iramurphy

Verbal visits are charged $15-25. The Visual/virtual visits are charged the same as the office visit. None of my virtual visits have lasted more than 20 minutes. (99213) Most of the clinic visits are 25-30 minutes (99214). Almost none of the virtual visits involve any physical. So although they are paid the same, revenues are down. Physical therapists are also doing virtual visits but can’t do modalities nor anything with equipment. In Minnesota the Governor doesn’t allow elective surgeries and Ortho Surgeon are doing very little so some specialties are suffering more than others. Lots a patients are canceling appointments. Most of my colleagues claim revenues down 70%. Once our supplies are replenished, our surgeons should be able to resume their outpatient procedures, but many patients will still postpone due to fears. Our clinics will close when we are needed in hospital or ER. Once the surge is over, I suspect it may be similar to starting a new practice with the advantage you have already a foundation of patients who have been seeing you prior to the crisis.

This is likely the toughest decision these governors have had to make. I think it has to be piecemeal and organized based on the state/region. Each state is also going to have a plan in place if the return to work causes a surge. We are going to have to be disciplined as a society to follow the return to work plan to decrease risks and chance of failure. Will we have the resources if the plan includes regular antibody or CV-19 testing. It’s likely the media and the political parties will criticize because there will still be new infections. The fact is, the longer this goes on the shut down becomes more than an economic emergency it is a threat to people’s health if people and businesses have no income and the food pantries can’t keep up with the demand.

I agree, but the political comment added nothing and many of us in the medical field who are willing to share thoughts, information and especially keikla’s NewYork experience are not willing to continue on this site if that crap gets going again. We can go back to PM’s between us because she has had a medical life changing experience in many ways similar to a soldier’s combat experience. I am learning from her despite almost 40 yrs experience including ER, ICU and combat as a medical officer. If someone else’s political rants are more relevant then what she is sharing then I’m on the wrong page. I’ve also learned a lot from business owners, employers and the rest of you sharing experiences and opinions. I’ve learned absolutely nothing from the political comments.

I agree. The challenge is timing.

Knock off the political crap. The majority of people are mature enough to do that. Give it a try.

I have seen some similar studies that put New York City area, Seattle area and California in a separate group. I think the amount of travel from countries with high infection rates early on and populations are major factors but we will need to sort out all of the other variables to know what else could have been done, when it should have been done, what shouldn’t have been done and how to best prepare for future threats. I’m sure almost everyone else knows at least this much but the how going forward is the tough part. Which cities did better? Which countries did better? In the meantime, we struggle to find best treatment, and an effective vaccine as soon as possible. We also need to monitor best practice and most effective means of returning to work while at the same time we minimize risk, spread of the disease and death. I hope you are feeling better. Be safe.

Pretty good article. Underlines the complexity of your world. In my simple mind, it seems to me, the multiple ways epidemiologists and scientist are trying to summarize rapidly changing data without constant variables, from multiple sources. The multiple sources aren’t using the same parameters to measure and collect data and statistics. Then, they try to apply that information to select models and try to hit a moving target in an ever changing environment. You live in a complex world with a difficult task if this is your world.

You too. Get lost.

Take this crap elsewhere. We had gone almost a day with only one other stupid post.

We are using same d dimer parameters. I will add fibrinogen to my protocols. Thanks. Get well.

I can’t remember if I learned from you or other research or both, but obese patients seem to be at higher risk for pulmonary emboli. We have included d dimer testing and anticoagulants in our protocols. Your advice and experience over the past couple of weeks is appreciated.

We tried that in our lobby but when the German Shepard stuck his cold nose between the guys cheeks he lurched forward about 8 feet and broke his collarbone. The lady waiting to see her provider for fibromyalgia freaked out when the guy dropped his drawers in the waiting room and soiled herself. Needless to say I am dealing with the guys attorney and the lady’s minister. Both incidents have been recorded as Covid related trauma.

Withdrawal from Sioux hockey when we had a great shot at #9? Take care of yourself and get well soon. Prayers and positive thoughts your way. Are you going to do antibody testing when you get through this? I had something similar in Feb and missed a day of work for illness for first time in 45 yrs. I assumed Influenza A cuz we had no Covid around the region back then but I’m going to do the antibody testing when the new more accurate test comes out.

They were referring to retesting. The theory was the false positive test could be due to dead virus or residual weak virus. I would defer to the microbiologists or others who have a thorough understanding of the test and how this would affect the results.

Your questions are valid and frankly, critical. I would guess return to work and other activities are going to be as much trial and error as what the medical professionals are trying with our treatment protocols. I’m not Yogi Berra, but he might say we don’t know until we know. Whomever is first to send their citizens back to work will have to accept the responsibility of the consequences, just as those who keep their citizens home. We all know regardless, they will be criticized and likely thrown under the bus by the media.

From what I read, some are showing mild symptoms. Questions raised included the question of false positives or incomplete recovery. It underlines the importance of finding a treatment and vaccine.

Well, we went went for an hour or two before someone felt the need to inject politics.

Correct. The other issue is that we need to figure out what the antibody testing tells us. We test for IgM and IgG antibodies. Results can vary. Patient can be positive for IgM and negative for IgG. Does that mean they have the disease but aren’t yet immune? If positive for both antibodies does that mean infected and now immune? If positive for IgG only can we conclude anything? In South Korea they have over 150 patients who had Covid recovered and are now positive for Covid again. That is why we are struggling medically and why the decision makers are struggling. We just don’t know.

I think Keikla understands confidence intervals as well as asymptomatic. You have made a very valid point in that the important information being gathered by epidemiologists/statisticians is in a state of flux. I’m not sure until one reviews all of the variables, parameters etc that we can reach conclusions but I think that is one of the points you and others are debating. Unfortunately, that makes it almost impossible for the government leaders to know what to do next.

Points well taken. The reason for stopping elective surgeries was to preserve PPE’s and medications necessary for intubation. If we reach a time when we have adequate supplies and meds, I would strongly recommend resuming all necessary medical procedures. We never stopped seeing patients in our clinic,? but we see patients by appointment only and screen for potential Covid patients at time of appointment. . They are all screened at the door including temperature screening, when they get to the clinic. Anyone with upper respiratory illness/fever etc is diverted to a designated area at our clinic/hospital facility 15 min away. We are all screened daily for fever or respiratory/flu symptoms at the door before we come in to the clinic. Patients are probably safer coming to the clinic compared to Walmart or grocery store. There is no reason for patients to neglect their health. They should keep their routine appointments for physicals, chronic illnesses and be seen for acute care problems. We do virtual visits and verbal visits for those who don’t want to come in. That doesn’t guarantee no risk, but it minimizes risk. For the patients you refer to, it is probably riskier to neglect their routine chronic care follow up. I would also reopen dental offices. Neglected dental care can lead to other health care issues. Dentists and their assistants have gowned, gloved, worn masks and shields long before Covid. If they screen like we do it should minimize risk.

So we have one pseudo-intellectual who disguises his limited knowledge by attempting to chase some poor souls to their “google dictionary “ to see what he is talking about. Other than the political bend, there seems to be nothing of substance. Reminds me of the Harvard geek who was put in his place by a janitor (albeit a bright one) for regurgitating other people thoughts and ideas in the movie Good Will Hunting. At one time there was an exchange of information and thoughts from medical people dealing with the crisis directly. There were discussions and comments from folks who have lost friends or loved ones, or folks suffering, both economically and socially, as a result of this pandemic. The blame game can wait and their will be plenty of blame to go around. If anyone doesn’t think multiple federal and state administrations, both political parties, world, federal, state, county, and city health departments, government health care providers, private health care providers as well as individual citizens mustn’t assume their share of the responsibility, then you need get get your head out of the sand. To dismiss the need for precautions whether it be social distancing, stay at home orders, masks, testing etc would be a mistake. At the same time to dismiss the suffering of those that have lost their jobs, face financial difficulties or financial disaster, and social isolation would also be a mistake. Regardless of what the Trump administration decides or your state government administration decides there will be risk involved. Testing is important but testing negative this week doesn’t mean much for next week. Antibody testing may indicate immunity but we aren’t sure yet. The medical community is still in the trial and error mode with different hospitals/institutions forming conflicting opinions with regards to same or similar treatments. Same with our government leaders. In the meantime, as people start to return to work, take precautions such as masks, hand washing, social distancing and resist the temptation to gather in groups for social events without being careful. There are too many people and families facing financial collapse to disregard their plight. At the same time returning work and other normal activities will involve the risk of spreading the infection. Reasonable arguments on both sides and because we aren’t the decision makers we need to focus on best practice. In addition to the recommended precautions accept the personal responsibility to get healthy.

We can assume that in some, but it is a new virus only months old so how do we know what the long lasting effects will be at this time??

Right on cue.

I will let Keikla answer for herself, but I believe across the country most providers use it early in the disease. We still are getting mixed reports as to the efficacy, but from what I have gathered if used it should be used early.

Thanks for your updates. I tried to address the issue with our clinic administrators and I doubt they had a clue why I was asking. It was clear they didn’t like questions and the answer was a brisk “it’s in the protocol”. Of course I can’t find the protocol but the information you have shared is invaluable. Thanks and thanks for your heroic and exhausting work. You and your colleagues are saving lives and giving comfort to so many whose families can’t be there. God bless and God speed.