NHPCO NewsLine Summer 2020 - 16

continued

The main barriers for us were
connection issues. Some patients
were just overwhelmed by the
technology and they refused, they
wanted their face-to-face visit.
What was critical to our success
was that our clinical team was
able to assist the families prior to
visits with the technology and do
a run through to make sure that
they were able to connect. That
decreased the frustration for
everybody. There are times when
we have connection issues and we
convert those visits to audio.
I have been using telehealth for
approximately six weeks and we
have been able to grow our
geographic coverage so that we
can see more patients. My patient
visits in a day have almost
doubled and I feel more connected
to my patients now than before.
They are verbally telling me that
they appreciate the more frequent
follow up because they are not
getting out to see their specialists
right now, which means that
managing their symptoms is more
important than ever.
I am finding that I am being more
aggressive with symptom
management and am going to
greater lengths to keep patients
out of the hospital. In the past six
weeks, I am having more direct
goals of care conversations with
patients and families about what
might happen if they were to
contract COVID-19, and we are
being very aggressive at
documenting these goals in a
shared electronic health record.

16

Newsline / Summer 2020

In these conversations, it seems
as if people are more willing to
consider hospice because they
fear going to the hospital and
dying alone. Patients are
watching the news about
COVID-19 and anxiety is running
very high, so having these virtual
conversations and planning for
the worst-case scenario seem to
be welcomed. I am still present
for patients and families to listen,
provide that needed education
and psychosocial support.
I have noticed there has been a
decrease in ER visits and
hospitalizations. The few patients
that have landed in the
emergency room or did contract
COVID-19 are ones that were not
able to participate in virtual visits.
Initially I was very skeptical about
providing virtual visits, but after
we kind of worked through all
those technical issues, I really
found it was an opportunity to
have more focused visits with less
distractions and obviously no
travel time. I'm still prescribing,
I'm still managing symptoms, I'm
still completing post forms. I am
accomplishing all the important
aspects of a visit when the
needed resources are identified,
our support team is there to help
with those needs.
I do believe there is still a need for
essential face-to-face visit. I have
to admit, I am looking forward to
getting back out to see patients,
but hopefully the reimbursement
for virtual visits will continue
because prior to this we did spend

a lot of time doing telephone follow
up that was not reimbursable. I am
hopeful that maybe moving
forward, this will be an avenue for
us to stay more connected with our
patients.

Christine Gardella, MMS, PA-C
Christine Gardella is representing
the American Academy of
Physician Assistants and the
Physician Assistants of Hospice
and Palliative Medicine.
I am a home-based Primary Care
and Palliative Care Practitioner. I
see homebound Medicare
patients in the DC Metro area
with my own small house calls
practice, and I went from zero to
100% telemedicine visits in about
two weeks. I was able to do this
by instituting the telemedicine
approach and I added a remote
patient monitoring system.
I am doing 100% telehealth in all
cases, from chronic care
management to urgent care and
hospital at home patients. With
my remote patient monitoring, all
my patients have their own blood
NHPCO NewsLine Summer 2020

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