Dr. Elizabeth Lowe, an internal medicine physician at MarinHealth, received an alert in early April that two patients in a Kentfield, Calif., memory care facility tested positive for COVID-19.
She went to the facility equipped with toolboxes filled with stethoscopes, socks that measure blood oxygen levels and donated hand-sewn masks. Kaiser Permanente caregivers accompanied her in lockstep with the Marin County Department of Public Health.
“Our aim was to get out ahead of it,” Lowe said. The group traveled in a mobile care unit to help long-term facilities that aren’t typically as well-equipped to combat outbreaks. “We realized these types of smaller facilities were in trouble.”
The University of California at San Francisco helped the providers set up an acute-care clinic with drive-through testing and provided them with test kits.
“The level of change going on in healthcare organizations throughout the country is profound,” said Dr. Eric Pifer, chief medical officer at MarinHealth. “We are forming new teams and relationships to find ways to address a fast-moving problem that is exhausting, but also really exciting.”
Lowe, Kaiser caregivers, and public health employees huddle each morning to map out their day. They’ll teach staff about proper use of personal protective equipment, infection-control protocols and how to test patients and staff.
“I call every day a new day of improv because we never know what we are going to walk into,” Lowe said. “I put my primary-care practice on hold to do this work because it feels so important. I never felt such a tight camaraderie with the public health department, Kaiser and our peers—we are all united.”
Pifer recalled a recent trip that took them to a skilled-nursing facility where a woman who was in the early stages of dementia resided. She was reluctant to get tested, so she played piano for them to build rapport. Pifer and Lowe danced along.
“It was one of the most amazing scenes,” he said.
Another one of Lowe’s patients had advanced dementia. She tested him, it came back positive and she returned a few days later to follow up.
He was declining quickly and needed to be moved to a hospice. But that would’ve taken a day, and he didn’t have that kind of time, Lowe said. She had an oxygen tank and morphine delivered to the nursing home. Lowe called the patient’s daughter so he would be surrounded by loved ones.
“I wouldn’t have had that experience before,” said Lowe, adding that she would’ve been a couple steps removed. “Everyone feels like they are part of something that is much bigger. This is much more relevant. It made it much more personal for me.”
Much of their outreach wouldn’t have been possible if CMS didn’t increase reimbursement for telehealth, Pifer said.
Meanwhile, MarinHealth will be exploring alternative payment structures via federal, state and local grants for the mobile care unit.
“As primary-care physicians we do around two hours of unbillable work a day,” Lowe said, such as answering emails, making telephone calls and helping patients organize medicines. “The need for these services has never been more pronounced.”
Looking ahead, there will be life before COVID-19 and life after, Pifer said.
“Healthcare providers will never be the same,” he said. “If we play our cards right and sustain some of the pride and camaraderie we are seeing, that will be a good thing.”
