We Are in This Together: Protecting Those Who are Protecting Us

We are now all familiar with versions of the now infamous #FlattenTheCurve graph, showing the intended impact of social distancing on the spread of Coronavirus (COVID-19):

A major reason flattening the curve is so important is to protect our clinical teams — our American heroes — who are at the frontlines of this epidemic.

‍Early evidence suggests that healthcare workers have a 3–5X higher infection rate than the general public.

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They keep showing up and sacrificing for us. Will we keep showing up for them?

To do our part, VitalFlo is waiving all subscription fees for primary care providers. More details below.

Structure and Summary of this Post:

• Primary care providers are overwhelmed
• Telehealth and remote physiologic monitoring can help
• There are already leaders we should be emulating
• To help providers, VitalFlo is making its platform freely available
• We can, and must, all step up and do our part

Our Primary Care Providers are Struggling to Keep Up

Dr. Farzad Mostashari, CEO of Aledade, outlined the major issues that independent practices are having with keeping up with the epidemic:

Lack of Personal Protective Equipment (PPE)

The supply chain for PPE has broken down. As a result of shortages some hospitals are issuing guidelines that are putting providers at risk:

We have seen some response to the dire need for PPE in recent days: companies are responding by retooling and reorienting their manufacturing lines.

Healthcare Staffing Shortages

In the meantime, if healthcare providers get sick (remember from above, they have a 3–5X higher infection rate), there is a risk that practices will not have enough staff to continue to manage the crisis.

This concern is particularly impactful for small independent primary care providers: after the first staff member gets sick, can the practice stay open? That employee was in close contact with everyone else in the office. That means, remaining employees are not only at risk of becoming infected themselves — but also at risk of infecting their patients (see next).

High-Risk and Chronic Disease Patients are Vulnerable

From what we know so far, older adults and people of any age who have serious underlying medical conditions have higher morbidity and mortality due to COVID-19:

This is complicated by the fact that these patients need higher levels of care in general. If coming into the clinic is a high-risk activity, how will patients who need continued medical supervision get the treatment they need?

Finances for Independent Practices is Being Devastated

The financial health of our primary care practices has not been making the headlines, but it is of critical importance:

It is a good thing that non-essential medical procedures are being canceled: it keeps clinical providers and at-risk patients safer, and reserves resources for COVID-19 response (see above). However, normal care visits are also being canceled (anecdotally, the cancellation rate is north of 50%).

However, because of how the current economics of practices are structured, this is crucial revenue for keeping the lights on!

Like any other small business, independent practices typically do not have deep pockets or substantial cash reserves.

Telehealth and Remote Physiologic Monitoring Can Help

There is no panacea and no silver bullet for these problems: we need to tackle all of them with every tool we have in the tool kit.

One very useful tool for these specific problems is the implementation of telehealth and remote physiologic monitoring (basically: the collection of health vitals from a distance). That’s because implementing these solutions can helps address each of these problems:

1. Lack of PPE: providers don’t need PPE when they are treating a patient on the other side of a screen. Increasing the ratio of telehealth to in-person visits will reduce PPE requirements.
2. Staffing Shortages: staff are protected from infection when the interaction with infectious patients is held over a screen. The temporary relaxation of telehealth and data regulations makes it possible to use commercial products for this (like Skype and Zoom).
3. Monitoring High Risk Patients: by using remote physiologic monitoring in combination with telehealth, it is possible to keep tracking patient outcomes and delivering care to the at-risk patients who need it most.
4. Practice Finances: Centers for Medicare and Medicaid Services (CMS) has expanded telehealth reimbursement in response to COVID-19. While it is a start, it may not be enough to keep practices afloat — the SBA is also stepping in to make low interest loans available. This still may not be enough. Deploying tools that make practices eligible for the Remote Physiologic Monitoring reimbursement codes may also help.

None of these improvements are perfect and we need to see much more support from policy makers, especially to support the smaller practices that do not have a voice in Washington. Support for small practices should be part of any COVID-19 stimulus package (sign the Petition to Congress to Support Independent Physicians and Practices During COVID-19)

The Leaders: Who to Emulate

There are several people and groups that have led the charge in response to the outbreak. Here are a few that should be applauded:

Dr. Farzad Mostashari, Founder & CEO of Aledade (Twitter, Linkedin)

A powerful voice on in #medtwitter, Dr. Mostashari and Aledade have led by example. They have been excellent communicators, and have provided useful guidance to all primary care providers throughout the epidemic.

Most impressively: In only three days, Aledade stood up Telemedicine for 150 independent providers in their network. Do not say it can’t be done, they have already shone it can be.

Dr. Rahul Rajkumar, Chief Medical Officer of Blue Cross NC (Twitter, Linkedin)

Under Dr. Rajkumar’s leadership, Blue Cross North Carolina was one of the first insurance companies to expand its telehealth reimbursements in response to COVID-19. (In fact, they have moved so fast, that the original link I posted over two weeks ago complementing their leadership has broken and been replaced with a rich amount of content).

They have continued to roll out helpful and useful information for their members and their network providers. They have expanded access to care through telehealth, allowed for early medication refills to promote sheltering in place, and continue to do everything in their power to make testing and care more available:

Dr. Jordan Shlain, Founder of The Private Medical (Twitter, Linkedin)

With his “Dispatches from the Frontlines” series on Tincture, Dr. Shlain has been one of the most active voices providing up-to-date (but vetted) information regarding COVID-19.

The founder of a direct primary care practice with offices in the San Francisco Bay, Los Angeles and New York, he and The Private Medical team are certainly at the front lines during this epidemic in the US.

VitalFlo’s Response: Doing Our Part

What We Do (Normally)

VitalFlo helps doctors keep their asthma patients out of the ER. We help clinical teams remotely collect data related to patient care including symptoms, lung function as well as potential asthma attack triggers in the home and local environment.

Dr. Jordan Shlain, Founder of The Private Medical (Twitter, Linkedin)

With his “Dispatches from the Frontlines” series on Tincture, Dr. Shlain has been one of the most active voices providing up-to-date (but vetted) information regarding COVID-19.

The founder of a direct primary care practice with offices in the San Francisco Bay, Los Angeles and New York, he and The Private Medical team are certainly at the front lines during this epidemic in the US.

VitalFlo’s Response: Doing Our Part

What We Do (Normally)

VitalFlo helps doctors keep their asthma patients out of the ER. We help clinical teams remotely collect data related to patient care including symptoms, lung function as well as potential asthma attack triggers in the home and local environment.

To help providers respond to COVID-19, VitalFlo’s platform can help keep at-risk chronic respiratory patients monitored from a distance. As discussed at length above, it is in everyone’s interest to keep these patients monitored without an in-person visit.

Our Patients are At High Risk of Severe COVID-19 Symptoms

Because COVID-19 is a respiratory disease, early evidence is revealing that asthma and other chronic respiratory patients are at a higher risk of getting very sick if they contract the coronavirus.

It is also very challenging for respiratory patients to differentiate between the symptoms of COVID-19, asthma, and seasonal allergies. Due to the current uncertainty caused by the outbreak, this can lead an asthma patient to visit their healthcare provider in person for something that could have been monitored remotely, increasing their risk of exposure to the virus.

In Response to COVID-19, We Are Waiving Our Platform Fees

This is a critical time and it is important for us all to do what we can to help.

Effective immediately, we are waiving all subscription fees for the most quickly scalable parts of our platform — our patient-facing automated daily symptom surveys and provider-facing clinical decision support dashboard, for the duration of this national emergency.

Additionally, providers will have the option to purchase home spirometry equipment to allow for more detailed vitals monitoring, which may qualify them for Remote Physiologic Monitoring insurance reimbursements. On behalf of interested providers, VitalFlo has secured preferred pricing through our device partners.

We Are Expanding the Vitals We Can Monitor

Our platform is very flexibly designed to best help collect patients vitals and symptoms. Following our automated symptom survey, patients who have spirometers or other respiratory devices export those measurements back to their doctor as simply and easily as texting a photo to a friend.

Because of this simple and intuitive interface, we are moving to rapidly add more vitals to the platform that will be useful for helping clinical teams monitor potential COVID-19 or flu infection (such as body temperature, blood pressure, and peripheral capillary oxygen saturation).

Providers Can Onboard Immediately, Individuals Can Soon

If you are a primary care provider, we can onboard you right now at no cost: sign up here for a 10–15 minute onboarding session.

VitalFlo has an automated process to notify your patients that they have the opportunity to enroll, to educate them about our data privacy provisions, and to onboard them into the remote monitoring system.

For patients interested in participating, please share this post with your provider and we will get them set up! VitalFlo is also working with our partners as rapidly as possible to launch a tool specifically for asthma patients. Stay tuned for more announcements (or sign up for announcements here).

You Can Help, Here is How:

Donate any Personal Protective Equipment You Have

N95 masks are especially in high need. If you have any N95 or surgical masks, please consider donating them to your primary care practice and help keep your care providers safe!

Stay at home as much as you can

You can help #FlattenTheCurve by breaking the chain of infection:

Pressure Lawmakers to Support Independent Practices:

Sign the petition:

Thank the people protecting you:

Now, more than ever, it is a time to come together.

Let’s celebrate our American heroes and do everything we can to protect and support them while they are standing in harm’s way to protect us.

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Luke Marshall is Founder and CEO of VitalFlo, a digital health company that helps doctors keep their asthma patients out of the ER. We help clinical teams remotely collect data related to patient care including symptoms, lung function as well as potential asthma attack triggers in the home and local environment.