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Learning From a Large Pediatric Practice

Learning From a Large Pediatric Practice

While there are benefits to having a large practice, all pediatric practices — no matter their size or structure — have experienced challenges during the pandemic. Now that everyone is navigating a new normal, it’s important to evaluate lessons learned and how to move forward in the coming months.

ONE Pediatrics, comprised of several highly esteemed practices in the Kentuckiana region, is a large pediatric group with seven practices, 10 locations, 45 providers, and 100 employees. Like all pediatric practices, ONE Pediatrics experienced difficulties during the COVID-19 crisis. In addition to trouble obtaining PPE, the team saw a significant decrease in patient volume, which had dramatic financial implications.

Despite the hurdles, ONE Pediatrics emerged successfully with valuable insights. Patrick Hynes, M.D., one of the founding partners of ONE Pediatrics, shared five valuable takeaways he and his colleagues learned during the pandemic.

Embrace Change

It might seem like a no-brainer in business and leadership, but change is still difficult for many people. We often spend so much focusing on what we want to change, and we don’t pay much attention to why we have to change. When COVID hit, things were changing so quickly — day by day and even hour by hour.

“Some of us are more adept to change and don’t worry too much about it, while some are very against change and will dig in,” Dr. Hynes said. “This time, the why smacked us in the face. We had no choice. We had to change, or we would have a massive problem.”

Gain Clarity in Decision Making

Despite the onslaught of information during the pandemic, ONE Pediatrics found a new sense of collaboration and clarity when it came to decision making. For example, the organization swiftly implemented telemedicine at the start of the COVID crisis. “Everybody got on the same page very quickly,” Dr. Hynes recalled. “Collaboration became easier.”

Prior to the pandemic, the ONE Pediatrics team would allow time for everybody to gather information at their own pace before having a board meeting. After meeting and thinking about the issue for a couple of weeks, leaders would come back together and vote again.

“That drove a lot of us crazy,” Dr. Hynes admitted. “During the pandemic, we got much more agile in our decisions.”

Continue Using Technology

Virtual meetings became critical for the survival of ONE Pediatrics — both for internal communication between team members and telemedicine appointments with patients. Now that in-person visits are more acceptable again, Dr. Hynes said the organization will continue to rely on remote communication technology when it’s appropriate and convenient.

“We’ve realized that tele-meetings work, and we can get a lot done,” he noted. “The assumption had always been that we had to be face to face to pull it off, but we can do the same thing in a boardroom that we can do sitting here at the computer.”

When it comes to telehealth, Dr. Hynes referred to its impact as “massive,” explaining that ONE Pediatrics has conducted virtual appointments for mental health and sick care.

“Where it’s really come in handy are the rashes and other visual things you can do,” he said. “And for mental health, it’s been a game-changer. Telemedicine is a perfect fit for anxiety, depression, and ADHD. I’ve been telling families left and right that we’re definitely going to continue telehealth well beyond this.”

Make Families Feel Safe

ONE Pediatrics found that the best way to get patients back in the office for their appointments is to help children and their caregivers feel safe. To do so, Dr. Hynes recommended the following four steps.

Wear PPE: Despite the challenges in obtaining PPE, donning masks, shields, gloves, and gowns make a huge difference in families’ eyes. It’s OK to get creative. Go to your local home improvement store and buy goggles and painting coveralls if you have to.

Make cleaning efforts apparent: Families need to see you cleaning. They don’t want to assume you’ve cleaned. Keep some cleaning supplies and sanitizers visible, though out of children’s reach.

Announce distinct sick and well areas: Make sure families know you have separate spaces for sick and well visits. If you have multiple locations, designate one office for sick and another office for well. For smaller practices with only one location, keep sick appointments in a separate area or hallway.

Offer curbside check-in: Dr. Hynes praised ONE Pediatrics’ EHR vendor for offering an option that allows patients to wait in their car and be notified via text message when an exam room is available. He said it’s been “phenomenal,” and patients prefer to sit in their vehicles, rather than in the waiting room.

Be Aware of Social Determinants of Health

While pediatricians have long been aware of socio-economic disparities among children and families, the pandemic has laid bare vulnerable populations. In addition, school closures for children and job losses among parents have magnified problems like food insecurity, internet access, and housing.

“Poverty is basically a poison to kids,” Dr. Hynes said. “For too many kids, school lunch was their meal for the day. Also, school went automatically to online learning, and that’s great, but what about those who don’t have internet?”

Dr. Hynes suggested that pediatric practices screen for these social determinants of health and be prepared to provide lists of available resources for families who need help with food and housing. He stressed the importance of identifying needs, connecting people to resources, and relying on community partnerships to better serve families. ONE Pediatrics will be incorporating appropriate screenings into routine care for the foreseeable future, in order to address the whole child. 

Additionally, the last few months have brought into sharper focus the true value of the medical home. Now is the time to use the opportunity to advocate for appropriate payment for pediatric primary care services. Providing the right care, at the right place, at the right time by whatever means is safest and most valuable for the family, needs to be paid at a level which is fair and creates value for all stakeholders and ensures sustainability for practices.

Sue Kressly
kiddrsue@gmail.com


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