Dr Irwin Lim writes about what rheumatology services might look after six months of the COVID-19 pandemic
On the 5th March, our team of BJC Health leaders met in my living room to discuss our plans for the next 10 years. The planning phase had begun four months before that. We had designed the change management piece, garnered agreement as to the direction we wanted to move it. We understood our WHY and we were finessing the HOW.
A week later, Trump announced sweeping travel restrictions to 26 European countries.
The penny dropped that day. Our 10-year plans were almost certainly in tatters, at least in that iteration.
We spent the following three weeks scrambling. My sleep was terrible, as the mind was racing, dealing with my own stress about myself and my family, our staff’s safety concerns and worries about the future, and the anxieties of many of our patients.
It’s been very difficult, with major protocol changes and contingency planning to try and keep everyone safe, while coping with the predicted drop in income for the clinic and cashflow issues. I’ve already written about how we pivoted at pace to telehealth and how our exercise physiologists rapidly developed an exercise anywhere program, delivered virtually.
While things are still difficult, and our community remains in a strange, partially lockdown mode, I’ve been able to slow down and to think.
I don’t think how we practice rheumatology can return to how it was. And at this early time of reflection, I don’t think I would want it to, given the changes we need to adapt to in this new reality.
The new reality for rheumatology in Australia, to my mind, involves:
The community having a greater appreciation that good health matters, as they increasingly work out what is important in life. When movement restrictions are gradually lifted, and the general anxiety abates, or at least, when people accept their new reality, there will be a demand for health services. Musculoskeletal complaints and mental health needs are likely to be higher.
There will be a deep recession with many people out-of-work, so while demand for services will be high, the ability to access and pay for these services in private practice, in the community, will clearly be reduced. There is unlikely to be extra money provided by a government faced with heavy deficits to increase public hospital-based rheumatology.
The public as well as the medical & health community has embraced telemedicine & new ways to access care, without the inconvenience of having to present to a clinic. Rightly, people should expect telemedicine to be funded after the current September 30th expiry date set by the government.
Rural & regional rheumatology fly-in, fly-out services will be harder to provide so I would anticipate a reduction of this type of service. The flip side is that the increased utilisation of telehealth will compensate for this, and should actually provide a greater quantity, and potentially, better quality of service given the reduction of access difficulty.
Greater choice for patients. People unhappy with their existing rheumatology service will be able to access other rheumatology services more easily without geographic constraints, given the acceptance of remote consultation, without necessarily requiring the in-person visit each and every time.
The forced pace of IT adoption will change how rheumatologists structure their practices, how they employ staff, where they might work, and this should deliver great benefits to patients. All health practice software companies are incorporating or working hard to incorporate online appointments, electronic remote payment systems, automation of workflow such as patient details being captured, integration of video consultation capabilities, and electronic prescribing.
So, the challenge for me and my rheumatology colleagues will be to design a rheumatology service to meet the challenges and opportunities I’ve highlighted above. Some of my early thoughts involve:
High out-of-pocket costs will be difficult for many patients. Rheumatologists will have to accept income reductions to help our community by reducing our typical prices for consultation.
Trying to offer some bulk-billed clinics in private practice to help with our most disadvantaged patients. This will help overcome the reluctance for some people to see rheumatologists & perhaps help some GPs who perceive private specialist care to be too expensive. Access is important for our patients who have to deal with chronic rheumatic diseases, especially as these usually do require specialist management.
Improve access outside of normal business work hours. People who have jobs will be very reluctant to leave work in the middle of the day to attend appointments & we should be flexible, accommodating them outside of our typical clinic times.
Embrace telehealth as part of our everyday practice. While we should use a consistent, health-compliant product, the user experience is key. Therefore, ease-of-use becomes the most important factor.
Be part of the solution for regional & rural Australia, at least for the areas near our Sydney-based clinics.
Built systems for appointments, billing, communication around telehealth. Many consultations will still be in person, and this is appropriate. However, the workflow improvements are likely to benefit all parties in a global way.
With lower income, we have to make a transition to a lower cost structure and a higher volume service.
To provide high levels of customer service, delivered at lower costs, means reduced human staff to an extent, with fast-tracked digital delivery & more efficiency.
Redesign the physical workspace. We need to consider less overlap between doctors and health practitioners given Covid-19 and possible future pandemics. Many of our staff are working remotely currently and this might continue in some form, meaning we could make do with smaller spaces. Flexible, clever room partitioning may be needed to allow for different uses in different scenarios.
It’s hard enough to predict what might happen in the next week or two, so I expect that I’ll be incorrect on a number of fronts and that I’m likely to swivel my thinking.
Please feel free to share your thoughts.
We want to hear what you think about this article. Write to the editor – irwin@bjchealth.com.au
This blog was originally published on BJC Health.
