Medical Business as Usual, but Less of It

YOUNGSTOWN, Ohio – Over the past month, nearly everyone around the globe has seen new practices woven into daily life to slow the spread of the coronavirus. But for businesses in the medical field, many such practices recommended by the Centers for Disease Control were already commonplace.  

“Whatever the CDC said was golden. We wanted to stay open and make sure we’re here for our patients and clients, but we also have to keep everyone safe,” says Dr. Trinetta Masternick, medical director at On Demand Counseling Services, Austintown.  

The substance abuse and mental health center screened all clients for symptoms and reinforced policies already in place, such as handwashing. At many medical offices, those best practices were already in place.  

“We’re under pretty strict policies and guidance in normal life. We added policies for questions during pre-op evaluation about travel and who they’ve been around,” says Taylor Cera, chief operating officer for Orthopaedic Surgery Center, Boardman.  

“We told [our staff], ‘Do what you’re trained to do. Follow the procedures in place.’ The protection with PPE and washing your hands, wearing masks – it all existed already and it’s how we should be doing things.” 

When it comes to cleanliness and safety procedures, the biggest change at Trumbull County Chiropractic is how they were presented to patients. 

“For confidence boosting, we’re doing all the regular sanitation and doing it in front of patients. Not only is the proper thing being done, but they get to see it,” says Dr. Patrick Ensminger, owner of the Howland practice. “We wipe down tables while they’re in the room and again when they’re done. I make a point, when I walk in, to be cleaning my hands so they know I’m sanitizing.” 

What has changed, however, is the number of patients the medical practices see. For On Demand, which offers drug testing in addition to its counseling services, those numbers have dropped because businesses have stopped hiring. 

At New Day Recovery, a sister organization to On Demand, on-site appointments fell 30% in the early days of the coronavirus outbreak in the area, although it has started to rebound, says Meghan Fawcett, director of clinical treatment. 

“Initially, there was a lot of information, from the state and resources and even as patients talk among each other, about places that might shut down and who would be open,” she says. “We saw that drop-off but we’re leveling off again and people are maintaining their appointments.” 

Orthopaedic Surgery Center saw the vast majority of its scheduled operations – upward of 90%, Cera says – wiped off the board when Gov. Mike DeWine ordered the suspension of all elective surgeries. On April 22, the governor gave surgical centers the directive to re-evaluate which procedures were being postponed.   

“One of the first things that came out, for what we do with outpatient [surgeries], were that some operations we do are essential: cancers, fractures and things like that that need to be done,” Cera says of the initial order. 

The surgery center has furloughed some staff, he says, but has remained in contact with all employees, regardless of whether they’re still being paid. 

“The staff is a huge deal in what we do, from start to finish. Getting the team back together is a start,” he continues. “We still communicate with all our staff on a weekly basis, even for people who aren’t here. We want to do what we did before and do it good. That’s what it’ll take to get back to normal.” 

Ensminger says he has retained all staff and forgone his own paycheck because patient visits are down about 60%  and revenues are down almost half.  

“I certainly can’t keep business alive that way. I’m borrowing money and hoping that some of this federal money is a reality. I haven’t seen any of it,” he says. “I am determined and responsible for the livelihoods of my employees. I’m toughing it out, borrowing money so that we can be here for the community and providing employment for our staff.” 

As part of the state’s emergency actions in response to the coronavirus, the Ohio Department of Medicaid allowed health-care providers to bill all telehealth appointments with patients, enabling organizations like On Demand and New Day to continue to provide services. Inpatient services remain available, but for those who don’t require medical care, such patients meet with staff digitally. 

“The state … did five years of legislation in a week,” Fawcett says. “They allowed us to bill for all client contact, whether it’s case management, individual counseling or medical appointments.  And it allowed those services via audio-visual such as Zoom or Doxy or even over the phone so there’s no lapse in care.” 

But in the mental health and counseling field, Masternick adds, in-person communication has always been the preferred alternative. 

“We can’t screen them. We don’t know if they are using. We don’t know if they’re taking their meds correctly. Medically, there are a lot of changes and things we can’t do like we should. For medical staff, it’s almost a step backwards,” she says. “Patients want to come in for that community, that support, that hug, that feeling that they belong and we’re here for them.” 

With some services limited – New Day had to lower its inpatient capacity so it could meet requirements for social distancing – the organization is working closely with its counterparts in the sector, Masternick says. 

“In looking at the agencies in our community, everyone’s done their best to maintain some level of access for clients. It’s imperative that they have a full continuum. If someone comes in for detox, then that next step down in medical care has to happen,” she says. “We have fewer people providing that level of care, but there is access. We’re all being diligent and screening for what’s available.” 

Likewise, Cera says Orthopaedic Surgery Center is in contact with area hospitals to make sure any help that can be provided is given.  

“We’ve done everything from sharing procedures to discussing the definitions the governor put out and how they affect surgical centers,” Cera says. “Everyone picks up the phone, from presidents of hospitals to physicians and surgeons. Everyone has conversations and shares information on everything taking place. It’s been good to be on the same team with the entire community.” 

Usually perceived as somewhat of an outlier in traditional medicine, chiropractors have found themselves seeing new patients, Ensminger says, either from referrals or patients seeking alternatives to clinics and emergency rooms. 

“They recognize it as a higher-risk environment. They’re stepping back and wondering where else they can go,” he says. “Chiropractors, like many medical doctors, are starting to see new patients that maybe otherwise wouldn’t want to commit to having a doctor.” 

In some cases, orthopedic surgeons unable to perform operations have sent patients to Ensminger for case management, ensuring that their conditions either improve or remain stable until elective surgeries can resume. 

“We’ve been functioning in a triage basis, “Ensminger says. “There was a patient who tore a ligament and probably wouldn’t have found herself in my office; but there aren’t many orthopedic surgeons available right now. I took her initial X-ray and arranged for a brace. We’re taking care of all of those things until she can be considered for surgery.”