In the first full week of May, the number people with COVID-19 who were hospitalized in Rochester hospitals went down and the number of people requiring ventilators has been about the same.
With the severity of cases seeming to level, at least in the short term, attention is turning back to people with chronic conditions who may have delayed seeking care, either because they were afraid to see a doctor, or their care providers were consumed by COVID.
While providers offered telephone or video visits, those weren’t options for many people.
“We went from 95% to 100% of our visits being in person to now having that be less than 20%,” said Dr. Laurie Donohue, chief medical officer of the Anthony L. Jordan Health Center.
Jordan’s main center on Holland Street was never closed, but Donohue said that some people were reluctant to come in because they feared catching the illness.
But it’s not just patients’ health at stake.
The U.S. health care system is a business, and it stands to lose billions of dollars because of COVID-19 – from the cost of treating the illness to the loss of revenue by having to delay elective procedures. People who stay away — for whatever reason — cost the system money.
Community health centers such as Jordan will be affected.
“Federally qualified health centers are not the richest organizations in town,” Donohue said. “We are OK right now.”
Jordan has received some federal funds and it has not had to furlough staff or lay off employees. Chief operating officer Jason Dunn said that is a last resort.
Jordan gets most of its revenue through Medicaid, which is funded by the federal and state governments. The center is reimbursed based on services provided, and less volume means less money. When the pandemic hit in March, state guidelines put routine visits on hold. In-person visits immediately dropped by 70%.
Revenue is down about $1.2 million from this time last year, Dunn said.
“We’re OK through July, maybe early August,” he said. “Unless we can get back to normal operations in that time frame, we have to take a long hard look at how we remain sustainable. Given who we serve, we cannot afford to go away.”
Health centers also want to know that they will be continue to be reimbursed for telemedicine visits through the COVID-19 crisis at the same rate as they are for office visits. Since most visits have been through telemedicine, that stands to be a considerable amount of money.
“We have to be sure that when all is said and done, we have the resources to keep going,” Donohue said. “Nobody knows what the future is going to bring.”
Donohue said it is important for Jordan, from a financial standpoint, to resume a full slate of office visits. She said emphasis now is on wellness visits for newborns through toddlers, and that will expand to 5-year-olds. She said that Jordan, like other providers, is working on how to reintegrate all ages into the office.
In April, Jordan opened a respiratory clinic for its patients with signs of COVID-19. The separate space at the Holland Street site reduced exposure to other patients and to allowed staff to see patients for their regular care. Jordan received help from the University of Rochester Medical Center, which also helped Trillium Health on Monroe Avenue open a respiratory clinic.
Donohue said in the past month, about 80% to 85% of Jordan’s visits were done over the phone or through videoconferencing.
“For follow-up for chronic illness such as diabetes, high blood pressure, asthma, one visit this way, maybe even two, are OK for folks who are stable,” she said.
While telemedicine has been useful, it also revealed shortcomings. Not everyone has access to a phone or computer. If they do, they may lack privacy. And sometimes a doctor or nurse needs to listen and look in person.
“As a family physician in the community for 30 years, the value of those face to face visits can’t be underestimated,” she said.
She said Jordan is working on how to resume those visits. So, too, are Rochester Regional Health and UR Medicine — for their own financial health as well as the physical and emotional health of the individual.
“I think the big thing for our community is don’t forget about your health in general,” Donohue said. “If we haven’t heard from you, please give us a call. We want to know how you’re doing, how your family is doing, that we are hearing from you. We will figure out how to continue your care.”