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    Samantha Sizemore
    Samantha Sizemore, RTR, BSHA, MBA, CMPE

    Since 2020, COVID-19 has tested the strength and collaboration capabilities within the U.S. healthcare system. Small practices were significantly impacted by the pandemic, and some were unable to recover, leading 8% of physicians to close their offices last year, totaling about 16,000 practices.1 Holston Medical Group (HMG), an independent practice that has served rural northeast Tennessee and southwest Virginia for more than 40 years, was fortunate to find opportunities to survive and, after  time, thrive again.

    But it wasn’t without hardship. When COVID-19 first came to our community, we did not know much about the coronavirus, but we understood the consequences of waiting to adapt.

    By April 2020, we lost nearly a third of our patient visits. Without this revenue, we had to get creative to remain true to our organizational mission: to be the community’s health partner for life. We adjusted scheduling protocols to support our team members and streamline care; this included a rotating furlough system for all staff members. 

    To ensure the team remained aligned and up to date on all COVID- 19 and internal information, HMG leadership also enhanced its internal communication. HMG executives initiated WebEx meetings each morning to discuss new information and daily priorities for maintaining the business. All call attendees were given daily directives for patient outreach regarding appointments, collections and quality gap status updates. Everyone knew the number of daily appointments the practice needed to retain its daily business model.

    As we learned more about the virus, we found new opportunities to adjust our services and care. This required each department to re-evaluate its current operations and address potential disruptions. One risk that stood out significantly was the ability of our rural patients to seek care when in-person visits were not an option or preference.

    With our internal team aligned on the threats this virus posed clinically and operationally, we needed to find a way to see patients remotely. Pre-pandemic, telehealth was not a widely used care option for our region, and we were unsure if patients would use it. In a time when no one wanted to leave the safety of their home and states were implementing shutdown orders, it was clear: Telehealth was an opportunity to reinforce our patients’ trust in our reliability.

    HMG adopted digital communications that allowed us to continue to serve our community safely. We successfully incorporated and trained each provider in the group on how to effectively use our telehealth product. As part of this process, we created an operational workflow to virtually schedule, invite and identify telehealth visits, which included custom details for telehealth appointments within our centralized appointment call center. By identifying the type of appointment, our team could support telehealth patients with their tech needs seamlessly. This also ensured we billed claims correctly and prevented unnecessary denials.

    The new appointment option allowed us to reschedule current patients and re-engage those we hadn’t seen in 2020. Our centralized call center employees supported incoming call requests and reached out to patients to check how they were doing. As part of this conversation, many scheduled a telehealth visit with their physician to close quality gaps in care, manage chronic conditions and refill medications. By April 7, 2020, we were seeing patients remotely and averaged more than 750 telehealth appointments per day.
    Not only were patients receiving care, but our providers were being reimbursed. Insurance carriers and payers also played a dynamic role in allowing the same amount of revenue for a virtual visit as an in-office visit. What we found was that by completing much-needed annual wellness visits with patients, we were able to support our community and approach pre-pandemic financial security.
    Over time, our team and patients began to feel safe about returning to in-person visits. To prepare, we made safety adjustments within our provider offices and surgery centers. We implemented plastic clear shield guards for each registration desk, moved lobby chairs at least six feet apart and made sure we had appropriate personal protective equipment (PPE) and masking for all patients who needed it.
    For additional validation that our patients and team members were safe, our outpatient care centers became early adopters of rapid testing kits, so we were able to pre-test all surgical patients, sleep center patients, and diagnostic patients prior to procedures. Our primary care and specialty offices also incorporated temperature checks and questionnaires at the entry to each office. If a patient wanted to isolate, we provided vehicle drive-up testing and visit options.
    Once we felt confident in our facility’s safety, we initiated the “wave” scheduling technique, allowing two or three patients to be scheduled at the top of the hour and safely seen by staff in separate rooms, then another wave of patients at the bottom of the hour. We alternated schedules to only allow routine follow-up visits before lunch and acute sick visits in the afternoon; this allowed all spaces to be cleaned thoroughly before the next day.

    Eighteen months later, we’re close to returning to pre-pandemic normalcy and remain a partner to our community using health education and clinical guidance. Patient volume has risen 12% per month. As extreme as the pandemic has been for our organization and others, I am optimistic this time will be viewed as a period during which many healthcare organizations were forced to adapt long-standing operational workflows and lean on their perseverance, which resulted in a positive evolution in care.


    1. The Physicians Foundation. 2020 Survey of America’s Physicians: COVID-19 Impact Edition. August 2020. Available from:

    Samantha Sizemore

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