COVID-19 upends finances, supplies and staffing for Michigan GI practice

Ypsilanti, Mich.-based Huron Gastroenterology was blindsided by the COVID-19 pandemic, according to research director Naresh Gunaratnam, MD, who was interviewed by NextServices President Praveen Suthrum.

In the days leading up to the crisis, Huron Gastro was preparing to recruit new physicians. With a bulging caseload, it needed more hands on deck.

"And then, within a day, it became full-stop. We needed to shut everything down," Dr. Gunaratnam said. "We just felt that if we got one patient who was COVID-19 positive that entered our hospital, our ASC [or] our office, it could be catastrophic."

Huron Gastro's board decidedmade the decision to halt most services even before CMS issued guidelines directing healthcare providers to do so with elective cases. Despite the swift action, two Huron Gastro clinicians tested positive for COVID-19.

One of the clinicians, an otherwise healthy marathon runner, started experiencing shortness of breath several days into making hospital rounds. The other had treated a patient with GI issues, which weren't identified early on as common COVID-19 symptoms. Both providers went into isolation.

Now, Dr. Gunaratnam and his partners are operating under the assumption that everyone has COVID-19. In the early days of the pandemic, they would primarily wear N95 masks when treating patients thought to have the disease. Now, they always put on the masks — and are reusing them whenever possible.

"We treasure that like it's a family heirloom," Dr. Gunaratnam said. "We're cleaning it as well as we can."

Huron Gastro is only providing in-person services when there is high suspicion of cancer. Otherwise, the practice's physicians have largely pivoted to telemedicine.

The learning curve is steep for both providers and patients. If a geriatric patient doesn't know how to download or use telemedicine, the provider may have to abandon their telemedicine attempt and provide consultation over the phone, Dr. Gunaratnam explained. That makes billing complicated.

As long as there was a "good faith attempt" to use telemedicine, providers should be safe billing it as such, Dr. Gunaratnam said. He believes that CMS will be forgiving in light of the pandemic.

Fortunately, most office-based gastroenterology services can be delivered via telehealth, according to Dr. Gunaratnam. Physical exams for low-acuity patients rarely influence his clinical decision-making; he gets the information he needs by asking targeted questions. For this reason, Dr. Gunaratnam expects more GI services will be delivered virtually even after the pandemic subsides.

As for finances, surgery centers could get help from the $2 trillion stimulus package signed into law in late March by President Donald Trump. The Digestive Health Physicians Association successfully lobbied legislators to earmark money for independent medical practices, according to Dr. Gunaratnam, who sits on DHPA's executive committee.

"As in any crisis, we're trying to stay calm and hoping that in a month or two we'll be able to come out of this," he said. "The good news is that there is going to be support for staff as well as ASC lost productivity. I think we need to go through the law very carefully and see how we can best use the laws and subsidies being given by the government to keep our business running."


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