As COVID-19 case-counts quickly climbed in bigger-population cities and states across the country, Iowa saw a late uptick. However, the late surge allowed Medical Associates Clinic and Health Plans in Dubuque, Iowa, to be prepared for what was to come.
“Because COVID-19 slowly ramped up, we really were able to get in a groove that worked for us,” said Brian Sullivan, MD, an internist at the physician-owned, independent multispecialty practice that also owns its own health plan. Medical Associates Clinic has over 170 physicians and a staff of over 1,000 health professionals and support personnel. Medical Associates Health Plans, the Tri-State’s first health maintenance organization, offers comprehensive health benefits to over 400 employers and 45,000 members.
“I can’t imagine being in New York City or places like that where they really didn’t have much time to plan or prepare,” said Dr. Sullivan. “Having that time, we were making preparations along with everybody else.”
Looking to best practices in other states as examples, this is how Medical Associates Clinic and Health Plans prepared for when COVID-19 would rise in Dubuque, which is home to about 60,000 people. Dubuque has seen almost 300 cases of COVID-19 and the state of Iowa has seen more than 20,000.
Set up incident command
To make quick decisions, Medical Associates Clinic set up an incident command, which Dr. Sullivan is a member of as part of his role as physician lead for the COVID-19 response. Initially, incident command met every day, but as cases lower and the clinic transitions to recovery, meeting has dropped to twice a week.
“The idea is set up to make quick decisions and have everyone around the table at the time to make decisions that normally would take a lot longer,” he said. “Right around the time that there was the first community spread documented in Iowa we were making changes every day.”
For example, incident command decided to stop all elective procedures in March and moved COVID-19 care and screening to the acute care center.
Lower in-office capacity
While the clinic had not seen the same impact from the pandemic as other areas, they still implemented similar procedures, such as reducing in-clinic volume.
“We cancelled appointments and stopped all elective visits and procedures,” said Dr. Sullivan. “Our overall volumes were very low and even our acute-care volume was probably less than half of normal.”
This allowed for “capacity to give extra time and attention to respiratory illnesses and ultimately the COVID-19 patients,” he said. “In a lot of ways, that really helped because we really were never overtaxed.”
“Because we shut everything else down—both on the outpatient side and the inpatient side—our hospital was running about half the normal census during the end of March and all through April,” said Dr. Sullivan. “By focusing all of the respiratory illness to our acute care, our acute care providers became experts at managing, seeing and evaluating possible COVID-19 patients and doing COVID-19 testing.”
Implement telehealth services
Like other physician practices and health systems, Medical Associates Clinic transitioned to telehealth to continue to care for their patients throughout the pandemic. In-person visits dropped to less than 10% in primary care and use of telehealth skyrocketed to help provide care while keeping patients at home.
Learn more from the AMA about how to establish telehealth and deliver patient care while practicing physical distancing.
“Telehealth has been critical in terms of being able to continue to care for patients and help them make sure that their chronic medical problems are being managed,” said Dr. Sullivan, adding that “telehealth is also critical in helping to manage COVID-19 patients.”
“We worked on a number of ways to communicate with people with telehealth,” said Mark Janes, a pulmonologist at Medical Associates Clinic. “For patients with COVID-19, we used telehealth so we wouldn’t have to walk in the room.”
“I was never excited about telehealth in the past and now I really can see advantages for our patients and not just in the setting of COVID-19, but flu season too,” said Dr. Sullivan.
Create a plan for recovery
Moving into reopening, the organization transitioned into focusing on operations recovery, which looks at how to build visits and procedures back up. While the clinics never closed, they did operate with reduced hours to account for proper allocation to the acute care clinic, which remained open every day.
As they continue to reopen, practices have increased to 50% of their historical outpatient volume. The next step would be to move to 75% volume.
“The problem is everything is opening back up and we don’t know how many people that are out there that will make others sick,” said Dr. Janes. “We should still be very cautious, continue to protect ourselves and others from exposure to others.”
“As much as we can—and the longer we can prevent another surge—the less likely it’s going to happen,” said Dr. Janes. “In general, it’s just wait, watch and see, protect yourself, protect the patients.”
Read the AMA’s guidance for reopening practices during the pandemic, and use the AMA checklist that has been developed to help physicians manage the safe reopening of their practices.
The AMA has developed a COVID-19 resource center as well as a physician’s guide to COVID-19 to give doctors a comprehensive place to find the latest resources and updates from the Centers for Disease Control and Prevention and the World Health Organization.
