Tag: patient

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Virtual care becomes new standard in era of COVID-19

The coronavirus pandemic has forced a reshaping of the landscape of healthcare, requiring the medical community to look for new, safer approaches to patient care.

To keep patients and team members safe, virtual visits are now conducted via remote communication technology, such as Telehealth and Telemedicine. This is the new normal of patient doctor interaction, and represents a new era of healthcare delivery, and one that will continue into the foreseeable future.

As the pandemic continues, frontline workers at doctors’ offices and hospitals have been put to the ultimate test. In response, new and better programs of communications via Internet technology were enhanced, and audio check-ins restructured. Through telehealth and telemedicine, doctors and nurses can now engage patients via digital devices to meet basic healthcare needs.

During the height of the pandemic, most elective procedures at hospitals and doctors’ clinics were cancelled. With new variants of the virus threatening the country, a new challenge has been created. With elective procedures canceled, questions arose on how to safely care for emergency and non-emergency patients in a safe environment.

The solution was a broadening of virtual care to interact with patients, maintain safe environments, and adhere to mandated social distancing guidelines. The Centers for Medicare & Medicaid Services (CMS) increased access to Medicare telehealth services so beneficiaries could receive a wider range of care from their doctors without them having to travel to a healthcare facility.

“To protect both staff and patients, some medical practices closed their doors to in-person visits because of concerns over the risk of transmission,” said Randall M. Taubman, M.D., CPE, regional medical director at ClareMedica Health Partners LLC, Miami Lakes. “We remained open; our staff wore personal protective equipment (PPE) and each patient was thoroughly screened. Anyone screened as a possible COVID candidate was seen remotely.”

According to Dr. Taubman, video-based visits are preferred and more effective. “The doctor and the patient can see each other and it’s a more natural interaction,” he said. “Plus, if there are any physical changes, doctors can analyze the problem, and that’s a big benefit over an audio virtual visit.” Differences also exist between the way medical codes are applied and how video-based visits are billed.

Scheduling a remote health visit
Telehealth visits can be Web-based or done through a phone call to the office, but prior to the online interaction, most practices require verification of identity and insurance information. “Patients must consent to this form of care, and when they ‘meet’ with their doctor, the visit is conducted in much the same way as an in-person visit,” said Dr. Taubman. “The one exception is that doctors may ask additional questions about a patient’s general health and well-being.”

Before opting for a telehealth or telemedicine visit, patients should make a list of questions. They should also be prepared to explain any symptoms and list medications, dosages, and times they are taken daily.

“The best way to prepare for a virtual health visit is to find a quiet, private room where there are no distractions,” Dr. Taubman said. “Patients need to download any applications needed for the two-way communications and decide beforehand if the visit will be done on a computer, tablet, or phone. The doctor’s office needs to be aware of the patient’s choice. When prescribing medications, doctors still use electronic prescribing to send the script to a pharmacy — a routine practice even before the start of the COVID-19 pandemic.”

A new revenue stream
Reaching out to patients and serving them remotely is now a necessity to sustain physician practices. It is even a benefit to hospitals where there has been a revenue decline in long-standing money-making units such as operating rooms, interventional radiology, and outpatient services. Virtual care is now a proven means of caring for patients safely while tapping into a revenue source that helps offset the decline of in-person visits.

Over the months, regulatory and reimbursement barriers that hindered the widespread use of telehealth were relaxed, allowing providers more freedom to use virtual care for their patients. The Centers for Disease Control (CDC) says that during the first quarter of 2020, the number of telehealth visits increased by 50 percent. This allowed providers to scale their technology, learn more about various platforms, and reshape strategies that would be the most benefit to patients.

The difference between Telehealth and Telemedicine
The words “telehealth” and “telemedicine” are sometimes used interchangeably, but they don’t mean the same thing. The Health Resources Services Administration (HRSA) says telehealth is the “use of electronic information and telecommunications technologies to support long-distance clinical health services, patient and professional health-related education, public health, and health administration.” These technologies include videoconferencing, the Internet, store-and-forward imaging, streaming media, and wireless communications. Telemedicine, however, refers to “specific remote clinical services.”

Both play a critical role in the new era of patient care. Virtual care allows doctors to communicate with patients at a variety of locations that include their residence, a nursing home, an emergency room, or specific divisions within hospitals such as wards, special care units, and even psychiatric units. In addition, access to remote care greatly reduces the potential of exposure to the virus and lowers demands on frontline workers.

Types of remote visits
The three basic types of access routinely used are: Medicare Telehealth (MTH) visits, Virtual Check-ins (VCI); and E-Visits (EV). MTH utilizes telecommunication systems between the provider and patient and may include office visits, out-patient visits, or consultations. The VCI is a brief phone check-in with a practitioner to discuss whether an in-office visit is required, or a remote evaluation can be conducted where a patient can submit images (as in the case of dermatology) to his or herdoctor for  evaluation. The EVs are a format to communicate between patient and provider via an online patient portal.

Telehealth popularity
According to the CDC, the number of telehealth visits in the U.S. increased by 50 percent during the first quarter of 2020 and providers reshaped their strategies to engage with patients. “The use of telehealth is a trend that I don’t foresee diminishing even if COVID improves,” commented Dr. Taubman. “It can help with physician shortage and travel issues in the medical industry, so I believe it’s here to stay.”

According to a Telehealth Impact Claims Analysis conducted by the COVID-19 Healthcare Coalition Telehealth Impact Study Work Group, the latest numbers on telehealth claims in Florida peaked at around 700,000 in April of 2020, and the primary diagnosis of circulatory issues exceeded 200,000. Claims nationwide for circulatory issues in the country exceeded five million in February of last year, and total claims exceeded 12 million.

New advances in digital health technology have transformed patient treatment models internationally. Greater access and more efficiency are the keys to serving patients in the era of COVID-19.

 

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A “hip” approach to state-of-the-art care

Dr. Leone’s specialized surgical approach, combined with personalized care, linked to faster recoveries for hip and knee patients.

More than a decade ago, Dr. William A. Leone, head of The Leone Center for Orthopedic Care at Holy Cross Health in Fort Lauderdale, made an intentional and compassionate decision, transforming the patient care model for his orthopedic practice. It was founded on his vision of providing state-of-the-art orthopedic care while treating every patient with how he would want his family members, and himself, cared for.

Dr. Leone’s unique integration of clinical, surgical, and technological expertise, combined with caring, personalized attention from him and his entire staff, have helped restore mobility and improve the quality of life for thousands of patients from throughout the United States and around the world. He cares for people in their 80s and 90s who refuse to relinquish their independence and opt for surgery to regain their quality of life. He also treats patients in their 20s and 30s who desire an active lifestyle and want to feel “normal” again.

His comprehensive and patient-centered approach begins with the initial consultation and persists throughout the entire post-operative period. Patients are guaranteed increased availability with Dr. Leone and his entire staff, work with a designated and responsive patient liaison, and are educated on what to expect throughout the entire process. This ensures each patient’s entire experience is as positive and comfortable as possible, resulting in successful results and faster recoveries.

“A wonderful trend I’ve seen over my extensive career is that each year my patients are getting well faster and recovering easier than ever before. My surgical procedures are more precise and reproducible and today’s implants are vastly improved compared to years prior,” said Dr. Leone. “Combined with less invasive and more anatomically-sparing surgical techniques and my emphasis on preempting, preventing, and down-regulating pain have all led to patients getting well faster than ever before and regaining their quality of life.”

To avert pain, medication begins prior to surgery, special anesthetic techniques combined with local injections and nerve blocks, gentle soft tissue handling with precise soft tissue balance, and post-operative medications from different families of drugs taken on a schedule, have all made a world of difference. One of the reasons Dr. Leone’s patients recover so quickly is that they are well prepared for their surgery. When patients go into surgery knowing what to expect before, during, and after their surgery, they are less anxious, recover quicker with more confidence, and have an overall superior experience.

“In my experience, a respected, well-informed patient not only has a faster, smoother recovery but also a much better experience, which contributes to a superior outcome,” said Dr. Leone. “Choosing the right surgeon with the right team and at the right hospital is critically important. Education combined with confidence are key ingredients for success.”

Dr. Leone encourages anyone considering hip or knee surgery, to browse his website. He’s written more than 100 blog articles; some are shared thousands of times each month. There is a section on “Frequently Asked Questions,” and he’s particularly proud of the hundreds of inspiring testimonials from patients who share their gratitude and inspiring stories.

The Leone Center for Orthopedic Care provides superb, highly personalized, orthopedic care for people with arthritic hip and knee conditions and for patients who develop problems with a prior joint replacement. Dr. Leone offers patients the latest, most-promising innovations for joint replacement surgery in a compassionate, patient-focused setting. He has performed over 13,000 joint surgeries throughout his career, restoring mobility and improving the quality of life for thousands of patients from around the globe.

The Leone Center for Orthopedic Care at Holy Cross Health is located at 1000 NE 56th Street in Fort Lauderdale. For more information or to schedule a consultation, please call 954-489-4575 or visit holycrossleonecenter.com.

 

 

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Congressman Ted Deutch (D-FL, 22nd District)

As we approach the first anniversary of the COVID-19 pandemic, we are reminded of how this public health crisis has impacted our community.

In the course of a year, we have lost over 28,000 Floridians, millions of Americans are still out of work, and the need for economic relief has never been higher. I’ll continue to work with my colleagues in Congress and the Biden administration to provide critical resources to South Florida.

While many of us are eager that COVID-19 vaccinations are now being distributed, I know many are frustrated with how distribution has gone so far. As we await more shipments to vaccinate our most vulnerable community members, residents are asked to remain patient.

For more information regarding vaccination sites throughout South Florida, please visit my Facebook page (Facebook.com/CongressmanTedDeutch) and my website (Deutch.house.gov).

One in twenty seniors in the U.S. is a target of fraud schemes, costing them at least $36.5 billion per year. Yet, the National Adult Protective Services Association has found that only 1 in 44 seniors actually report that they are victims of a fraud scheme.

Last Congress, I joined Rep. Buchanan and Rep. Welch to introduce the Seniors Fraud Prevention Act that was incorporated as Title II of the Stop Senior Scams Act (H.R.2610). The Stop Senior Scams Act passed the House and the Senate but it was not signed into law.

This bill would create an office within the Federal Trade Commission charged with tracking scams, educating and alerting seniors to new scams, and establishing a more effective complaint system to ensure reports of fraud are quickly addressed by the appropriate law enforcement agency.

As we begin this year with a historic opportunity to continue our actions to help prevent gun violence, I am proud to rejoin the Gun Violence Prevention Task Force leadership for the 117th Congress. Task Force leadership is drawn from members with diverse backgrounds, including former prosecutors and members of law enforcement, gun violence survivors, veterans, hunters, and teachers. These leaders hail from rural and urban districts in states across the nation as well as districts that have experienced devastating gun- related tragedies.

As always, please feel free to reach out to my office if we can be of any assistance. I urge everyone to continue to follow CDC guidelines to help stop the spread of COVID-19. Stay safe!

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Broward Health Coral Springs offers elite cardiac services

For many years Broward Health Coral Springs (BHCS) provided cardiac care services to the community, but one key component was missing—a cardiac catheterization lab for emergency catheterizations. Subsequently, patients were transported to other facilities, but that’s no longer the case.

Last June, a new state-of-the-art cath lab became operational at BHCS. “We now have the ability to care for specifi c patients with ST Elevation Myocardial Infarctions (STEMI),” said Mohamed Osman, M.D., director of the Cardiac Catheterization Laboratory and specialist in Interventional Cardiology at BHCS. “This is a unique opportunity to provide an even higher level of care through angioplasty procedures.”

Designated as a Level 1 Heart Program by the Agency for Healthcare Administration, the new cath lab was termed a “milestone” by hospital CEO Jared Smith, one that “increases our ability to provide a high level of care and uphold our recognition (per Our City Magazine) as the area’s best hospital and Emergency Department.”

Gary Lai, D.O., and chief of Emergency Medicine says the addition of the STEMI heart program makes it possible for EMS to pre-alert the ER and send electrocardiograms prior to a patient’s arrival. “We can prepare immediately to stabilize, medicate, and expedite patients to the in-house cath lab,” he said. “This saves lives and maximizes outcomes.”

The new catheterization lab allows BHCS specialists to perform invasive cardiac procedures and utilize advanced imaging for diagnoses by using contrast dye to determine the severity of the arterial blockage. Once identified, a balloon angioplasty is performed, or a stent is inserted to clear the artery and save as much of the heart muscle as possible. Pacemakers and defibrillator implant procedures are also performed.

Generally speaking, the last 20 years has seen a rapid transformation of new techniques focusing on minimally invasive procedures, rapid care, and shorter hospital stays, according to Dr. Osman. “Although open heart surgery is certainly an option, the major shift has been toward less invasive, less traumatic procedures that obtain excellent results.” People with severe heart valve problems always required open heart surgery. A significant number are now treated with stents to reduce the risk of a major heart event.

Surgical progress in cardiology can be defi ned by an alphabet soup of acronyms: SAVR (Surgical Aortic Valve Replacement); CABG (Coronary Artery Bypass Graft); BAG (Bilateral Arterial Grafting); PCI (Percutaneous Coronary Intervention); TAVR (Transcatheter Aortic Valve Replacement); EVAR (Endovascular Abdominal Aneurysm Repair): and ICD (Implantable Cardioverter Defi brillator). The term Electrophysiology refers to leadless pacemakers and remote monitoring devices. “Because of these techniques, patients spend less time in the hospital, recover faster, and there’s less trauma to the body,” said Dr. Osman. “An aortic valve replacement once required open heart surgery, but now the TAVR procedure accomplishes the same goal by inserting a transcatheter through a small incision in the groin.”

Surgical complications 

Any medical procedure has the potential for complications such as excessive bleeding, stroke, and even death, but the key is how often complications occur as a result of surgery. “Both minor and major complications are possible, but keep in mind that no patient is the same,” said Dr. Osman. “If a younger patient requires open heart surgery the only problem is the heart and nothing else, so the focus is isolated, but older patients—especially those with underlying conditions such as diabetes, kidney problems, or a previous stroke, are in a high- risk category for complications,” the specialist said.

To show that one size doesn’t fit all, Dr. Osman uses the example of two patients with the same high percentage of blockage that would be treated differently. “The one who is asymptomatic can be treated with medications and dietary changes, while the other who has difficulty breathing and may have underlying medical conditions is a prime candidate for a stent.” He reminds us that everyone is different, and each patient requires a different mode of treatment depending on general health and underlying conditions. “The key is a full evaluation to create a treatment plan with the best benefit.”

Dr. Osman refers to the doctor-patient relationship as “the art of medicine.” The unique relationship includes listening, evaluating, diagnosing, and treating. “At the end of the day when pieces of the ‘puzzle’ come together it’s the collaboration between the surgeon and interventional cardiologist that makes it happen,” he said. He recently saw a patient with a 90-percent blockage of the artery. CABG open heart surgery was performed, and the person is expected to make a full recovery. Choosing the right therapy is the goal.

The COVID consequence

When COVID’s first wave peaked in March 2020, it impacted cardiology services.

With a focus on caring for acute COVID patients, the shift was away from elective cardiac procedures. “Many patients feared coming to the hospital out of fear of COVID and that posed a huge problem,” said Dr. Osman. “In cardiology, time is a big factor and the longer treatment is delayed the worse a condition can become.” He cited a patient who suffered a heart attack yet remained at home for two days. They were able to save his life, but the heart muscle was significantly damaged and he’s now living with a very weak heart muscle. “Things like this are still happening but not to such a high degree. Remember that the margin of error is much less with age,” he said.

The medical facility keeps a log on how long it takes after arrival in the ER to when a clogged artery is opened in the cath lab. According to Dr. Osman the best time to date has been 23 minutes.

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Congressman Ted Deutch (D-FL, 22nd District)

I’m honored to once again serve the people of Florida’s 22nd District. As we enter the new Congress, we continue to live through a pandemic that has weakened our economy, put millions out of work and taken the lives of hundreds of thousands of Americans. We need efficient vaccine distribution, additional economic relief, and continued response efforts to heal and protect our neighbors and restore our economy.

Since last year, the COVID-19 pandemic has caused tremendous challenges for our community. In December, Congress passed a long overdue COVID-19 relief package to address our community’s top concerns. However, Congress must continue to support families and small businesses to help them get through this pandemic. I look forward to working with the new Biden administration to extend economic assistance and strengthen our pandemic response efforts throughout South Florida.

While many of us are eager that COVID-19 vaccinations are now being distributed, I know many are frustrated with how distribution has gone so far. I share your frustrations and have been pressing state and local officials to make public a comprehensive vaccine plan. We must be patient due to limited supplies but also continue to urge a distribution plan with full transparency for all Floridians.

For more information regarding vaccination sites throughout South Florida, please visit my Facebook page (Facebook.com/CongressmanTedDeutch) and my website (Deutch.house.gov).

As always, please feel free to reach out to my office if we can be of any assistance. I urge everyone to continue to follow CDC guidelines to help stop the spread of COVID-19. Stay safe!

I look forward to working closely with the new administration on shared priorities such as ensuring meaningful action on gun violence and climate change, two deeply personal issues to Florida. We need to strengthen Social Security by increasing benefits and extending solvency to ensure this essential program remains for generations. Congress must also exercise its role in foreign policy to defend human rights, support our allies, and protect our national security.

 

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Something about him was familiar

Best Christmas story or nightmare. You choose.

One day I had a new client come in with a 7-year-old Bernese mountain dog. Chewy presented with a lack of appetite, diarrhea, and vomiting. When the clients came in, I immediately recognized their dog. He had an unusual white stripe on the forehead. The puppy I remembered had the same color pattern and white stripe as Chewy. So, I asked my technician to leave the room and look up Bernese mountain dogs that I have seen over the past 7 years.

I asked another technician to come in to help me perform the physical examination on Chewy. Chewy was clinically dehydrated, his abdomen was tense, the fur on his face smelled like vomit, and his rear end had remnants of diarrhea still on the fur. I told the clients that we would need to start with some blood work and x-rays, and my technicians recruited some help to pick up this 135-pound beast onto the x-ray table. I went back into the exam room and started to talk about the other Bernese mountain dog with similar markings.

Looking back, it was about 7 years ago when a young couple bought a puppy from a breeder. It was in December and the young couple went away for Christmas and left the puppy with their friend and my client. They didn’t leave a cage or toys and the young woman who took care of the puppy left him in a spare bedroom where the puppy did tremendous damage.

One day the puppy got out of the bedroom and destroyed their Christmas tree. He knocked it over, ripped open presents, chewed up ornaments, and ate the stockings. I remember informing the young woman when she brought him in that I was going to have to perform surgery to retrieve all the things that he ate. It ended up being a problem because we couldn’t communicate with the owners based on their travel, but the surgery was an emergency. I ended up performing the surgery which went without complications. The friend ended up paying for the surgery and I found out later that the whole ordeal ended their friendship.

My technician who was doing the deep dive into the research came in and told me that my instincts were correct and it was the same dog. His name was John. When the new owners found out that his name was John they asked if the original owner’s name was Hortensia. It was.

Same dog, similar situation. I ended up telling the new owner my history with John. They adopted John about a year ago, hated the name and call him Chewy because he always has something in this mouth.

My technicians came back in with Chewy and we put the radiographs on the examination computer and we could see the problem right away. Chewy had  about 9 pacifiers in his stomach. I asked the owners if they have a child and they did. Each parent thought it was the other one that got rid of the pacifiers, but it was Chewy. I told them that Chewy needed surgery. The fact that there are 9 pacifiers means that they are not passing. I thought it was fortunate for them that when they adopted John the previous owners transferred the insurance to them, and they never canceled it. And I told them that they never will. Best holiday news ever. Love, Chewy.

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