Part 3 – How to advocate for patients during COVID-19

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By Kathy McGrath, BridgeHealth VP of Member Operations

People who need surgery are hurting and scared. That’s generally the case, but such emotions are made exponentially worse in the face of COVID-19. What’s more, the rules of the game change almost daily so what makes sense one day may not be feasible the next. Many patients are also dealing with economic concerns that stem from their own job loss or that of someone else in the family.

Patients are frightened and overwhelmed, especially if they’re not used to navigating the healthcare system or are unfamiliar with their insurance benefits. Their concerns also extend to the quality of their care. Some are just trying to understand things like what does pre-certification mean and what’s the difference between a deductible and a copay. Others may be in a near-panic about the costs associated with their care.

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All, especially if they’re not used to the healthcare system, have a lot of questions, including:

  • Is my surgeon good?
  • How much will my surgery cost?
  • How long will I be off work?
  • Will the surgery itself be painful? What about my recovery?
  • Will I need someone to take care of me while I’m recovering?
  • Who will care for my family?

COVID-19 makes surgery harder

And now, due to COVID-19, patients have a whole new set of concerns. Many were caught in limbo as states started restricting elective surgeries and issuing shelter-in-place orders, often without much notice. These orders and restrictions continue to change as COVID hotspots shift.

Plus, the healthcare system is harder to navigate than ever. One reason is the backlog of surgeries; experts predict it may take a year or longer to clear them. This backlog makes it difficult for patients to get answers to an entire new set of questions, the most common of which include:

  • Is it truly safe to schedule my surgery now?
  • While I wait for surgery, is my condition getting worse?
  • Is it better to go to a hospital or a surgery center?
  • Can my spouse or other family member come with me?
  • Do I need a COVID-19 test? If so, what happens if I test positive?
  • If I do test positive, will I need to be quarantined?
  • What if I get sick while in the hospital?

What’s more, answers to these questions can change over time, which causes additional stress for patients and their families.

Many patients are also dealing with economic concerns. They or someone in their family may have lost their job due to the pandemic, perhaps their insurance as well.

Patients need advocates

Healthcare and benefits providers must take the lead in ensuring patients receive the care they need. At BridgeHealth, our care coordinators and providers make sure to:

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Monitor. As healthcare providers, we must monitor our patients, as well as the family members who will be responsible for providing post-surgery care. It’s important to know the patient’s ongoing condition while they are deciding whether to have surgery or are waiting to be scheduled. If their condition or situation worsens, they need to be evaluated and reprioritized.

We also monitor what special protocols are required by each surgeon and facility. Our providers keep abreast of current safety protocols, as well as all state and federal mandates. These mandates change on a near-daily basis so keeping up with them—and emerging hotspots—requires vigilance on everyone’s part.

Coordinate. Just as there’s a lot to monitor, there is also a lot to coordinate: scheduling and rescheduling, the transfer of medical records and other paperwork, travel, pre- and post-tests, medical clearances, physical therapy and more. COVID test scheduling and coordination is especially tricky since the labs have been backlogged and it takes longer to get results. In addition, when patients need to travel to get their surgeries, we also coordinate access to help them safely obtain all their necessities, such as food delivery.

Verify. Before surgery can take place, all details must be verified. Has all paperwork been submitted and is all information correct? Has the patient been medically cleared and tested for COVID-19? Has benefit eligibility been confirmed? Are there any employer guidelines or waivers that must be adhered to? Has a follow-up care plan been created and communicated?

Support. Post-surgery follow-up is critical to both a patient’s physical and mental health. A call within a day or two of surgery can reassure the patient and provide an opportunity for him or her to ask questions and raise concerns. Another call 30 days out can help identify any issues that may need to be escalated to the surgeon or the assigned insurance company case manager.

Advocacy makes a difference

Now more than ever, the care we offer our patients also requires us to be staunch advocates, for their physical health, as well as their mental and emotional wellbeing. Special services, such as BridgeHealth’s mindfulness and in-home virtual physical therapy partnership with SWORD Health, help patients cope with the stress and pain of delayed surgeries in a safe environment.

BridgeHealth also helps with intake and evaluations, decision support, provider selection and scheduling, as well as administrative and clinical reviews. This requires an in-depth understanding of each patient’s health, as well as personal circumstances and preferences.

Only, by attending to all these factors, can we—and the patients we serve—set realistic expectations and timelines. Doing so ensures well-informed decisions that will lead to better outcomes.

As evidence, we need look no further than our satisfaction surveys. Our Net Promoter Score® is 90. Patients are writing letters, calling and sending emails about the process, which they are grateful for.

It all comes down to clear lines of communication, the right resources to stay on top of each case and well-defined contingency plans that make it possible to quickly address issues as they arise.

By taking so many factors into account, we truly can make a difference by ensuring that our patients get the surgery they need without putting their health at risk.

Adapted from BridgeHealth webinar: Is now a good time for surgeries?

See related blog posts:

Part 1: Impact of COVID-19 on the healthcare industry

Part 2: Impact of COVID-19 on healthcare providers

Part 3: How to advocate for patients during COVID-19

See our video – Preparing for Surgery during COVID-19:

BridgeHealth delivers industry-leading, value-based healthcare solutions, including its national, bundled-payment surgical centers of excellence programs.

 
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