Also on the virus front lines: Primary and urgent care doctors

They tend to be closer to their patients, and can spare them an unnecessary trip to the emergency room.
Primary care physician Dr. Brett Levine shows a coronavirus test kit Monday in his St. Petersburg office. "Primary care is important, and this is shining a light on just how important it is,” said Levine, who has tested multiple patients for the virus.
Primary care physician Dr. Brett Levine shows a coronavirus test kit Monday in his St. Petersburg office. "Primary care is important, and this is shining a light on just how important it is,” said Levine, who has tested multiple patients for the virus. [ SCOTT KEELER | Times ]
Published Apr. 7, 2020

Dr. Brett Levine fires off weekly emails to his 300 patients. Lately, they’ve been more difficult to craft.

In early March they focused on how he was more concerned about flu season than the coronavirus and its spread from China. By the end of the month, he asked that anyone experiencing cold-like symptoms call ahead before coming in for an appointment.

“The tone is getting more concerning,” said Levine, a family medicine physician at LevMed Health in St. Petersburg. “I don’t want to strike panic, but I want my patients to be prepared and have a strong understanding of how coronavirus affects them.”

As the number of positive COVID-19 cases in Florida speeds past 13,000 and deaths rise to more than 200, the focus has been on the health workers who staff hospitals and drive-through testing sites. But Levine and other primary care doctors say they also have a vital role on the front lines of the crisis.

"We have a relationship,” Levine said, referring to his patients. “I can screen them and let them know right away if they should be concerned or not be concerned. Primary care is important, and this is shining a light on just how important it is.”

Levine is able to test patients who meet the U.S. Centers for Disease Control and Prevention guidelines for COVID-19, thanks to kits he received from the state.

While most of his appointments are handled virtually through telemedicine, he still offers “essential visits” in his office and can test patients for coronavirus from his office parking lot. When he thinks a patient needs to go to a hospital, he can call ahead to the emergency room.

But his biggest concern is being an advocate for the patients he knows well.

“Not all my patients have insurance,” he said. So if they call and are experiencing symptoms, Levine can assess them before they need to shell out a co-pay for an E.R. visit or additional care.

Dr. Trinette Moss, a family practice physician at Total Family Wellness in Clearwater, is also screening her patients for COVID-19 to help them avoid unnecessary costs.

Most insurers have waived the costs associated with testing and telemedicine appointments at this time. Florida Blue has waived all fees for its members who require care due to a positive COVID-19 diagnosis. But not all fees are so easily defined.

“I’ve only had about four to five patients who I thought testing was necessary,” Moss said. “But the cost is a concern. I’ve seen prices from labs fluctuate from $60 to $2,500 for the cost of testing. That’s not something my patients with a high deductible or on a cost-sharing plan through medical ministries can likely afford. I haven’t seen anything reliable that says the health department is controlling the costs of these tests.”

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Moss sees her role as helping triage patients and keeping them out of the E.R. if they don’t need to be there. The E.R. can be expensive, and health care workers are trying not overwhelm hospitals as the number of coronavirus cases peaks in Florida.

“I’ve been getting incessant calls of people asking me if their symptoms can be coronavirus," she said. "I can usually talk them down and explain why they don’t need a test — or if they do, send them to an appropriate place. My job is to keep them out of harm’s way if I can.”

Like Levine, Moss has shifted to mostly virtual appointments, but is still seeing patients in her office when there’s a critical need. She said she and her staff wear masks and personal protective equipment during all appointments, even though those materials are hard to come by.

“We haven’t been able to get adequate supplies. Everything is on backorder," Moss said. "But I still have patients with other conditions and needs. I’m still treating patients for other illnesses like strep and flu. But we are being as cautious as we can.”

Urgent care clinics across Tampa Bay are also still treating patients for coronavirus, along with the usual other ailments, said Dr. Paul Nanda, chief medical officer for a chain of 10 urgent care clinics operated by Fast Track and Tampa General Hospital.

“We were the first urgent care to move rapidly and convert two of our locations to COVID-19 testing centers only,” he said of the Carrollwood and Brandon clinics. “We did this to safeguard our staff. So right when a patient comes in the door, they’re stopped and asked questions, then rerouted to one of our testing centers if needed.”

Those COVID-19 testing sites are seeing an average of 30-40 patients a day, Nanda said.

“The challenging part for us is the labs are backed up. The turnaround time is a lot, which can be frustrating when you’re trying to give a patient accurate information,” he said.

Primary care physicians have expressed the same frustrations with testing backlogs from state sites and commercial labs like LabCorp and Quest. “If someone is stable," Nanda said, "we can treat their symptoms but they need to be isolated until we get the results back.”

He echoed primary care physicians in saying that the “E.R. is not the place you want to go” when it comes to time and cost.

“If you have mild symptoms, they’re just going to tell you go home and quarantine,” he said. "The E.R. is reserved for acutely short-of-breath symptoms or people with underlying issues that make them high-needs patients.”

Meanwhile, urgent care clinics can test for COVID-19 and other common ailments this time of year, from strep throat to the flu.

“Our patient numbers are down 60 percent because people are staying home. There are less accidents because people are staying home,” Nanda said. “Flatten the curve is an overused but important phrase, and the more people who stay home and out of the hospital, the better.”

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