How primary care medical groups are trying to alleviate pressure on hospitals

Vanguard Medical Group founding partner on his 11 locations, 19 doctors: We do everything we can to divert patients from going to the ER

By Paul Bergeron
Verona | Mar 29, 2020 at 2:52 pm

There’s a yellow balloon hanging by one of the entrances to Vanguard Medical Group in Verona. But it’s no party — that’s for sure. It’s a “Welcome” sign that leads to a special facility entrance for its most needy patients who are suffering from respiratory ailments, and possibly COVID-19.

The entrance leads to what is a makeshift and yet highly secured examining area within the two-story building. Here, patients can be evaluated by staff in full personal protective equipment, Dr. Robert Gorman said.

“We ask the patients to park near the door and to call a special number so they can enter through a locked door (it previously served as the employees’ entrance) that leads down a corridor,” he said. “This way, we have complete control of the entire floor. We clean it after every patient. The rest of the office is used for patients who need to be seen but are not exhibiting signs or symptoms of respiratory infections.”

Staff members don Personal Protective Equipment to see potential COVID-19 patients.

Emergency rooms and hospitals across New Jersey are being overrun by patients during the COVID-19 outbreak. And, while Gov. Phil Murphy and Health Commissioner Judith Persichilli are looking to open more hospitals — and open closed wings in existing ones — facilities such as the ones run by Vanguard Medical Group quietly are helping to handle the overflow, too.

“It’s what brings us to work every day,” Gorman said. “One of our most important goals is to see patients in person or on video and do everything we can to divert them from going to emergency rooms. We’re all very worried about the state of hospitals these days.”

Vanguard Medical has 11 New Jersey locations, the Verona office being the largest. Gorman, a founding partner of the group more than three decades ago, said the Verona team includes 19 physicians, nurse practitioners, physicians’ assistants and an additional 34 support staff. They are making adjustments during the day, every day, he said.

“I’ve never seen anything like this in my 34 years of practice,” he said.

As a clinical assistant professor of family medicine at Hackensack Meridian Health School of Medicine at Seton Hall University, Gorman has both accepted the reality of the biggest health crisis he’s experienced and his role in helping his patients and the medical community as a whole get past these unprecedented times.

Gorman travels to other facilities, as well. He is chairman of the department of family medicine at Hackensack Meridian Mountainside Medical Center in Montclair.

“Hospitals in northern New Jersey, in particular, are at capacity — that’s what scares us the most,” Gorman said. “As physicians, we know we have to do everything we can to help people. We need to ‘shield’ the emergency departments as much as we can.”

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Gorman is encouraged by the steps being taken to flatten “the curve,” a statistical model that measures the number of cases.

“It may be flattening, yes, but not by enough,” he said. “By all indications, we’re still 2-3 weeks away from the peak. We will exceed capacity. There will be challenges to provide needed care once our capacity is exceeded.”

Public officials’ efforts to create a national pause in the United States and isolate as many people as possible is helping, Gorman said.

“We’re building ‘firewalls’ nationally, outside of New Jersey areas, almost in the way they handle forest fires,” he said. “Hopefully, we can slow this outside major metro areas.”

Gorman doesn’t want to look back at the national response a few weeks ago, but he can’t help but think of how many didn’t take the crisis seriously, such as students on spring break who flaunted warnings and grabbed the media’s attention.

Dr. Robert Gorman.

“You see those same people now on television showing remorse,” he said. “This is the real deal. It’s not being blown out of proportion. For now, we just have to listen to the epidemiologists and hope for the best and do the right thing and stay home.”

Gorman said Vanguard is doing limited COVID-19 testing at its facilities, but only for patients who are really sick.

“We’ve probably had patients who come in and might have the virus, but who aren’t sick enough to be tested with our limited supplies,” he said. “We have them quarantine at home for 14 days.”

Gorman and his coworkers have also had to pay mind to facing patients who do test positive. There have been four such persons across Vanguard’s 11 facilities, ranging in age from their early 30s to 64. They are all recovering and quarantining at home.

Two Vanguard employees have contracted COVID-19, too. There’s a doctor, who Gorman said is “still fighting through it and is improving.” And a health care worker who has recovered.

“When members of our staff learn about a coworker or patient who has tested positive, the initial reaction is fear and concern,” Gorman said. “Everybody tries to recreate what kind of contact they had with these individuals to see if they might be personally at risk. Fortunately, each of these contacts at our facility occurred in a setting where the worker had full PPE. But there are periods where our staff cries in private or with a small group. But, after that, they then put their game face on and come back out and take care of the patients.”

Gorman says TV news has done a respectable job covering COVID-19 circumstances globally: “But I can’t watch too much. They are looking to sensationalize it. After 15 minutes, I have to get a break and switch the channel to something else like ‘Seinfeld.’ Unfortunately, I can’t even watch a ball game.”

Gorman instead gets ready to spend the next day on the front lines of the fight.

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Gorman said he’s encouraged about the use of telemedicine, an approach being used out of necessity. It has worked well to divert his patients from the ER. He said he took part in 12 such consults last Thursday.

The Verona office generally sees 200 patients per day, but, lately, Gorman says many are afraid to come to the office given the environment surrounding COVID-19. On one day last week, for example, they saw 34 patients in person and 96 through telemedicine.

Telemedicine traditionally was something used for psychiatric patients, those who check in for their prescriptions or so that mental health providers can talk to them to determine how they are doing, Gorman said.

“(Prior to COVID-19), we had two doctors who used it. Now, ‘everyone’ does,” he said. “The government has relaxed the rules to administer and charge for it and expanded what treatments it could be used for.”

Telemedicine was not often used in the past because its costs weren’t covered by Medicare and Medicaid or insurance companies. Now, the government is telling our industry, “Do whatever you need to do,” Gorman said.

Many doctors’ offices were not fully prepared to move to telemedicine and are forced to jury-rig things as they go, Gorman said.

“We had the software to do it, but it was not activated (until now),” he said. “We text or email our patients and ask them for their communications preference, then we send them a link. It connects them to us with video.

“At our offices, doctors see two screens while meeting with remote patients — one with video of the patient and the other that posts their medical history. We use an e-MD platform that includes Updox (a patient messaging tool that can create secure text and video chat with patients). It’s HIPAA-compliant and approved. It’s working fine.

“Our patients love it. They’re happy if they don’t have to leave the comfort of their homes to be ‘seen.’ They thank us at the beginning and end of the appointment. They are so grateful and almost apologetic, ‘I don’t want to take too much of your time,’ they tell us. They are just glad to be able to be seen, and we’re happy they do because it potentially keeps them out of the ER.”

Paul Bergeron is a freelance business reporter based in Herndon, Virginia.

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