding the ICU capacity at our hospital and they’re not going to want to be doing anesthesia in the hospital for endoscopy unless necessary. Number three, were supporting our staff we are paying our staff and keeping them on as much as possible it’s a high priority. So, I call that a business continuity plan. We plan to utilize whatever federally passed care legislation benefits can help us do that most importantly the payroll protection program. We are perfect for that… so, you know we’re a business of under five hundred employees, we will retain our staff, you must retain your payroll and so what happens there is that the Small Business Association through local lenders will give us…forward us a loan amount of 2.5 times our monthly payroll average monthly payroll over the last 12 months as long as we retain at least 75% of our payroll during that time. If we don’t, we have to pay the money back if we do it’s largely forgiven that’s an outstanding benefit that we plan on taking advantage of. We are also at the ambulatory surgery center allowing our staff to borrow PTO…up to 80 hours of PTO from the future things that might be automatically deducted from their paychecks a lot of those things are being forgiven right now for instance previous medical bills or previous loans against their retirement accounts. Those things they’re not having to pay right now. So, supporting the staff is critical, continuity plan long term again for your business. The next things are things that relate to closely working with the hospital. Patients are losing their insurance. People that lose insurance have lack of financial resources, they’re a little bit harder to get out of the hospital so we are actually participating in our transitional care clinic here. A transitional care clinic is a clinic that the hospital has for patients immediately after discharge regardless of their ability to pay. So, when a patient you know is on the edge of whether or not they should stay in the hospital or not or care is not fully coordinated they don’t need to stay in the hospital because they can come to the transitional care clinic. We are participating there for patients with digestive problems so those patients will be seen by the G2, the 2nd gastroenterologist on call and help care coordination and make sure those patients are getting the best possible care, shorten hospital stays etc., the ER, the clinical decision units in the hospital we’re working with those closely and the Transfer Center. So, now the Transfer Center knows we’re eager to talk down line facilities. Other hospitals that normally refer in outside providers. We’re eager to talk to them first if they have digestive questions, so that we can coordinate their care as an outpatient rather than in the hospital. Avoid some of those transfers and have them taken care of. Some of those patients can actually now be sent to our ASC if they’re COVID negative, properly pre-screened, low-risk, they can be seen at our ASC and CMS has expanded the ability for a ASCs to work in that kind of capacity. Of course, telemedicine, teleconferencing, we’re doing a lot of that. We are like I said about 50% of our visits now or telemedicine that’s working extremely well. That will continue to evolve I think maybe I’m using technologies in the hospital… by the way, teleconferencing technology that allows us to see patients in the ICU or in their patient rooms without physically going in there. So, we can round on patients remotely, reducing exposures etc., they are wiring up that kind of technology at our hospital and then maybe teleconferencing consultations with outlying facilities so those are some of the things we’re also doing. You know, right now a lot of meetings happen. I’ve encouraged my colleagues to make meetings regular, structured and highly efficient. We don’t have time right now for lots of unstructured conversations. So, we are having twice weekly structured meetings, all the stakeholders the endoscopy center, the hospital, the practice, the administrators, to go over things quickly. Status in the hospital, how many GI census patients are there, how many of them are being affected by COVID, how many are patients under investigation, what’s happening in the Transfer Center, the transition clinic etc., we’re going to be having those structured meetings regularly. We are really ramping up and making sure the infection control plan is in place and then taking care of ourselves those things are all things I recommend.
Praveen Suthrum: Well, Dr. Wilson thank you very much for your time and you know, these action items that you’ve shared please keep the resources coming and I wish you well and your staff well and do stay safe. Thank you.
Dr. Wilson: Thank you Praveen. I wish you lot of support I mean health good health during these times. Thank you.
By Praveen Suthrum, President & Co-Founder, NextServices.