Virginia Mason Medical Center
We have all heard the quote “Never let a good crisis go to waste,” and that can clearly be applied to the COVID-19 pandemic. The state of Washington was an early epicenter for the outbreak, and we experienced an immediate impact on how healthcare was provided. Elective procedures were cancelled, and clinic visits were reduced to only those considered to be urgently necessary. With lower clinic visit volumes, several regional medical centers in our system were temporarily closed and care delivery consolidated into a few facilities.
Our team-based care model was also significantly impacted by these changes, resulting in the furlough of more than half of our clinic pharmacist providers. This rapid change required the teams to get creative and redesign the care model in the face of COVID-19. Indirect work from all clinics was centralized and shared by remaining team members. Our in-person visits were shifted to telemedicine visits and care management that was previously handled outside the visits was redirected to video visits as well. This not only improved patient interaction and the care we provided, but also allowed for improved billing for the services.
Reimbursement parity for telemedicine visits allowed the pharmacists to manage care in the same manner as other providers and get paid for the care provided. The care teams also implemented innovative methods to manage our at risk anticoagulation population by implementing drive-through visits that allowed for an INR check and medication management, all from the safety of patients’ cars.
An additional benefit of this crisis was the appreciation of the pharmacist contribution to the care team. Due to concerns about Covid-19 infection, many patients missed or delayed routine visits, and this became apparent in our quality performance metrics. Our physician colleagues realized the urgency to get our patients with chronic diseases back in to care and there was no question as to which providers were best suited to make this happen. Previously furloughed pharmacists have been brought back to work and patients with chronic illness (chronic opiate therapy, anticoagulation, hypertension, asthma, and diabetes) are being pulled back into care.
The pandemic crisis fast-tracked the implementation of telemedicine visits, pushed needed change to the visit methodology that improved reimbursement, and highlighted the value that the pharmacists provide as part of the team-based care model. While none of us really like working in a crisis situation … never let a good crisis go to waste.
Roger Woolf, PharmD, FASHP, is chief pharmacy officer at Virginia Mason Medical Center.