By Allen Meadows, MD
Fear of COVID-19 is keeping allergy and asthma patients away from the doctor’s office. For the sake of their health, I’d like to set the record straight.
It’s safer to come to the allergy office than it is to make a weekend trip to Home Depot. Or to browse the produce aisle at your local grocery store. At my office, we screen people as they come in. We take their temperature, and we require a questionnaire to identify any recent symptoms or COVID exposure risk.
I’ve had patients who take biologics ask me if they should discontinue their medication because the drugs can lower immunity. I tell them absolutely not. In my mind, it’s the secondary effects of COVID that are really scary. When patients lose control of their asthma and wind up in the emergency department, everyone loses. The patient suffers unnecessarily, the health care system carriers a higher cost and the risk of actually contracting COVID-19 is greater.
Health care providers are committed to making it work, to mitigating risks, to being flexible and innovative during these strange times. We are determined to provide the same patient-centered care we always have. But we need patients to trust us and to stay on top of their health.
For example, a practice in our area uses the parking lot as a stand-up clinic for extra cautious or high-risk patients. People remain in their cars while the providers and staff – in face mask and clean gloves – go vehicle to vehicle to administer medications as needed. Patients see the doctor, receive care from the safety of their own car and then go home. In our practice, we also administer certain biologics in the car.
Novel and patient-centered approaches like these can help us carry through. So can flexible health insurance policies.
We see this already with new telehealth capabilities. An important part of mitigating risk for our patients is doing follow-up visits virtually. These visits can be done via phone, laptop or tablet from the comfort and safety of patients’ own homes. Our patients are very satisfied to have telemedicine as an option.
Historically, telemedicine has been limited by low or nonexistent reimbursement. When the Centers for Medicare and Medicaid Services temporarily updated its policy in March to close that gap, a whole new window for treatment opened up. For certain visits the agency even allows telephone consultations now. The option is ideal for low-tech patients, including seniors or those with limited internet access.
With telemedicine visits for our Medicaid patients, our show-up rate is a staggering 94%, compared to less than 50% for in-person visits prior. Last week I saw four patients that I hadn’t seen in over a year. We intervened, got them back on their medication and positioned them to be less likely to wind up in the emergency room.
Patients see televisits as a personal touch, something akin to the house calls doctors made in decades past. This is hugely promising for adherence, continuity of care and the general health of our patients living with asthma and allergies.
Other flexibilities would also be helpful. For example, certain drugs have historically required our Medicare patients to go to the hospital for administration. Our small clinic can’t shoulder the cost of Medicare’s buy-and-bill approach, where offices purchase thousands of dollars of injected or infused biologic medicines and bill them back as patients require them. Instead, we would evaluate the patient, prescribe the medication and arrange for the patient to receive the drug at the local hospital.
But patients aren’t eager to visit a hospital under current circumstances. As an alternative, we’d like the ability for patients to pick up the medication, either from a pharmacy of a hospital pick-up location, and have it administered in our office instead. Allergists have pleaded our case to regulators, but the challenge remains.
The pandemic has led us all to question what in our lives is essential and what’s optional or even frivolous. I’d encourage patients to see care for chronic conditions as essential. I certainly see allergy and asthma clinicians as essential providers. I know that together, with clear communications and a little creativity in how we provide care, we can keep patients both safe and healthy – and, with any luck, out of the hospital.
Allen Meadows, MD, is an allergist and president of the American College of Allergy, Asthma and Immunology, a member organization of the Biologics Prescribers Collaborative.