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COVID-19 PANDEMIC

THE EXPERIENCE OF A PHYSICIAN IN PRIVATE PRACTICE

Sylvia P. Preciado, MD

Private Practice, Internal Medicine

Co-Chair, COVID-19 External Surge Committee Co-Chair, Operation COVID-19

Community Liaison, Pasadena Public Health Department Chair of Care Continuum, Huntington Memorial Hospital Board Member, NHMA Board of Directors

Pasadena, CA

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Private Practice Physicians/ Primary Care Physicians

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• Must be a Leader
• Control of your Practice
• Flexible
• Well Connected
• Proactive and Responsible

CONTINUUM OF CARE

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Hospitalization

Nursing Home

End of Life

How healthcare providers follow a patient from preventative care through their medical diagnosis, hospitalization, long term care and end of life care.

Preventative Care Treatment of Medical Illness

The Fragmentation of Medicine

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Hospitalist

Sniffist

Primary Care Doctor

Subspecialists & Urgent Care

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Extensivists

Formation of Operation COVID-19

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A group of Private Practice Internists who immediately teamed up to address areas of vulnerability related to the Novel Coronavirus within our:

1. Private Offices

2. Nursing Homes

3. Our Hospital

4. Our Community

5. Pasadena Public Health Department

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COVID-19

1. Mitigation via testing, education of staff in nursing homes and community to reduce infection rates.
2. Drive through testing and COVID-19 testing at nursing homes.
3. Obtaining donations for appropriate PPE, which was shared with nursing homes.
4. Support one another by sharing latest evidence based data, testing and STATS.
5. Planning for an external surge situation within our community
6. Maintaining quality of care for our elderly who have other chronic illnesses (eg: Cardiovascular diseases, HTN, and Diabetes)
7. Reduce admissions to Emergency Room and Hospital
8. Utilize other services such as Home Health and Hospice to assist chronically-ill patients
9. Partnered with Pasadena Public Health Department to vaccinate thousands of patients.

COVID-19

⚫ Arbor Vista Assisted Living

⚫ Brighton Care Center

• Foothill Heights Care Center
• Californian Pasadena Conv. Hospital
• Huntington Dialysis Center
• Rose Garden Healthcare Center
• Pilgrim Tower North
• Pasadena Care Center
• Pasa Alta Manor Residential Care Centers
• The Villas by Regency Park
• Villa Esperanza Allen House
• Villa Esperanza Murphy Home
• Villa Esperanza Services (Main)
• Golden Cross Health Care
• Jasmine Terrace

Pasadena LTC Facilities

• Villa Esperanza Wagner House

• Villa Esperanza Wynn House
• Camellia Garden Care Center
• Regency Park Comm (fair Oaks/Oak Knoll)
• GEM Transitional Care Center
• Jasmin Terrace
• Legacy Care of Pasadena
• St.Vincent Health Care
• Villa Gardens Health Center
• Regency Park Astoria
• Regency Park Oak Knoll
• The Fair Oaks by Regency Park
• The Villa by Regency Park
• Pasadena Grove Health Care
• Pasadena Meadows Nursing Facilities

What did we learn about risk for the Elderly, Our Latino and underrepresented communities?

• Staff adequately trained in the proper PPE usage and sanitation is a key element in preventing transmission of the virus

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• It is very difficult to isolate patients in the standard SNF environment

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• There was a higher incidence of infection in nursing homes in certain communities. It appeared that nursing home in less affluent communities had higher infection rates

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• Because many employees work several

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jobs, they are a significant concern for

transmission of disease

• In the underrepresented communities it is

very difficult to isolate especially if

multigenerational families are living

together

• Vaccine distribution did not favor our

latino communities

• Primary Care Doctors were not equipped for Pandemic.

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• Our Public Health Departments did not have the manpower to adequately deal with the COVID Crisis

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• No Hospital was prepared to deal with this Pandemic and we needed to partner with them to assist with communication between patients and families

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• Primary Care Physicians are the MOST essential part of the care team.

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Did Telemedicine Work??

• Access
• Safety
• Further exposed the Disparities in Healthcare

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Promoting A Sustainable Work Environment in A Community Clinic

Presented by:

Loraine M Gutierrez, MD

La Maestra Community Health Centers

San Diego, California

La Maestra Community Health Centers 2022

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“To provide quality healthcare and education, improve the overall well-being of the family, bringing the underserved, ethnically diverse communities into the mainstream of our society, through a caring, effective, culturally and linguistically competent manner, respecting the dignity of all patients.”

OUR MISSION:

HISTORY:

Clinic formed in 1990 under La Maestra Amnesty Center. The need for culturally competent healthcare was identified by Student Council representing over 12,000 students who participated in legal residency and citizenship programs, ESL, VESL, job training at LMAC.

ABOUT LA MAESTRA

La Maestra Community Health Centers 2022

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La Maestra Community Health Centers 2022

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La Maestra Patients and Visits

Total Visits

Unduplicated Patients

• Over 33 languages and dialects spoken by 750+ employees

• 21 Sites in 4 San Diego communities: City Heights ,

El Cajon, National City, Lemon Grove, Mobile Clinic, and Mobile Mammography

La Maestra Community Health Centers 2022

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IF IT WERE ONLY THIS EASY

PROVIDER

RECRUITMENT

AND HIRING

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CREDENTIALING ONBOARDING

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TAILORING SUPPORT STAFF

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PROVIDING WORKSPACE AND EXAM ROOMS

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Retention

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IMPACT OF LOSING A PROVIDER

PATIENT CARE INTERRUPTION

REORGANIZING CLINIC WORKFLOW DEMORALIZING IMPACT ON STAFF

SENSE OF FAILURE AS AN ADMINISTRATOR

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WORK

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ENVIRONMENT

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SUSTAINABILITY

ADEQUATE STAFFING

ADEQUATE SUPPORT

FLEXIBLE WORK SCHEDULE

REASONABLE PRODUCTIVITY EXPECTATIONS

SCHEDULING THAT WORKS

PROVIDER SATISFACTION

PROVIDERS

Physicians

Nurse Practitioners

Physician Assistants

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CARE TEAMS

Providers

RN Staff

RN Case Managers

Medical Assistants

Scribes

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OTHERS

Guest Providers - Specialists

Per Diem Providers

Medical staff in training (Residents; Nurse Practitioners; Medical Students; Medical Assistant Externs)

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ADEQUATE STAFFING

“Compliments to the chef - Pass it on”

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ADEQUATE SUPPORT

ADMINISTRATIVE SUPPORT

PROVIDER TYPE RATIO

MENTAL HEALTH WARM HANDOFF

SOCIAL SERVICES and CASE MANAGERS

CULTURAL LIAISONS AND TRANSLATORS

PHARMACY AND LABORATORY SERVICES

REFERRAL AND MEDICAL RECORDS TEAMS

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WORK HOURS

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PRODUCTIVITY EXPECTATIONS

WORK HOURS FLEXIBILITY

WORK SITE

TIME TO COMPLETE TASKS

FAMILY RESPONSIBILITIES/WORK-LIFE BALANCE

REFERRAL NETWORKS FOR PATIENTS

PROVIDER PRODUCTIVITY

REASONABLE EXPECTATIONS BASED ON YOUR PATIENT POPULATION

REMOTE ACCESS TO EHR

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PLAN FOR THE UNEXPECTED

SCHEDULING

HEALTH PLAN EXPECTATIONS

DEDICATED TIME SLOTS

ROTATE CLINICAL DUTIES

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Set Realistic Goals

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Follow Through With Reviews and Promotions

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Protect Your Provider Meetings

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Brainstorm as A Provider Group

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Identify the Frustrations

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Promote ongoing Professional Development

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Off Site / After Hours Team Building

PROVIDER

SATISFACTION

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PROVIDER SUSTAINABILITY

La Maestra has over 750 staff members who are culturally aligned and representative of the patients served

The Care Team model develops the provider-patient relationship and creates consistency within the patient experience and integrated approach to care

Comprehensiveness of services within The La Maestra Circle of Care® brings needed resources that extend to the patient’s entire wellbeing

Access to specialty care in the medical home via telehealth modalities, home visits, and alternative access points brings services to patients

Models of care delivery promote sustainability and satisfaction, leading to improvement in the cost and quality of care

Providers feel good at the end of the day about the care they are able to deliver, which highly correlates with professional satisfaction

La Maestra Community Health Centers 2022

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Thank You

RESOURCES

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Journal of Health Care for the Poor and Underserved

American Academy of Family Physicians

AAFP Family Practice Management Journal

Agency for Healthcare Research and Quality

American College of Physicians

Center for Practice Improvement & Innovation

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Health Literacy, Private Practice and Covid 19

Nereida Correa, MD, MPH

Associate Professor

Obstetrics and Gynecology

Family and social Medicine

Albert Einstein College of Medicine

Attending Physician: North Central Bronx Hospital

CEO, Eastchester Medical Associates

Objectives

• Discuss the role of the private practitioner in the Hispanic Community
• Review Covid 19 in 2020 in the Bronx and the health disparities identified
• Identify coping skills of our practice and staff during the pandemic
• Show how collaboration with NHMA/NHFF Health Literacy Project helped get the message on vaccines to our patients

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Secretary’s Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020. Healthy People 2020: An Opportunity to Address the Societal Determinants of Health in the United

Social determinants of Health

Economic Stability

Employment

Food Insecurity

Housing Instability

Poverty

Education

Early Childhood Education and Development

Enrollment in Higher Education

High School Graduation

Language and Literacy

Neighborhood and Built Environment

Access to Foods that Support Healthy Eating Patterns

Crime and Violence

Environmental Conditions

Quality of Housing

Health and Health Care

Access to Health Care

Access to Primary Care

Health Literacy

Social and Community Context

Civic Participation

Discrimination

Incarceration

Social Cohesion

Impact of Covid 19

Loss of jobs

Decrease income

Schools closed

Graduations cancelled

Loss of Contact

Shutdown of essential service

Safety issue

Essential workers

Access to care impacted

Fear of healthcare facilities

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Breakdown in communication

Mixed messages

Health Disparity in Covid 19 in New York City

• In New York City, Latinos represent 34 percent of the people who have died of the coronavirus but make up 29 percent of the city’s population, according to preliminary data from the city’s Health Department. Black people represent 28 percent of deaths but make up 22 percent of the population

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March 31, 2022

New York Times, Jeffrey Mays and Andy Newman, May 7, 2020

Virus Is Twice as Deadly for Black and Latino People Than Whites in N.Y.C

• Physicians in the same building were Covid infected and had to close their offices, others closed in fear
• Dental Office next door closed indefinitely
• Office closed except for 1 day a week and appointments were converted to Televisits
• Personal protective gear was needed and not in good supply anywhere
• Cleaning materials and essential paper products were scarce
• Masks had to be produced by staff!

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The start of the Pandemic

�Resources in Spanish

Private Practice: Community Based and preferred by many Hispanics and others in the neighborhood because they speak Spanish and understand their culture

Current Issues

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• Unstable in its finances since the Affordable Care Act that favored Federally Qualified Health Centers
• Fear of infection kept patients away
• Need to close for a prolonged period endangers their viability
• Paycheck Protection Program with 75% payroll support
• Rent, malpractice and other expenses may prevent practice from re-opening

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Just 2 months before with office staff

Information posted in the building

Health Literacy NHMA/NHHF Centene Project on Covid 19 and Vaccines

• Practice collaborated with NHMA/NHHF to introduce vaccine information over a 6 week period
• A designated staff member approached every patient seen and surveyed the patients on whether they were vaccinated
• We gave them access to the computers to look at a video on vaccine either in English or in Spanish that have been provided by NHMA and downloaded in the exam room computers

NHHF/NHMA Toolkit and Project

• Health Literacy Patient Resources
• Videos in English and Spanish to download to computers
• Infographics
• Myths and Facts about Covid 19
• Travel information
• Survey on vaccination
• Meetings with NHMA/NHHF staff and progress reports

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Posted in Exam Rooms in English and Spanish with URL to access Toolkit

Computers in exam room used by patients while waiting

Computer screen with Covid resources for patients

Optional links to program in English and Spanish

Results of Survey

• Total who took survey: 487
• Vaccinated 420
• Not vaccinated 67

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• Accepted information 43 of 67
• Others who were vaccinated took link for their families 37/420

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Results and comments

• Program was very effective in providing information- some took the link home to show their family who had not been vaccinated
• More than 2/3 (67%) of our patients were already vaccinated since many were home attendants and other health workers

Conclusions

• Hispanic Community was disproportionally affected with Covid 19 and many refused the vaccine
• Sources of healthcare in the community such as private practices were vulnerable but persisted in finding ways to care for our patients and community
• Providing information in various formats was helpful and useful in getting the message regarding the vaccine to those most affected