CMA issues guidelines on reopening California’s health care system

CMA issued guidelines and recommendations for reopening the health care system. The document was developed by a task force of practicing physicians from different parts of the state and different sizes...

As the COVID-19 pandemic spread throughout the world, California and the United States took steps to limit the transmission and impact of the virus by implementing shelter in place orders. While this has so far prevented any surges overwhelming our hospitals, it has also meant that many other parts of the health care system have been idled to preserve resources and capacity in the system and limit the opportunity for transmission or exposure of the virus.

Physician practices and health care facilities have seen massive drops in patient visits, caused by a combination of shelter in place orders and patient fear. This may lead to much more complex problems in the future, as patients miss routine screenings and preventative care. With proper safety precautions, a doctor’s office is one of the safest places for a patient to be. Reopening the health care system in a thoughtful and safe way is a necessary and important step for California to take.

Reopening California’s health care system will not happen all at once, and will not be the same in all parts of the state. Reopening should be in phases based on testing, treatment and data, and the regional capacity within local health care systems throughout the state

Why your doctor's office is the safest place.

All physicians will be adhering to the guidelines from the CDC.

It is important for patients to visit their physicians in the next several months. This is especially so for those with chronic medical conditions such as diabetes, hypertension, those with immunosuppression or any condition requiring regular followup. Call your physician for an appointment.  In many cases, medical practices have adopted telehealth which sometimes can substitute for a visit. In some cases, you can obtain monitoring devices such as blood pressure devices, glucometers for diabetes, spirometers for COPD, and pulse oximeters to measure oxygen levels.   Your doctor may send you to a lab for blood work. In order to minimize clinic visits ask your doctor for a 90 day supply. Consider using a mail order pharmacy. Some insurance companies and HMOs offer zero copayments for pharmaceuticals if you use a designated pharmacy.

Hospitals are now allowed to perform elective surgeries as well.















CMA issues guidelines on reopening California’s health care system:

The Latest Smart Device: Circular Ring:

We have seen the Desktop, laptop, tablet, smartphone, and now a smart ring from circular.xyz

And no, contrary to opinion it is not the latest futuristic smart item from Apple Computer. Sorry Tim Cook, Steve Jobs is turning over in his smart coffin. Given Apple's size and market share don't be surprised if Apple buys Circular Ring. Amazingly this powerful smart device can be pre-ordered for only $199.00. 

Control your ring, visualize your trends, your progress, and benefit from personalized advice to energize your life and improve your daily performance over the long term. Circular is a smart ring that includes Personal & Smart Alarm Clock, Sleep and Fitness tracking, Wellness monitoring, Alert notification, Pushbutton.

The Circular Ring has many functions:

Sleep quality score

The score reflects how well you slept based on valuable metrics calculated during your sleep.

Sleep overview

Quickly overview the times you slept. Edit your sleep logs.

Sleep metrics

See the result of each sleep component so that you can directly identify what to change.

Sleep/wake detection, Naps detection, Real sleep, Sleep debt, Time to fall asleep, Sleep stages monitoring, Circadian Rhythm, Disturbances, SpO2, HR, Night HRV, Sleep quality score©.

Sleep graphs

In-depth insights about sleep metrics. You can compare to your own short- and long-term trends and get to know your evolution.

Activity Tracking
Quantify your physical activities with empowering metrics
Circular keeps track of your daily activities and fitness goals at any time

Activity overview
Quickly see when you've practiced sports. Edit your activity logs.

Activity metrics
Quantify each component of your physical activity.

Automatic activity recognition, Activity intensities and volumes, Steps counter, Walking equivalency, Calories burned, Active minutes, SpO2, Heart training zone.

Activity graphs
In-depth information about numerous metrics for you to quantify your current performance and compare it to your own short-and long-term trends to get to know your evolution.

Wellness Monitoring
Find the perfect balance
Monitor your overall wellness and energy with day & night advanced cross analyses

Wellness metrics
Make your own wellness extra correlation with advanced metrics.

Day HRV, Heart recovery, RHR, Sleep balance, Live heart rate, VO2 max, Energy Score©.
Energy score
The score reflects your energy level for the day based on your sleep and activity data. Get to know when you can push yourself to max out your daily performances or when you may take it easy.

Wellness graphs
You can compare your wellness metrics on your own short- and long-term trends and get to understand the impact of your lifestyle on your well-being in order to improve it.

The device is only in pre-order status, so I would be very cautious, as this may just be pre-marketing hype.





Circular Ring: Features: .

Why you should remember your anesthesiologist’s name

 This article was reproduced from KevinMD written by TIFFANY POULDAR, MD | 

You’ve probably thanked them countless times for getting you through a scary time. Whether they excised your cancerous tissue, repaired your ACL, or removed your inflamed gallbladder, you have likely sung their praise, time, and time again.

But do you remember who your anesthesiologist was the day of your surgery? Probably not, and that’s okay. You may recall them as the quiet doctor, or maybe they eased your nerves prior to placing your IV. You might not remember anything at all if it was an emergent or urgent case, and you were “put to sleep” before you even saw their face.

The view for the Anesthesiologist in the O.R.

Your anesthesiologist is the man or woman behind the drape, at the head of the bed, next to a machine with a bunch of buttons that no one but they understand. They’re skilled with procedures, have a cart full of drugs that they know inside and out, and monitor patient’s hemodynamics throughout the case. They resuscitate you when you are losing too much blood. They keep you breathing. They make sure your blood continues to circulate and perfuse your organs. They control your pain. They make sure you don’t remember any of the surgery. And most importantly, they make sure you wake up.

Anesthesia in the I.C.U. for Covid19 intubation

But right now, amidst the COVID-19 pandemic, they’re the people in my hospital who are running into possible or confirmed COVID-19 patient rooms to place a breathing tube to give patients a fighting chance.  Despite this being the most aerosolizing of procedures, anesthesiologists and ICU doctors are gowning up and facing COVID-19 head-on. I can only speak for my own hospital, but they are being pulled left and right to make sure that patients receive appropriate and timely endotracheal intubations. And they’re not complaining about it. While none of us expected this virus to have this kind of impact on society, they’re still fearlessly waking up early in the morning, heading to work, and delivering admirable patient care.

Unfortunately, it feels as though it took a pandemic to remind us that medicine relies on the interdisciplinary efforts of multiple team members. Because the reality is, this pandemic hasn’t changed anything. Anesthesiologists have been doing exactly what they’ve been doing for years. They work with nurses, respiratory therapists, pharmacists, surgeons, ICU doctors, and hospitalists on a daily basis, to better serve the critically ill patients who need them the most. Now more than ever, they have been putting their oaths and vows to the test, jeopardizing their own health and wellness to help patients.

So the next time you come across an anesthesiologist, or respiratory therapist, pharmacist, nurses, and even the janitorial staff, make an effort to remember their name and thank them. 

Why you should remember your anesthesiologist’s name: 

I’m an E.R. Doctor in New York. None of Us Will Ever Be the Same. - The New York Times

A Covid diary: This is what I saw as the pandemic engulfed our hospitals.

A few days from now, I will come across the name of Guido Bertolini, a clinical epidemiologist who studies intensive care. Through a colleague of his, I reach out to him over Whats­App, and we begin corresponding. He had been high up in the Italian Alps through the last day of February, when the distressing messages started to come in from colleagues asking him to join a new Coronavirus Crisis Unit for Lombardy, a region in northern Italy. Some of the pleas had an Excel file attached. When Bertolini opened it, he tells me, he couldn’t believe the numbers. He had to see the situation for himself.  With an E.R. doctor from Milan, he drove to the Lombardy city of Lodi the next day. He was horrified by what he witnessed. “So many patients, in every corner,” he says. “They were attached to oxygen in all possible ways.” Individual oxygen dispensers, meant for single patients, were being split among four people at a time. “When we came out, we were silent for all the journey home,” he says. “We could not speak.” He knows the hospital has already passed its maximum capacity.

Inside t

I’m an E.R. Doctor in New York. None of Us Will Ever Be the Same. - The New York Times: I’m an E.R. Doctor in New York. None of Us Will Ever Be the Same.

The COVID-19 Tsunami: The Tide Goes Out Before It Comes In

Most people in the US have withdrawn from their daily routines unless their jobs are essential. Quiet streets, shuttered stores, silent schools. More than 400,000 live with the knowledge that they have the disease, but the slowness of our testing means that multiples of that number are likely to be infected. In pockets around the country, hospitals feel the earliest surges from those most vulnerable to COVID-19, but countrywide, the tsunami is still out at sea.

The devastating effects of a tsunami are usually preceded by an abnormally fast and long low tide, as water is actually pulled away from shore toward the epicenter of the underwater earthquake. Most of the US currently sits in that temporary equipoise. Most Americans who receive any health care in a given year do so in a primary care setting, (CLICK THIS LINK) to see where primary care fits into health care. where they generally have the relationships that they count on most when they are sick—or scared that they might be. In 2016, primary care provided 54.5 percent of all patient care visits and despite representing only 30.0 percent of the physician workforce, primary care physicians manage the majority of the care of people with the same high-risk conditions that put them at risk for the coronavirus. Research published in 2016 reminded us that the “Ecology” of care-seeking and receiving behavior in the US has not changed in 60 years. In a given month, 113 people in 1,000 visited primary care clinicians, while only eight were hospitalized and less than one was cared for in any of the university hospitals that dominate the US health care landscape and conversation. Primary care clinicians are the predominant providers of health care in small towns and rural areas where they often also staff many of the rural and critical access hospitals that those communities depend on. And although the relationship between the US population and its primary care workforce should, therefore, serve as protective breakers in the face of an unprecedented pandemic tsunami, the outgoing tide may actually be undermining the defensive wall before the surge arrives.  

Most primary care practices are seeing a 30-70 percent reduction in visit volume due to the pandemic. Simultaneously, many are being asked to self-finance a total transformation to telemedicine to provide needed care while reducing patient exposure to COVID-19. Most practices still live on fee-for-service contracts and will struggle to bear that loss of revenue. Nearly one in three family medicine practices remain independent and are not only financially hemorrhaging but cannot even afford the jump to telemedicine, meaning that they either choose to stop seeing patients or to put themselves and their patients at risk by continuing face-to-face visits. Many practices are facing difficult decisions about laying off staff or closing due to the likelihood that operating margins will run out in a matter of a few weeks to a few months. These vulnerable family medicine practices are just a subset of the wider group of practices facing these difficult choices. We estimate that a 50 percent reduction in visits will mean a $700 million loss for independent practices across the country over the next three months, more if they are unable to implement telemedicine. The rest of the primary care workforce will lose much more, and we estimate the total loss in primary care to range from $10 billion to $15 billion.

Although CMS (Medicare/Medicaid) and private payers have quickly authorized reimbursement for telehealth visits this requires acquiring available telehealth solutions as well as training how to adapt it to a practice setting. It is unknown whether the loss of income due to reduced in-person visits will be offset by telehealth reimbursement.  Telehealth function is available by subscription service to a cloud provider such as one of these. 

Nevertheless here is some of the bad news..The National Rural Health Association has reported that more than half of rural hospitals were already operating in the red, and deep losses in their traditional fee-for-service functions mean many will run out of cash in the next month. Federally qualified health centers (FQHC), which provide care to 1 in 12 people in the US and are mostly staffed by primary care, are projected to lose more than $3 billion over the next three months and more than one-quarter becoming bankrupted. All frontline primary care practices also face unplanned costs related to the epidemic beyond implementing telemedicine. These include stocking up on protective equipment and working with public health and hospitals to figure out how to manage the waves of people needing triage or intensive care that are about to crash down on our health system. The third and most recent stimulus package related to the pandemic offers $100 billion for health care providers, most of which is likely to go to hospitals. While $1.3 billion was appropriately allocated for the sustenance of FQHCs, nothing was specifically directed toward other frontline clinicians. While independent and small practices may be able to eventually apply for support created for small businesses, they have no special standing and little idle time to queue for this funding.

Many frontline primary care physicians are displaying tremendous professionalism as bulwarks for their patients and the public at great personal cost. They are fulfilling their commitment to the social contract, and it is on stark display. The government should respect this contract and help keep them whole in ways that directly reach this workforce. It would be a potent signal that they can focus on serving their patients and the public with faith that their practices will survive.

Understanding the tide of the COVID wave is already out, and a giant wave is visible on the horizon, but without more help, the primary care bulwark against the tsunami and its aftermath is in real jeopardy.  And like a tsunami wave the first is not the largest.

https://tinyurl.com/yclngrec

Comparing the COVID-19 Coronavirus to 7 Other Infectious Diseases

The outlook on the COVID-19 coronavirus is changing every day. As of this moment, the United States has just declared a national emergency —It's difficult to contextualize rapidly evolving circumstances, but it's also equally necessary to help ourselves and others. This is why a list comparing prevalent diseases of today with the 2019 coronavirus follows.

Comparing the COVID-19 Coronavirus to 7 Other Infectious Diseases

We look at some common, and recent, infectious diseases in order to put the COVID-19 coronavirus in perspective.

COVID-19

The COVID-19 pandemic has spread to every corner of the world. The landscape is murky, and while Chinese sources claim the outbreak is slowing down in its eastern origin, some global experts are claiming we should prepare for months of disruptions before the virus is controlled.

As of writing, there are 125,048 cases of coronavirus infections in over 114 countries, and the death toll is now over 5,000 and continuing to rise.

After days and weeks of constant developments, it might feel like the COVID-19 coronavirus is the only thing we hear about. But the very novelty of coronavirus — first diagnosed in November 2019 according to Chinese officials — is why we know relatively little about it, compared to other diseases, and why it's important to follow the latest updates and the advice of local authorities.

After days and weeks of constant developments, it might feel like the COVID-19 coronavirus is the only thing we hear about. But the very novelty of coronavirus — first diagnosed in November 2019 according to Chinese officials — is why we know relatively little about it, compared to other diseases, and why it's important to follow the latest updates and the advice of local authorities.

Then there's the death rate. COVID-19 has been shown to be fatal in roughly 3.5% of confirmed cases, as ScienceAlert reports. While we don't have enough data to know the exact mortality rate — many milder cases may have gone undiagnosed — the seasonal flu typically kills only 0.1% of those infected.

Then there's the fact that we don't have a vaccine, as well as the fact that the coronavirus pandemic has the potential to overwhelm health systems worldwide, leading to deaths for people with other ailments that would have otherwise been treated.

Yearly cases: approx. 3 to 5 million

Yearly death toll: approx. 290,000 to 650,000

(Statistics from WHO)

2. SARS

As the other most prominent coronavirus in recent times, SARS is also often compared to the COVID-19 coronavirus.

SARS, also known as severe acute respiratory syndrome, was first identified in November 2002 in the Guangdong province of southern China. The SARS coronavirus, which also caused a viral respiratory illness, was eventually contained in July 2003. Before it did so, it spread to 26 countries in North America, South America, Europe, and Asia.

Though the global health community has taken on many of the lessons of SARS in the containment and treatment of COVID-19, this year's coronavirus has far outdone the damage caused by SARS. During the outbreak, there were 8,098 reported cases of SARS and 774 deaths. As per the Centers for Disease Control and Prevention, there have been no known new cases of SARS since 2004.

Though SARS killed 10% of patients, making it deadlier to sufferers than COVID-19, it infected a fraction of the people over a longer period of time.

Total reported cases: 8,098

Death toll: 774

Source: CDC

3. MERS

Another recent coronavirus, MERS, or Middle East Respiratory Syndrome, was first reported in Saudi Arabia as recently as 2012. It spread to 27 countries in Europe, Africa, Asia, and North America.

Much in the same way that COVID-19 likely originated in bats, and was subsequently passed on to humans by an as yet unknown bridge animal. MERS is thought to have been jumped to humans via camels that originally got the disease from bats.

Since it was first identified, there have been 2,494 reported cases of MERS, and 858 deaths. Infections occurred mainly due to close face-to-face contact between humans.

Though MERS's fatality rate is a very high 34% (much higher than COVID-19), the low transmission when compared to the coronavirus that originated in Wuhan means that the death toll has stayed relatively low.

Total reported cases: 2,494 

Death toll: 858

Source: WHO

4. HIV/AIDS

Did you know that before the COVID-19 coronavirus isn't the only ongoing pandemic in the world? The HIV/AIDS pandemic began in 1960 and continues to this day. However, as World Atlas points out, the peak of the hysteria surrounding the disease came in the 1980s when the world became widely informed about its existence.

From 1960 to 2020, the virus has caused over 39 million deaths. Treatment first became available for people with HIV/AIDS in 1987 and just last week the second person ever to be cured of HIV was announced.

 

Source: gevende/iStock

Today, there are approximately 37 million people living with HIV, and cases have been reduced by 40% since its peak in 1997, as access to antiretroviral medicines has a greatly extended life expectancy. Today, approximately 68% of global HIV/AIDS cases are found in Sub-Saharan Africa. This is due largely to poor economic conditions and a lack of sex education.

People living with HIV (end of 2018): 32.7 million–44.0 million

Death toll (2019): 570 000–1.1 million

Source: UNAIDS

5. Ebola

Unlike the COVID-19 coronavirus, Ebola, also known as EVD, is not an airborne disease; infection occurs solely when someone comes into direct contact with bodily fluids of some who is infected.

Recent outbreaks of the viral infection, which was first detected during an outbreak in 1976 near the Ebola River in what is now known as the Democratic Republic of Congo, have led to alarming spikes in deaths from the virus. 

Ebola is another virus that is thought to have originated in bats — in this case, specifically, fruit bats, which are a local delicacy where the outbreak started. Ebola caused the deaths of approximately 11,325 people between 2014 and 2016 and the fatality rate sits at an average of 50%, according to the World Health Organization.

Cases (Aug 2018- Nov 2019): 3,296

Deaths (Aug 2018- Nov 2019): 2,196

Source: CDC

6. Meningitis

Meningitis is caused by inflammation of the meninges. These are membranes that cover the brain and spinal cord. The infectious disease is often caused by fungi, viruses, and bacteria, though it is also possible to get it after suffering a head injury, having brain surgery or having specific types of cancer.

According to the World Health Organization, small outbreaks of meningitis occur sporadically worldwide, except in the African Meningitis Belt where large outbreaks are common and account for most deaths.

The disease can cause flu-like symptoms, as well as vomiting, nausea increased sensitivity to light and a confused mental state.

Yearly cases: approx. 1.5 million

Yearly death toll: approx. 170,000

Sources: CDC/COMO Meningitis

7. Malaria

Malaria is caused by a parasite that is carried by mosquitoes. The initial symptoms include fever, chills and flu-like symptoms, which can quickly progress into more serious complications.

The disease was eliminated from the U.S. in 1951 thanks to the pesticide DDT. Campaigns are ongoing to distribute mosquito nets to help prevent the disease in poorer countries.

As the WHO says, "Africa carries a disproportionately high share of the global malaria burden." In 2018, Africa saw 93% of malaria cases and 94% of malaria deaths.

Cases (2018): 228 million

Deaths (2018): 405, 000

Source: WHO

The 10 Worst Epidemics In History                         

Yersinia bacterium

Black Plague Mask worn by Doctors

Comparing the COVID-19 Coronavirus to 7 Other Infectious Diseases: We look at some common, and recent, infectious diseases in order to put the COVID-19 coronavirus in perspective.

Telehealth is going to change Everything | LinkedIn

The Covid19 pandemic is responsible for the tragic loss of life and a shattered world economy. Will there be any positive outcomes?

Healthcare will change immeasurably. The most obvious and immediate benefit is the massive acceptance and adoption of telehealth. During the preceding five years,  when technology was developed and readily available there was only a tepid acceptance and usage of telehealth. Social distancing and a lockdown of almost the entire United States and overwhelming demand for health services motivated insurance companies and Medicare/Medicaid to authorize reimbursement for telehealth services.

After one week of telehealth, I can see that the medical world is not going to be the same. Going to the doctor is a pain in the butt. As a board-certified pain specialist, I'm well qualified to say that.

For years patients would ask why I could not just "call-in" their medications. For routine medications, I'd tell them the truth, that I needed to assess them every so often for medication efficacy and side effects. For opiates and controlled substances, I'd add that due to DEA guidelines I could not "call" them in any way. Now that the regulations have been relaxed to encourage social distancing I can legally assess patients via video chat, even when they live just around the corner from my office. Add in electronic prescribing of controlled substances (EPCS) and now I can send in that prescription.

My patients, providers, and staff are still working out the mechanics of a telehealth visit. It's been amazing though. We implemented work from home for most of the staff and telehealth for 90% of office visits in 1 week. Providers are figuring out what you can learn by just looking at a patient. Who knew that a knee effusion would be obvious on an iPad or that you can count respirations? Then the patient can demonstrate functionality, press on their own leg to test for edema, even perform a rudimentary neurologic and musculoskeletal exam. I want more data, like vital signs, but in this crisis, a telehealth visit is worlds better than nothing. A telehealth system that integrated with my EMR would be better yet. The best option would be a system that offered telehealth, EMR, and remote patient monitoring in a single platform.

For now, we are settling into a new normal, but what happens this summer (or fall) when we go back to seeing patients in the office? I highly doubt that Medicare is going to force the nearly 60 Million beneficiaries to go back to in-person visits for all non-rural care. On the other hand, I fully expect that HIPPA requirements will return. Whether the DEA allows EPCS with only Telehealth documentation is my main uncertainty. Here again, I'd bet that politics will lean towards patient satisfaction. Perhaps C-III and C-II prescriptions will get different guidelines. We will need (and get) new regulations on this. Plus, what defines supervision for my physician assistant when she works from home "seeing" a patient who is also in their home?

It's an open question as to how best to adapt to a telehealth world. I don't like doing new patient consults via video, but routine follow-ups have been fine. A business may be better. Patients may opt for more visits if they're easier. We'll be able to expand our catchment area since patients don't have to drive in to see us as often. But we'll also have more competition from outside providers who are able to see patients in "our" local region. I envision a less structured clinical day. Currently, I segregate surgicenter days from office days because the other providers are using those resources when I'm elsewhere. In the future, I could see telehealth visits from my device anywhere. We may need fewer support staff with fewer in-office visits. It'll be a whole new world and if we adapt we'll do well and if not we will lose out to those who do.

Published by

Brian Block, MD, PhD

Pain Specialist, Physician, Interventionalist









Telehealth is going to change Everything | LinkedIn

Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China: Multicenter User Profiling Study | Gong | Journal of Medical Internet Research

How are other countries using the internet to prevent and control the COVID19 pandemic?

During the spread of the novel coronavirus disease (COVID-19), internet hospitals in China were engaged with epidemic prevention and control, offering epidemic-related online services and medical support to the public.

Internet hospitals can serve different types of epidemic counselees, offer essential medical supports to the public during the COVID-19 outbreak, reduce the social panic, promote social distancing, enhance the public’s ability of self-protection, correct improper medical-seeking behaviors, reduce the chance of nosocomial cross-infection, and facilitate epidemiological screening, thus, playing an important role on preventing and controlling COVID-19.

A new approach to outpatient service delivery has been developed in China. Patients go to a medical consultation facility near their home and meet through the internet with a doctor who is based in a top-level hospital in a big city. The doctor asks the patient about his or her state of health via a webcam, through an instant chatting platform designed for the internet hospital. The patient answers questions and shows or sends images of his or her medical checks to the doctor through the internet. Meanwhile, data for the patient's body temperature, blood pressure, and blood glucose concentrations can be obtained by machine-operated devices on-site and uploaded to the diagnostic system. The doctor then makes a diagnosis and prescribes for the patient online. A few minutes later, the prescription is printed out and can be used to buy drugs at the consulting facility or another drug store. This outpatient service is in use in Guangdong province, 

As a teaching hospital of higher medical schools in Guangdong Province, a research base for postdoctoral mobile stations of Sun Yat-sen University, a non-directly affiliated hospital of Southern Medical University, and the first Wu Jieping Fund minimally invasive surgery training center in the country, there are 9 doctoral tutors and master tutors in our hospital There are 75 members, including 30 chairman and deputy directors of the National and Provincial Societies, and more than 200 doctoral and master students are enrolled in Southern Medical University. More than 300 full professors and associate professors have passed on to the medical profession; more than 2,000 white-dressed angels, Mu Chunfeng and Fangfei.

***************************************************************************************

References
1.The Second People's Hospital of Guangdong Province
Internet hospital of Guangdong province: making quality resources from top-level hospitals available widely. April 8, 2015 (in Chinese).

http://www.gd2h.com/news/yydt/a_101582.html








JMIR - Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China: Multicenter User Profiling Study | Gong | Journal of Medical Internet Research:

Implementing Telehealth in Your Practice: COVID-19 Emergency : CMA

Telehealth continues to deliver value in fighting the COVID-19 pandemic by allowing physicians to see patients safely and limit the spread of the virus. Additionally, federal and state waivers, guidance and directives now enable physicians to get reimbursed fairly for telehealth visits, practices.    

TELEHEALTH was struggling to become a routine feature of medical care only a month ago. Flash forward to today.  The state of telehealth has changed immeasurably. How did that occur?  In the past telehealth struggled to survive due to reimbursement issues with payers and medicare.

COVID 19 pandemic happened in early January in the United States.  Medical facilities, emergency rooms, and hospitals quickly became overrun, along with shortages in PPE and sanitizers.  In several days stores were depleted of paper goods, sanitizers, and other disinfectants. Even today 3 months later store shelves lack many paper goods and sanitizers.

Long waits occur for ordering masks (N 95) online with delivery dates given as mid-May 2020. The situation changes from day to day and even hourly. The President declared a national emergency in order to source masks from suppliers, distributors, and a national stockpile. Promises have been given and promises were broken. Despite denials, politics have played a role.  Conflicting opinions from supposedly reliable sources add to the confusion.

Governors and the President ordered a national lockdown and shelter in the home to prevent further spread of the Covid infection.

Fortunately, despite telehealth's barriers, the infrastructure was already in place with many resources readily available. This is one of the rare occasions when technology was ahead of the need.

Many medical practices have no or little experience in telehealth.  The California Medical Association developed a protocol and training module for physicians in California.

CMA Physician Services has also updated its telehealth implementation webpage with additional guidance.  

Telehealth Implementation

Covid 19 Telehealth Toolkit

Covid 19 Resources

COVID-19: Frequently Asked Questions








Implementing Telehealth in Your Practice: COVID-19 Emergency: CMA