The Future: Navigate the Practice Challenges of COVID-19
Chair of the AAO-HNS Future of Otolaryngology Task Force evaluates the impact of COVID-19 on the future of otolaryngology.
COVID-19 has killed more than five million people. An ever-changing constellation of requirements, recommendations, and guidelines that can be confusing, contradictory, inconsistent, and applied differently to different locations and different practice settings has already forced some otolaryngology practices to close. Surviving practices are still working out approaches to best meet patient needs while minimizing the risk of SARS-C0V2 infection, meeting regulatory requirements, and paying the bills.
“The status of the coronavirus impacts the current and future practice of every otolaryngologist worldwide,” said AAO-HNS/F Past President Gavin Setzen, MD. “We have to be able to continue to practice irrespective of where, what level of resurgence of COVID-19, or which variant is circulating.”
Dr. Setzen will moderate a special livestream presentation exploring the “Future of Otolaryngology: Practice and PPE” from 3:15 – 4:25 pm (PT) on Sunday, October 3. He is Chair of the AAO-HNS Future of Otolaryngology Task Force and a partner in Albany ENT & Allergy Services, PC, in Albany, New York. Presenters will discuss the current impacts of COVID-19 on the practice of otolaryngology and strategies to help navigate future developments.
In broad terms, Dr. Setzen said practice has returned to something approaching normal. Where more than 90% of ENT visits were virtual during the second quarter of 2020, probably around 95% of visits are now face-to-face in most major centers around the country.
But just what face-to-face means depends on disease prevalence and velocity, local vaccination rates, local mandates—or prohibitions—on masking, and other disease control measures, practice type and setting, specific procedures, and other variables.
A few things are clear, he said. COVID-19 has accelerated the use of digital technologies. Telemedicine is an obvious example, but adaptations such as virtual check-in and check-out have accelerated low-touch opportunities for patient engagement, thus transforming the patient experience.
Personal protective equipment (PPE) has become standard practice. But standard can vary. PPE requirements for an office exam may be different than requirements for an office procedure and different again in a hospital setting and in the OR. Patient factors also play an important role, starting with vaccination and infection status.
“If you are performing a tracheostomy on a COVID-19-positive person, the precautions and infection control measures required are at the highest level,” Dr. Setzen said. “One has to adapt and take those considerations into account. COVID-19 definitely impacts the number of patients one can see in a day. It impacts access, and there is a definite increase in the cost of providing care that is uncompensated and substantial burden on every medical practice.”
More vulnerable practices, most often small, independent, rural, or private, have succumbed to the financial pressures of reduced patient volume, fewer surgeries, and increased costs. There has been a corresponding uptick in consolidation, mergers, acquisitions, and private equity interest.
“Those trends may continue,” Dr. Setzen added, “but to a lesser extent than in dermatology, GI, and some other areas. Most practices pivoted successfully to telemedicine and returned just as quickly to in-person visits. There is less of a role for telemedicine in our field because otolaryngology is a very visual, hands-on diagnostic field. We need to look in the nose, the mouth, and the back of the throat, use various telescopes and microscopes to be able to diagnose and treat.”
The key lesson from the pandemic is to follow, and keep following, published, medically acceptable Centers for Disease Control and Prevention, Occupational Safety and Health Administration, and other responsible guidelines for room preparation, clean-up, instrument sterilization, patient separation and waiting areas, and other facilities.
“There is tremendous federal, state, regional, and local variation concerning regulatory requirements with many different stakeholders,” Dr. Setzen said. “And the guidance changes from time to time and place to place. It depends on local conditions and whether there is a resurgence in one part of a state or even in a neighboring state, with impact on medical resource availability and utilization. There is more nuance to the conversation than there was a year ago. We will provide general approaches that will allow one to continue to practice in an ongoing coronavirus environment.”
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