North Texas doctors call for continued physical distancing measures as rural counties see COVID-19 surge.
The North Texas Medical Society Coalition (NTMSC) is calling for additional measures as statistics show a surge of COVID-19 cases in smaller counties. Large counties, such as Dallas and Tarrant, are continuing to struggle with high numbers of COVID-19 patients, but their cases have been effectively managed through existing hospital systems. As the number of cases have increased, the growth has spread into smaller surrounding counties–areas that do not have the support of multiple hospital systems.
“Why should a doctor in Fort Worth care about the number of COVID-19 patients in Sherman? We have a highly mobile population in North Texas, making us more vulnerable to a rapid spread of the Coronavirus. This has already spread across the globe and it’s only 90 miles from Sherman to Fort Worth,” states Fort Worth physician, Robert Rogers, MD.
Over the last two weeks COVID-19 cases have more than doubled in daily hospital care of presumptive COVID-19 cases in Grayson County alone. As North Texas counties slowly start to reopen, revised projections reflect rising cases doubling more than rates of recoveries.
North Texas Infection Rate Statistics
County
May 5, 2020
May 12, 2020
Collin
804
939
Fannin
20
23
Dallas
4370
6123
Denton
806
946
Grayson
53
105
Tarrant
2624
3745
Ultimately, if rural hospitals become overwhelmed, patients will seek care in the larger counties. The pandemic outcome depends on a balance between physical distancing, adequate testing, and contact tracing.
“The power is with the people; everyone has to take ownership to protect themselves and others,” states Grayson County physician, Jonathan Williams, MD.
NTMSC wants to remind the community to continue practicing safe physical distancing measures. Even though businesses are beginning to re-open, remember that some areas are at the height of risk. Because many individuals are no longer staying home, safety measures are more critical than ever to suppress the curve to a degree that is manageable in North Texas.
About North Texas Medical Society Coalition:
The NTMSC represents more than 11,500 physicians in the communities of Collin-Fannin, Dallas, Denton, Grayson, and Tarrant County. Founded in 2020, the NTMSC works with community healthcare partners, including public health departments, hospitals, and business leaders, to advise on medical recommendations to serve the health care needs of the residents of North Texas.
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Wednesday, May 13, 2020.Find more COVID-19 information from TCPH here.
* These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
Thursday, May 14, at 11am, Tarrant County Public Health is hosting a COVID-19 Tele-Town Hall with updates and resources for senior citizens. If you are a senior citizen and/or caring for a senior, you don’t want to miss hearing from these community experts on the work being done in Tarrant County. You can join by calling 817-541-7163 at 11am.
The guests will be:
Monique Barber – CEO, Sixty and Better
Carla Jutson – President & CEO, Meals On Wheels, Inc. of Tarrant County
Tina Tran – Texas State Director, AARP Texas
Don Smith – Director, Area Agency on Aging and Vice President of Community Investment, United Way of Tarrant County
There will also be an update from Dr. Venny Taneja, Director of Tarrant County Public Health
Thursday, May 14, 2020
11:00am – 12:00pm
Dial 817-541-7163 to join If you have a question please email commissionerprecinct2@tarrantcounty.com with the subject line, “Senior Citizen Tele-Town Hall Question” or reply to this email.
The President’s Paragraph from the May/June 2020 issue of the Tarrant County Physician.
by Tilden L. Childs III, MD, TCMS President
At the beginning of this year, I was asked by several people what my goals were for the Tarrant County Medical Society during my presidency. What projects was I planning to work on? At the time, I half-jokingly responded that I did not really have anything particular in mind (although I did), but that I was sure something would come along. Well, as we all know now, something big and important and scary came along: COVID-19, the disease caused by the novel coronavirus now known as SARS-COV-2. The disease has caused an unprecedented disruption in the world. This was succinctly documented by The Economist magazine with a cover illustration of the world labeled with a “Closed” sign. As this is a rapidly evolving medical crisis with drastic implications for all walks of life and for our future, anything specific that I share with you at the time of writing this article may likely be out of date at the time of publication. However, here are some of my thoughts today.
First of all, I would like to share with you my unwavering appreciation and my awe at the overwhelming response of our medical communities at the local, county, state, and national levels. At the local and county levels, the TCMS leadership is working with and coordinating with the Tarrant County Public Health Department and with our city and county representatives and governmental agencies through our representation by Dr. Veer Vithalani, Acting Medical Director of Medstar EMS. The Tarrant Medical Operations Center (TMOC) has been activated by Dr. Vithalani to help coordinate the medical response in the community. We are also working with the local healthcare systems through our TCMS COVID-19 Task Force. TCMS is helping to facilitate the transfer of information to our local physicians as well as to provide a valuable resource to the media and the public. Additional TCMS projects include assembling a list of medical volunteers, helping to recruit and distribute personal protection equipment (PPE) obtained from community and public resources to local physicians’ offices, and monitoring the availability and progress of COVID-19 testing in Tarrant County.
Also, TCMS is working with the Dallas County Medical Society to review the recommendations previously developed in the North Texas Mass Critical Care Guidelines document. Additionally, TCMS is working closely and integrally with the Texas Medical Association (TMA). The TMA has marshaled many resources together, has implemented a COVID-19 Task Force, and conducts daily telephone conference calls through the TMA Incident Command Center. The TMA daily morning telephone calls have approximately 100 participants. The TMA gives excellent daily updates of all of the activities being performed by the TMA as well as working closely with the members on the various concerns that have arisen during the course of the medical response to COVID-19. The American Medical Association (AMA) has been working at the federal level as well. Of course, numerous resources are available online. TCMS provides information and updates on our blog. Additional information is available and is updated daily on the TMA and AMA websites.
“In times such as now, we all need courage- the courage to persevere, to serve, and to honor our commitment to our patients and our profession.“
What I have observed at this point in time is that containment has given way to mitigation, which has given way to suppression, with increasingly severe restrictions on our daily life. This includes “shelter in place” restrictions and the closing of non-essential businesses. Of course, the goal of all of this is to “flatten the curve” of new infections over time so as to try to keep from overwhelming the healthcare system. Current estimates predict a decline in the curve sometime in mid-April to early May, and this appears to be occurring!
Suppression strategies may work for a while, but what is the exit strategy? What will the “re-opening” of our society look like? Will it be relaxation of societal restrictions in conjunction with continued surveillance through extensive testing and contact tracing, new or improved treatments/medications, vaccinations, the eventual development of “herd immunity,” or what? The threat and severity of a “second wave” of infections following the relaxation of restrictions remains to be seen. Will COVID-19 become a seasonal disease? Will a vaccine be developed in time to prevent a recurrence of this crisis? This is doubtful, with current estimates of 1-5 years to develop a vaccine. Possibly the virus will become less virulent over time. Perhaps the “new normal” will represent a significant modification of our daily routines and practices as we learn to cope with this virus. Will tele-medicine/telehealth become entrenched in our practices? As always, time will tell.
For our healthcare system and particularly the members of the healthcare team, this has been and continues to be a time of great challenge and sacrifice. The uncertainty of the current situation and of the future is scary and anxiety provoking. We want clarity of the threat and the knowledge upon which we can trust and then to act accordingly to care for our patients and society as a whole. As this crisis has evolved, it has become painfully clear that expectations of a strong and swift federal government response were unfulfilled. However, I do believe this is not due to the lack of leadership by the medical profession at the highest levels of government.
The ongoing critical lack of PPE and the slow ramp up of testing has been incredibly stressful and indeed threatening, if not outright harmful, to the health and welfare of our medical personnel on the front lines. This in turn threatens our ability to provide the necessary care for future patients. The impending surge (at the time of this writing) also threatens our patients with a lack of ventilators for the ICUs. Fortunately, American ingenuity and a “can do” attitude is rising to the challenge.
In times such as now, we all need courage—the courage to persevere, to serve, and to honor our commitment to our patients and our profession. Although the winds and waves of the world are bashing against us, take heart. Have an anchor. Social distancing does not mean spiritual distancing. Be strong and keep the faith. I look forward to seeing you all, each and every one of you, again soon!
Managing pregnant and postpartum patients during the COVID-19 pandemic has changed the way obstetrician-gynecologists provide screenings and treatment, in both hospitals and clinical practices.
Pick up your phone at 7 pm (CT) Monday, May 18, for the Texas Medical Association’s next Tele-Town Hall meeting on COVID-19, specifically for Texas OB/Gyns. Hear from Texas physicians who will share COVID-19-related epidemiological trends, clinical best practices, and tips for improving your practice’s financial viability, including how to effectively use telemedicine and patient outreach.
Our tentative list of speakers includes:
Catherine Eppes, MD, Baylor College of Medicine
Valerie Smith, MD, member of TMA’s COVID-19 Task Force
John Thoppil, MD, president of the Texas Association of Obstetricians and Gynecologists
Joseph Valenti, MD, chair of TMA’s Practice Viability Workgroup
There’s no need to RSVP or register for this event. TMA will call the home telephone number on file in your membership records. If you prefer we call a different number – or don’t call at all – please email that information to the TMA Knowledge Center by 5 pm (CT), Thursday, May 14.
TMA designates this townhall for a maximum of 1 AMA PRA Category 1 Credit™.
During this interactive, hour-long event, you can ask questions of our panel. TMA President Diana Fite, MD, will host, and Eugene Toy, MD, chair of the American College of Obstetricians and Gynecologists District XI (Texas) will moderate the call.
Created by the Texas Medical Association. Read their article about it here.
By now, you have most likely made several practice changes to keep you, your staff, and your patients safe during the COVID-19 pandemic, including requiring face masks, keeping sick and well patients separated, and using telemedicine wherever possible.
But patients coming to your practice – for COVID-19 care or other health issues – might not be aware of all you’ve done.
The Texas Medical Association is here to help.
TMA has created a digital poster you can share with patients before they arrive that outlines your COVID-19 safety precautions. The poster includes steps for patients, such as calling ahead to learn your practice’s facemask policy, completing intake forms before arriving, and asking family members to stay home. You can send it to patients before their appointments, post it on your website, and share it on your social media accounts.
The “COVID-19 Safety at the Doctor’s Office Checklist” also outlines some of the steps you might’ve taken, including checking patients’ temperature in their vehicle, and social distancing in the waiting room. Also, TMA soon will publish a version for you to download, print, and post in your office.
If you’re looking for more tips and resources to increase patient visits safely, TMA’s practice viability experts have organized the information you in need in one document: Road to Practice Recovery: A Guide for Reopening Your Practice Post-COVID-19.
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Tuesday, May 12, 2020.Find more COVID-19 information from TCPH here.
* These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
The COVID-19 pandemic led to a public health emergency the damaged medical practice viability. Physicians are in the difficult position of having to navigate operational, financial, and clinical challenges while still staying up-to-date with compliance, payment, and coverage issues. These changes have had a significantly negative impact. According to TMA’s COVID-19 telephone town hall meeting in mid-April, 36 percent of poll respondents indicated that they have lost between half and three quarters of their revenue since the start of the pandemic. Another 24 percent have lost three-quarters to all of their revenue.
As the COVID-19 curve flattens and trends downward, you can take decisive actions to restore your practice operations. TMA’s practice viability experts have organized the information you may need to successfully reopen your practice in one resource: Road to Practice Recovery: A Guide for Reopening Your Practice Post-COVID-19. From evaluating staffing levels and managing patient appointments, to ensuring patient safety and communicating regularly with patients and staff, this guide will provide the information practices need to more confidently head in the right direction.
Refer to TMA’s COVID-19 Practice Viability web page for additional tools, resources, and frequently asked questions regarding operational challenges that affect your practice’s viability.
In December 2019, the world learned of a new Coronavirus called SARS-COV-2, causing the disease COVID-19 in which patients were experiencing respiratory illness and death in Wuhan City, Hubei Province, China.
Since then, we have been deluged with information about the virus, its epidemiology and transmission, its target populations, and its effects on new human hosts. COVID-19 has captured the attention of most of the world.
We have learned much in the last few months. The viral genome has been sequenced, permitting development of diagnostic tests and paving the way for development of vaccines and antiviral therapies. Several excellent sources of curated scientific data regarding COVID-19 became indispensable in our understanding of the rapidly changing guidance regarding how best to respond to challenges posed by the new virus.
These sources include the Johns Hopkins COVID-19 website, which updates worldwide data on cases and deaths in real time; the World Health Organization (WHO) COVID-19 website, which updates daily and has been prolific in issuing and amending guidance on measures designed to blunt the impact of COVID-19 worldwide; and the Centers for Disease Control (CDC) COVID-19 website, which was for several weeks the only outlet for testing in the U.S., and whose guidance is crafted with U.S. healthcare workers, other affected workers, and the broader public in mind.
As of April 27, 2020, per the Johns Hopkins COVID-19 site, there were more than 3,000,000 confirmed cases globally, and 208,131 COVID-19 deaths worldwide, with more than 993,103 confirmed U.S. COVID-19 cases and 55,729 COVID-19 U.S. deaths. For reference, on March 25, 2020, Johns Hopkins reported 54,000 U.S. COVID-19 cases and 787 U.S. COVID-19 deaths.
With no proven effective treatments or vaccines yet available to curb COVID-19’s worldwide impact, controlling the virus remains focused on time-tested communicable disease control measures. These include social distancing, hand hygiene, respiratory etiquette, staying home if ill, cancellation of mass gatherings, school closures, and the shuttering of nonessential services and retail establishments.
Against this background, healthcare providers and patients struggle to keep up with voluminous and changing guidance and filter out the cacophony of misinformation which has dominated some corners of the internet and other outlets.
Testing has been difficult in many places, including the U.S., due to a shortage of test kits (swabs and viral transport media) and reagents required for testing. In the U.S., only the CDC’s Atlanta laboratory could test initially, and results could take several business days. Eventually state labs were authorized to test and the Tarrant County Public Health North Texas Regional Laboratory (a Laboratory Response Network facility) began conducting tests using a two-target real-time polymerase chain reaction assay developed at the CDC. Commercial laboratories are now online with testing as well, facilitated by FDA emergency use authorizations to address scarcity of testing capacity.
With schools and many businesses closed, our lives have been altered, and we all know people stressed by the measures implemented to curb the spread of COVID-19 in Tarrant County. Frustration and fear of COVID-19 have been felt throughout our country and across the world.
We have also watched the devastating effects of COVID-19 on populations and healthcare infrastructure in Washington, California, New York, and elsewhere. Tarrant County Public Health and its partners are assisting with the COVID-19 response, investigating cases and contacts, in hospitals, long-term care facilities, correctional institutions, and other settings. (COVID-19 is especially threatening to the elderly, and persons with diabetes, heart disease, underlying pulmonary conditions, and immunosuppression).
Tarrant County Public Health and our neighbors have confirmed community spread of COVID-19 in persons with none of the previously identified COVID-19 risk factors, including travel to endemic areas or contact with a known case. Tarrant County has recorded 53 COVID-19 deaths so far. On March 25, 2020, that number was two.
Many facets of COVID-19 responses have been frustrating, and guidance has changed frequently and materially at times throughout our short history with this virus, but reliable sources of information continue to be the CDC, Johns Hopkins, and the WHO.
The CDC’s Coronavirus 2019 Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings is a highly readable document which emphasizes three key messages:
Decreasing traffic throughout healthcare facilities;
Isolating symptomatic patients as soon as they are flagged through screening procedures;
Protecting healthcare workers and other frontline workers by limiting staff caring for COVID-19 patients; prioritizing respirator masks and airborne infection isolation rooms, or negative pressure rooms where possible.
Most of us are old enough to remember at least one recent outbreak, but COVID-19 will be noteworthy in our history for the scale of its disruption of our lives and work, and for the lessons we learned about how to better prepare for the next such crisis.
Commercial payers have temporarily modified prior authorization timelines to help physicians care for patients during the COVID-19 emergency.
Below is an overview of some payers’ COVID-19 prior authorization policies:
Blue Cross and Blue Shield of Texas is temporarily extending approvals on services with existing prior authorizations until Dec. 31. This applies to services originally approved or scheduled between Jan. 1 and June 30. It applies to most nonemergent elective surgeries, procedures, therapies, and home visits for all group, fully insured, retail, self-funded, and Medicare Advantage members..
Aetna is approving prior authorization requests for commercial members for nine months instead of the standard six months. Physicians who already have received an approval for six months and plan to go over that time need to call Aetna to extend it for an additional three months. Aetna also will review precertification requests for elective procedures because the approvals are effective for a predetermined length of time.
Cigna: For prior authorization requests received March 25 until at least May 31, Cigna is temporarily increasing the authorization window for all elective outpatient services from three months to six months. This applies to all prior authorization requests received for all Cigna lines of business. Elective outpatient prior authorization decisions made between Jan. 1 and March 24 will be assessed when the claim is received and will be payable as long as it is within six months of the original authorization.
UnitedHealthcare has instituted a 90-day extension of open and approved prior authorizations, including those for many physician-administered drugs, with an original end date or date of service between March 24 and May 31 for services at any setting. This applies to all individual and group health plans, and Medicaid and Medicare Advantage plans, and to in-network and out-of-network existing prior authorizations. Approvals issued on or after April 10 will not be subject to extension. If a prior authorization approves the number of visits or services, the physician must obtain a new prior authorization for additional units, visits, or services beyond what was approved in the original authorization.
Tarrant County Physician Online 