Covid

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The clinic our residency works in is trying to transition completely to tele and phone. Ideally able to work from home.
 
The clinic where I work is doing a combination and I am doing that at my private practice for now as well.
 
My department is aggressively cancelling/rescheduling clinic appointments and pushing for as much as possible to convert to telepsych.

As a PGY2 still close to medicine I am fully expecting to need to work off service once the flood of critically ill patients starts.
 
Which Telepsych platform are people using?
Zoom for Healthcare
Skype for Business
Clocktree
doxy.me

I believe a gt modifier code is used? How are insurance companies reimbursing typically?
 
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Sushirolls said:
Which Telepsych platform are people using?
Zoom for Healthcare
Skype for Business
Clocktree
doxy.me

I believe a gt modifier code is used? How are insurance companies reimbursing typically?
Click to expand...

Doxy.me

Unfortunately, only 1/2 of the insurances I take reimburse for telemedicine; so, I'll be doing a hybrid.


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Sushirolls said:
Which Telepsych platform are people using?
Zoom for Healthcare
Skype for Business
Clocktree
doxy.me

I believe a gt modifier code is used? How are insurance companies reimbursing typically?
Click to expand...

I’ve used Vsee
 
Celexa said:
As a PGY2 still close to medicine I am fully expecting to need to work off service once the flood of critically ill patients starts.
Click to expand...
Wait? As in medicine medicine??? Could this happen? As someone who has not touched a stethoscope or worked with adults in years, this is terrifying. All the covid posts about pips and peeps and airflow seem like latin to me at this point. 😱
 
Ironspy said:
I’ve used Vsee
Click to expand...

I’m converting to 100% telepsych for now. Figure if I can prevent a dozen patients per day from coming into a doctors office, it could be helpful. I Do not anticipate payers giving patients/doctors a hard time for doing a telepsychiatry visit if it’s done in an effort to decrease potential transmission of COVID-19.
 
Monocles said:
Wait? As in medicine medicine??? Could this happen? As someone who has not touched a stethoscope or worked with adults in years, this is terrifying. All the covid posts about pips and peeps and airflow seem like latin to me at this point. 😱
Click to expand...
Yes, this could happen. In Italy specialists have been pulled in to help. However, I doubt off service residents would be managing vents... More likely medicine residents would be prioritized to the critical patients and off service to floor or triage.

forums.studentdoctor.net

Coronavirus: Residents being told to work in DIFFERENT specialty

Just got word that residents at my institution (a large academic medical center in NY) across *all* specialties (OB, Peds, Psych, etc.) will be required to staff and work adult medicine floors as expected adult admissions, including to the ICU, increase as more test positive and need...
forums.studentdoctor.net forums.studentdoctor.net
 
Monocles said:
Wait? As in medicine medicine??? Could this happen? As someone who has not touched a stethoscope or worked with adults in years, this is terrifying. All the covid posts about pips and peeps and airflow seem like latin to me at this point. 😱
Click to expand...
 
89527244_10163201886735582_1758511966357291008_n.jpg
 
RomanticScience said:
Unfortunately, only 1/2 of the insurances I take reimburse for telemedicine; so, I'll be doing a hybrid.
Click to expand...
It is likely most major insurers will make an exception for this - many already have. I am hoping so but I will just eat the cost for those who we cannot get coverage. I can't justify bringing patients in to see me anymore. But things are worse here than where you are as of now.
 
I switched nearly all my patients to video/phone last week with the exception of a few that have unstable housing where I can’t quite figure out yet how to mail medications safely.

My comment on reviewing vent settings in another thread wasn’t a joke. Spent the last week reviewing things on uptodate, brushing up on interpreting ABGs and watching videos/tutorials on managing vent settings just in case. I’m fully expecting that I may get asked at some point to help and I’d rather be prepared than on my heels.
 
I just signed up for doxy.me been trying to setup the work flow for patients, plan to roll it out and alert people with more gusto tomorrow AM. Was planning on diving into telepsych in a few years once practice is full, but this is good enough reason to dive on in.

Psychiatrists will not be asked by the state medical board or the local hospitals to come on in to help out. Simply put there just aren't enough ventilators, nor are there enough in the stand by emergency gov supplies or local DME rentals. The Pulm/Crit/Anesthesiology/well to do IM will be more than enough to manage the pittance of ventilators available. This is the real limiting factor.
 
Sushirolls said:
I won't touch a vent. I know enough to know I will actually harm patients, and kill them if I were to manage vent settings, and in direct violation of my oath to do no harm, I simply won't. No amount of quick refreshing will fix that. I refuse.
Click to expand...

How long have you been out from residency? Wondering if that’s the difference.
 
Sushirolls said:
I just signed up for doxy.me been trying to setup the work flow for patients, plan to roll it out and alert people with more gusto tomorrow AM. Was planning on diving into telepsych in a few years once practice is full, but this is good enough reason to dive on in.

Psychiatrists will not be asked by the state medical board or the local hospitals to come on in to help out. Simply put there just aren't enough ventilators, nor are there enough in the stand by emergency gov supplies or local DME rentals. The Pulm/Crit/Anesthesiology/well to do IM will be more than enough to manage the pittance of ventilators available. This is the real limiting factor.
Click to expand...

I don't think we'll be called to manage vents, but I would bet we'll be called to do H&Ps in non-COVID patients. My hospital has already put us on standby.
 
As an update, I'm gotten an assurance that both of my insurances will cover telemedicine. I have some patients who still want to come in. As a back-up, I used google meet (if you have gsuite, their BAA covers meet [i.e., HIPAA-compliant]). The downside to google meet is that each meeting needs a unique code.
 
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RomanticScience said:
As an update, I'm gotten an assurance that both of my insurances will cover telemedicine. I have some patients who still want to come in. As a back-up, I used google meet (if you have gsuite, they're BAA covers meet). The downside to google meet is that each meeting needs a unique code.
Click to expand...

Interesting that you can use google meet that makes things super easy software-wise.
 
Mass Effect said:
I don't think we'll be called to manage vents, but I would bet we'll be called to do H&Ps in non-COVID patients. My hospital has already put us on standby.
Click to expand...

Thankfully we have ~200 psych beds so no one is talking about pulling is to manage medical beds at this point but they are talking about pulling upper levels back onto c&l which is almost worse. C&L in our program is the 10 weeks of 2nd year where most of the residents on service experience daily PDW and if I could guarantee I just got one of those mild cases of COVID I would choose that and weeks of quarantine over doing that again in a heartbeat.
 
clausewitz2 said:
Thankfully we have ~200 psych beds so no one is talking about pulling is to manage medical beds at this point but they are talking about pulling upper levels back onto c&l which is almost worse. C&L in our program is the 10 weeks of 2nd year where most of the residents on service experience daily PDW and if I could guarantee I just got one of those mild cases of COVID I would choose that and weeks of quarantine over doing that again in a heartbeat.
Click to expand...

Wow, that bad?
 
Mass Effect said:
Wow, that bad?
Click to expand...

Every new consult gets a full psychiatric evaluation regardless of question and we basically refuse to do curbsides. The norm is always to tell them to consult us and we'll see the patient. This combines with certain attendings who are of a nervous disposition and want essentially everyone we are consulted on followed every day for extended periods of time AND would like all decisions for the 20+ people you are meant to be seeing every day staffed with them before writing them in a note anywhere.

After a year and a half of outpatient if I have to engage with one more extended soliloquy about starting with 25 or 50 mg of Zoloft I will be looking for a high window.
 
I'm currently at a rotation site that does tons of truly ridiculous voluntary admissions. Suggestions that we maybe curb admissions in the face of this have been met with scorn / indifference. In the meantime they keep putting policies in place that make no sense, public health-wise. Feeling really frustrated.
 
drzoidbergsgotnothingonme said:
I'm currently at a rotation site that does tons of truly ridiculous voluntary admissions. Suggestions that we maybe curb admissions in the face of this have been met with scorn / indifference. In the meantime they keep putting policies in place that make no sense, public health-wise. Feeling really frustrated.
Click to expand...

Let me guess, for-profit hospital? These places are terrible.
 
Are inpatient units changing to single patient in each rooms? Our unit has a few single rooms but most are doubles. Unclear if we should have only one patient per room. They still come out for groups and meals. They’re out of the room mingling in the milieu more than in their room.
 
nexus73 said:
Are inpatient units changing to single patient in each rooms? Our unit has a few single rooms but most are doubles. Unclear if we should have only one patient per room. They still come out for groups and meals. They’re out of the room mingling in the milieu more than in their room.
Click to expand...

And as with rationale for non-existent contract precautions when on an inpatient unit it isn't exactly therapeutic to be stuck in a single bed hospital room sans groups and activities. This is new ground I guess we will figure it out as we go along. I saw an interesting blurb from CMS regarding transfer of inpatient psych patient to medical bed, treat it as continued psych admission, document necessity and they are able to remain safe on medical floor.
 
Jules A said:
And as with rationale for non-existent contract precautions when on an inpatient unit it isn't exactly therapeutic to be stuck in a single bed hospital room sans groups and activities. This is new ground I guess we will figure it out as we go along. I saw an interesting blurb from CMS regarding transfer of inpatient psych patient to medical bed, treat it as continued psych admission, document necessity and they are able to remain safe on medical floor.
Click to expand...

Say. . . What?!

If the **** hits the preverbal fan, we won’t have room in the hospital for more healthy people. It’s a bad idea. Risk to the patients.

We have an associated psych unit that transfers lots of things they can’t do logistically (basically contact precautions for diarrhea). Sometimes its frustrating, but as a 600+ bed hospital, we have been on and off at capacity for the past 6 months.
 
clausewitz2 said:
Every new consult gets a full psychiatric evaluation regardless of question and we basically refuse to do curbsides. The norm is always to tell them to consult us and we'll see the patient. This combines with certain attendings who are of a nervous disposition and want essentially everyone we are consulted on followed every day for extended periods of time AND would like all decisions for the 20+ people you are meant to be seeing every day staffed with them before writing them in a note anywhere.

After a year and a half of outpatient if I have to engage with one more extended soliloquy about starting with 25 or 50 mg of Zoloft I will be looking for a high window.
Click to expand...
If I didn't already know where you are in residency, I'd think you were at one of the two hospitals we rotate at. Pretty much the same exact experience here.
 
NITRAS said:
Say. . . What?!

If the **** hits the preverbal fan, we won’t have room in the hospital for more healthy people. It’s a bad idea. Risk to the patients.
Click to expand...

Relax I wasn't suggesting doing anything simply pointing out inpatient psych doesn't necessarily fit too well in general hospital type directives. As I said its new ground but we will figure it out.
 
Monocles said:
Wait? As in medicine medicine??? Could this happen? As someone who has not touched a stethoscope or worked with adults in years, this is terrifying. All the covid posts about pips and peeps and airflow seem like latin to me at this point. 😱
Click to expand...
www.natlawreview.com

HHS Issues Section 1135 Waiver, and CMS Issues Blanket Waivers of Health Care Laws, in Response to Coronavirus (COVID-19) Emergency

Following the President’s proclamation on March 13 that the COVID-19 outbreak constitutes a national emergency, Secretary of the Department of Health and Human Services (HHS) Alex Azar issued a Waiver or Modification of Requirements Under Section 1135 of the Social Security Act (full text...
www.natlawreview.com www.natlawreview.com

"Allows acute care hospitals with distinct psychiatric units or inpatient rehabilitation units, to move patients from those units to acute care beds/units, and also allows acute care hospitals to move acute care patients to “excluded distinct part units” (e.g., to the psychiatric or IRF units), if appropriate for the care to be provided."

My bet is most psych units will close down, with the sickest patients transferred to state psychiatric hospitals and everyone else treated alongside medical patients or released, after which all beds will be converted temporarily to medical beds and psychiatric residents, nurses, and techs will have to care for some of the less I'll patients that are in serious but not critical condition
 
NITRAS said:
Say. . . What?!

If the **** hits the preverbal fan, we won’t have room in the hospital for more healthy people. It’s a bad idea. Risk to the patients.

We have an associated psych unit that transfers lots of things they can’t do logistically (basically contact precautions for diarrhea). Sometimes its frustrating, but as a 600+ bed hospital, we have been on and off at capacity for the past 6 months.
Click to expand...
I strongly predict that psych will take a back seat in a full blown pandemic and psychiatric patients will largely be left to their own devices or the criminal justice system. Our ER is usually about 1/3 psych patients and that just isn't tenable in a pandemic situation- psych ER beds will likely be cut to a set number (our four locked area beds) with everyone else turned away.
 
I noticed a significant increase in "R/o Covid" on the ED tracker tonight. I pray this does not get out of hand.
 
With CMS relaxing guidelines around telehealth today, psychiatrists have a tremendous role to play in not only caring for folks without covid, but holding and processing anxiety of clinicians and healthcare workers, and the patients/families impacted directly by this.
 
Please try to convert your non-urgent appointments to telepsych appointments or telephone visits. Do what you can over the phone and minimize face-to-face contact.

I'm very irritated by my own institutions response to this (I'm a graduating fellow) but for those who are attendings, do what you can to be safe and keep others safe.
 
I completely agree.
SourceOfDenial said:
With CMS relaxing guidelines around telehealth today, psychiatrists have a tremendous role to play in not only caring for folks without covid, but holding and processing anxiety of clinicians and healthcare workers, and the patients/families impacted directly by this.
Click to expand...
ara96 said:
Please try to convert your non-urgent appointments to telepsych appointments or telephone visits. Do what you can over the phone and minimize face-to-face contact.

I'm very irritated by my own institutions response to this (I'm a graduating fellow) but for those who are attendings, do what you can to be safe and keep others safe.
Click to expand...
 
Things can always be worse. That is one of the unofficial learning objectives of (O)MS-III/IV. The experiences of the human condition illustrate that life can always be worse.
 
Update regarding my crash course into Doxy.me, so far the video quality is okay for the free version. Gets the job done, not crisp enough to point out my wrinkles or random acne.
-Discovered its best to do two browsers, one for the EMR charting, and another for the doxy.me video, side by side.
-Actively reminded myself to look at the camera to simulate eye contact.
-Pre-run trials, noted that cell phones on cellular data didn't connect, but cell phones with wifi connection do. Computers worked. Lap tops work.
-Getting paperwork like PHQ/GAD, pre appointment questionnaires done are a bit more tedious.
-Needed to review billing criteria for 99214 as not doing any vitals, and making sure I was still on track for it.
-GT modifier from very brief reading seems to be what I'll be putting down
-Laborious process to reach out to the whole patient panel 'we now have telepsych! Click on in!'
-For better or worse you get a glimpse into the back drop of the living arrangement of your patient.

I had reached out to Luminello folks, and they have no immediate plans to implement their own de novo program or third party integration.
 
Last edited:
Mass Effect said:
Get?
Click to expand...

Maybe I'm naive, but what has been the issue thus far? Our University hospital (in a million person city) is slightly less busy than normal. When is this tsunami of patients supposed to be coming?
 
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