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Maintaining An Office-Based Practice During The COVID-19 Outbreak

It seems like everyone is dealing with ramifications from the novel coronavirus and as health-care providers, we are all scrambling in trying to figure out which path is best for our practices. Self-protection and stay-at-home orders are important, but continuing to work and provide care to our patients are important as well. Not only are the concerns for decreased income valid and worthy of consideration but the duty and obligation to our patients are still present. Office-based practices need to remain functioning. Accordingly, we are maintaining our practice with adjustments for the safety of our patients and staff.

When navigating through your appointment book, identification and triage of appointment reasons are necessary. Certainly, one needs to see post-op patients, patients with acute trauma and injuries, and patients with infections. Patient that have diabetes, neuropathy and peripheral vascular disease who present for routine foot care are a gray area. On one hand, physicians may consider postponing these appointments given that these high-risk patients may have an elevated risk of contracting the coronavirus. However, postponing the appointments of these patients too long may lead to increased risks of infection, ulceration, skin breakdown and infected ingrown toenails. 

I would recommend evaluating patient risk on a patient by patient basis. In this high-risk population, it might be beneficial to perform a needs assessment through video monitoring prior to authorizing an in-office visit.  

Other patients who you would see for follow-up care of heel pain, neuromas, tendinitis and other conditions are perfect candidates for telehealth. Video conferencing through WhatsApp, Zoom, FaceTime and Skype is possible and there are many guidelines and resources for billing these patient encounters during this time.

For patients you do see in the office, here is a list of my recommendations to ensure a safe and clean environment.

1. All new patients should download forms on your website to eliminate the use of pens and clipboards.

2. Consider spacing out your schedule so no two patients are in the office simultaneously.

3. Do not use the waiting room. Have your patient wait in his or her car and call upon arrival. You can call him or her when you are ready to begin the visit. 

4. Greet the patient at the door prior to entering the office and screen to ensure that he or she is healthy and that you can proceed with the office visit. Basic questions including a symptom survey, travel history and interaction with anyone who is positive for the virus are standard. You may even opt to measure the patient’s temperature through a sensor thermometer. Provide the patient with a pair of gloves and a mask. Staff should wear masks at all times. Escort the patient to a private room where the doctor will also wear gloves and a mask, and practice social distancing. 

5. Offer telemedicine appointments through video consultation when appropriate.

6. After the patient leaves, have staff thoroughly clean and wipe all surfaces with disinfectant wipes.

7. Consider telling all your patients how your office is handling patient care during this time. Consider posting this notification on social media platforms, in newsletters and possibly via phone calls. Patients want to know they are safe and protected while receiving continued medical services.

Dr. Schoenhaus is a Diplomate of the American Board of Foot and Ankle Surgery. She is in private practice in Boca Raton and Boynton Beach, Fla. One can follow Dr. Schoenhaus online at @bocafootandveindoc and

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