New Jersey’s suspension of elective surgeries, instituted March 27, was lifted May 26 by Gov. Phil Murphy, who himself had undergone surgery on March 4 to remove a tumor from a kidney.
Steven Sheris, MD, senior vice president, physician enterprise, for the six-hospital Atlantic Health System based in Morristown, New Jersey, compared the scheduling of postponed surgeries to being an air traffic controller with multiple planes in the sky.
Some of those “planes,” however, have been unable to land for weeks. Dr. Sheris explained how Atlantic Health, an AMA Health System Program Partner, developed a continuous process of engaging with patients waiting for surgery to make sure their conditions were not worsening.
“It’s a fallacy to characterize surgeries and procedures as ‘elective’ or ‘emergency’—it’s more nuanced than that,” Dr. Sheris said. “You have patients whose condition was deteriorating in that 60-day period. It’s really not an ‘emergency,’ but you want to do the surgery as quick as possible.”
If patients’ conditions worsened to the point of threatening life or limb, surgeries were done under strict COVID-19 safety protocols.
Other services, such as chronic-condition management and pediatric well-child and immunization visits, have continued in physician offices reconfigured to accommodate physical distancing, with scheduling that keeps patients with infectious conditions apart from those who don’t, and effective use of telehealth.
An AMA checklist has been developed to help physicians manage the safe reopening of their practices
“We had to create new environments of care that were safe for our patients who were coming into our offices and safe for our team that was taking care of them,” Dr. Sheris said. “The most-ready vehicle to do that was our telehealth applications.”
Loosening government regulations on telehealth payments allowed rapid deployment of the technology, and Atlantic Health physicians didn’t require much training in its use.
“Much of the art of taking care of patients on a chronic basis has to do with the interview of the patient:
Taking their history, getting an assessment of how they’re doing and how they’re feeling, what is their quality of life, and do they have any alarm or symptoms that require more immediate attention,” Dr. Sheris explained.
For physicians looking to expedite telehealth implementation during the pandemic, the AMA created this quick guide to telemedicine in practice.
For patients requiring a physical exam, home nurse visits are used. Others, however, require a visit to the office.
Those patients often require two important messages:
- It’s safe to come into their doctor’s office.
- You should not put off needed care and let a medical condition worsen because of concern about COVID-19.
New Jersey had been a COVID-19 hot spot, with some 161,000 cases and 12,000 deaths, and it had the highest state rate for deaths per 100,000 residents. In Morris County, Atlantic Health’s home base, there were more than 6,500 positive tests and more than 600 deaths.
“We were very proactive in reaching out to our patients and letting them know we were open for care with safety as a priority,” Dr. Sheris said. “The confidence of the patient community was a problem eight weeks ago. It’s still a challenge now.”
He added that, with measures that have been taken, receiving health care is safer than it was in the beginning of the pandemic—especially with how physician offices and scheduling have adapted to the growing knowledge base.
“Also, medical care is necessary care—it’s as necessary an activity as going to the supermarket to get food,” Dr. Sheris said. “People need to accommodate that in their psyche, if you will.”
This is as true for children as it is for adults managing chronic conditions. Keeping children on their vaccine schedule was made a “day one” priority.
“We didn’t want to compound a problem by having kids miss their regular vaccines and then put themselves at risk,” Dr. Sheris said.
“If it takes an extra explanation or a little extra comforting, that’s what we scripted our staff to provide,” he added. “We’ll get there, it just takes a little bit of momentum.”
Dr. Sheris sees better days ahead coming out of what was learned from the COVID-19 experience, but not necessarily what one might expect.
He said there was learning about tactics involved in flexing space, obtaining personal protection equipment and developing testing processes. But the main learning was that the investment Atlantic Health made in its people and in developing a culture of innovation was validated.
This culture was described as freeing people to self-manage in pursuit of a common cause and to innovate to solve problems.
“Our ability to align our team to a mission and then let them execute really gave us an advantage,” Dr. Sheris said. “On the other side of this, we’re going to double down on that strategy, and we’re going to accelerate our strategy to move to value-based payments, to getting rewarded for better outcomes and better patient care that is patient-centered at lower cost.”
With that eye to the future, there is still a recognition of what’s at stake now.
“At the same time that we’re rebalancing our health care system, we’re in a perpetual state of readiness for the foreseeable future,” Dr. Sheris said. “We’re ready to flex in whatever direction the community needs us, and we’re ready to flex in response to the COVID virus—let’s just hope that’s not necessary.”