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Members Spotlight: Frederick Turton, MD, MBA, MACP

COVID-19: An Opportunity For Learning Even After Practicing for 40 Years

(July 2020) 

ACP recently spoke to Frederick Turton, MD, MBA, MACP, medical director for primary care at Emory Healthcare. He helps oversee a practice of 200 internists that serve throughout the Emory network. Dr. Turton's clinic is based in midtown Atlanta and primarily serves an older population with chronic diseases.

In mid-March, when COVID-19 hit, your practice made a rapid shift to telehealth. Did you have any previous experience with telehealth?

Absolutely none. The issue had always been payment. Emory had contracted with a company for telemedicine, but it had been used pretty much exclusively for surgeons doing postoperative care. The the finances of doing a full primary care visit were just not there. But when COVID-19 hit and Medicare and insurance companies elected to pay for telehealth, then in the course of two weeks, we got 200 providers up on Zoom. It was not a small undertaking, but I am really proud of us for doing it.

What was that process like?

When the pandemic hit, patient volume plummeted. So, providers had the time and we started experimenting. There was a committee in charge of figuring out the bigger picture of how to make it work, but we all went out on our own ways to learn how to do it. There were many issues to deal with. How do we communicate with our support staff when we're not in the same building? So, we put an off-the-shelf messaging system in place so that my medical assistant can text me the status of patients and I can do the same so that we can communicate outside of Zoom.

Twelve weeks in what is the status of telehealth and patient volume now?

This is tough for us financially and we are having to learn how to use fewer staff more ways. We are in a transitional phase right now. We have asked our providers to be 80% telehealth and 20% in person. Financial pressures are pushing folks to see more in-person patients. Also, some patients have to be seen in person. At many of our clinics we have a doc of the day and that doctor sees the patients that need to be seen face to face. I am 69, so I am higher risk, so I am electing to see all of my patients via telemedicine. Just like out there in the world, some of our providers see COVID-19 as less of a threat than others.

How did patients respond to offering telehealth?

When we started it, everybody loved it. Even when we were trying to figure out how to do it and we were cutting people off, the patient comments were amazingly good. I think it just has to do with the fact that we found something new. We were reaching out to them and working with them through a very difficult time. As time has gone by, it has become more routine, which is good and bad. It is always nice when you are doing something really cool, really neat, that's the new shiny object. But now volumes are picking back up and comments were still good.

Were you seeing COVID-19 patients via telehealth?

Emory elected to centralize their response to the coronavirus pandemic. When somebody calls and they are sick with respiratory illness, we are able to triage them to specialists who are able to manage their course from there — from a screening clinic to an acute respiratory clinic. Instead of standing up every clinic to be capable of taking care of the advanced needs of COVID-19 patients and dealing with personal protective equipment and procedures within each clinic to keep everybody safe, we elected to have special tracks for those patients.

If you reflect back on the past 12 weeks what are your takeaways?

We are still trying to figure this out, but I think isolating the flow of acute respiratory illnesses and presumed COVID-19 patients was the right thing to do.

We started having a daily Zoom huddle with all of our primary care providers, which is over 200 now. It allowed us to ask questions of each other, discuss best practices, and discuss issues we kept running across, like with state licensure for Zoom calls with patients. As we were learning Zoom, we were also learning the practice of telemedicine. We would have people discuss the best ways to do it, what worked for them, and it allowed us to level set at a reasonable competence. We had a family doctor talk to us about his techniques for examining shoulders and other musculoskeletal issues over Zoom. That has been a lot of fun. We are learning some new stuff. This is my 40th year practicing. It is nice to have something brand new to learn.

Will you continue with the morning meetings and telehealth?

One of the things about volume being low was that people could get on Zoom every morning. Typically, the problem with getting people together in this business is time.

My assumption is that telehealth is here to stay. That assumption is based on the payers seeing it that way too, of course. They could cut it off, but that would change the world just like the changes they made allowing telehealth changed the world. Going forward I could see us having two tiers of visits, a yearly in-person visit for a total physical examination, a comprehensive review. And then I could see them in three, six, nine months to check in. If they have a home blood glucose monitor, a home blood pressure monitor, and a pulse oximeter, and we teach them how to do it, how to keep the logs, then we can check in every three months on video, I think my patients would like that. Many of my patients have transportation problems, so, would they rather do that at home? Yeah, I think they would.

Have patients had any challenges with telehealth?

I was asked the other day, what's the most important thing for my patient to have to help them communicate with me. My answer is a granddaughter! Even my Medicaid patients have a smartphone. They frequently don't have a computer, but they'll have smartphone. And we can do this over a smartphone very nicely. I talked to a man yesterday, 89 years old living in a retirement home where there were no visitors, so no granddaughter. All he could do was talk on his iPhone. He couldn't figure out the picture. But that was better than nothing.

Personally, how has practicing during the pandemic affected you?

It is hard to be at home. Not being able to sit down with somebody face to face, to talk to him, touch him. That's definitely a lack. We are all doing our best with this telemedicine and it may never go away, but it's not the same. We are learning that there is just an amazing amount of medicine you can do without touching somebody. That's contrary to what we've been taught But, I think we're doing a pretty good job this way.

Members Spotlight: Jim Hotz, MD, MACP

A COVID-19 Profile in Courage: Serving from the Front Lines of the Pandemic

(June 2020) ACP recently spoke to Jim Hotz, M.D., the founder of Albany Area Primary Health Care, a large community health center practice with 28 sites, including eight school-based clinics, a large HIV program, two dental practices, a podiatry clinic, as well as internal medicine, pediatrics, and family medicine. Albany Area Primary Health Care serves eight counties, including Albany, Ga., the seat of Dougherty County, (population approx. 88,000), which has the highest per capita rate of COVID-19- related deaths in the entire state. As stipulated by federal rules surrounding funding of community health centers, Albany Area Primary Care provides care for medically underserved populations.

Dr. Hotz likens his practice to the Marines — running toward the chaos of the front lines of a battlefield. The community health center is like the beachead, staying open to serve needy patients in chaotic times. While the 41-year old practice has weathered natural disasters and other health crisis, like the HIV and the opioid epidemic, none caused the far-reaching upheaval that COVID-19 did.

"What really distinguishes the people who don't go extinct is the ability to rapidly evolve," says Dr. Hotz. "In a system that is under stress, the odds are those who evolve quickest are going to be the ones that are most successful."

Dr. Hotz shares the challenges, the rapid pivots, and the positive takeaways that his practice has experienced in the past 10 weeks.

What immediate effects did the pandemic have on your practice? We had 38 employees come down with COVID-19. One person died and two spouses died. We are a large organization with about 350 employees, and we were out in the community when this virus first hit and we didn't know it was here.

All of a sudden, we had a significant loss of income and loss in the number of patients that we were seeing. Organizationally, we went from seeing 855 patients a day before the pandemic to 455 a day in the first week of April. That's a loss of probably $400,000 in March and $600,000 in April. Financial folks were scrambling to maintain our staff.

What has been the impact of the pandemic on caring for patients? Patients have had disruption in their care. People are afraid to come to see you in the office. They were sheltering in place, which is what they were supposed to do, but a lot of them have chronic conditions. So, the issue became how do we connect with people that need to be followed?

How has your practice evolved? We rapidly pivoted to offering telehealth. But there are challenges to offering telehealth in a community health center practice where 80% of our patients fall below 200% of the Federal Poverty Level. It is very rural and there are issues with broadband access. Only 35% of our patients are web enabled and 30% have a smartphone that would allow for a visual visit. Often, it is those that don't have a visual way to connect that are the ones that need it the most, but that we are financially the least incented to see.

Our organization decided to just do the right thing and take care of our patients. I have done now 400 virtual visits and about 70% of my visits are voice only. I found that patients are extremely appreciative of the fact that we are calling. We have made a lot of other adaptations, too. We have a pharmacy within our program, and we have switched a lot of people to home delivery.

We also found out a lot of people did not have the tools to safely shelter at home. They didn't have a thermometer or a blood pressure cuff. And they, didn't have a pulse oximeter. We were fortunate that a foundation called us and asked what we needed. We said we need to be able to get these things to people's homes. So, our school-based nurse practitioners, who no longer have a school to go to, volunteered to go to people's homes and teach them how to use these tools. We now have provided over 250 people with blood pressure cuffs and I think I may be getting better blood pressure control. This is probably something we already should have been doing.

How will these adaptations have a lasting impact on your practice? This has opened our eyes to the effectiveness of virtual visits. When you're dealing with a lot of people living in a rural area, where transportation is a real issue, so it's allowed us to really understand the positive impact of the virtual visit. You can manage almost everything you need to with a virtual visit.

The greater the barriers, like transportation, the greater the no shows. And what we've learned from personally calling folks is that the noncompliant patient is a myth. When we remove barriers by using telephonic communication and electronic communication, I have had a total of 11 no shows out of 413 appointments. Normally, the no show rate in my patients is around 20%. There are other ways of connecting and reaching people then making them drive to your place for an appointment. It is important to be flexible and that is one of those lessons that this experience opened our eyes to.

Is there a specific event as part of your pandemic response that is going to personally stick with you? There is a young man that I have taken care of for 35 years. He is diabetic and bipolar and lives by himself. He has done an extremely good job after a struggle in which every bad thing that could happen to somebody happened to this poor guy. Before COVID-19 we got him proper mental health support, got him disability, and he's being productive. This hit and he is afraid to come in the office, justifiably so. So, I tell him, 'We'll have a visit and I'll call you.' We spoke two days beforehand and I told him I need his finger stick, blood sugar, and blood pressure. I call him, and no answer.

I call back, no answer. On the 12th time, I am worried. I finally hear slurring on other side. I say, 'Eat some cookies.' Then I hear a couple of crunches and about five minutes later I could almost make him out. And I say, 'Check your blood sugar.' Five minutes later he says, it's 43. I say, 'Eat two more cookies.' Finally, he wakes up and he gets his hyperglycemia resolved. And I ask, 'What happened?' He said he got so depressed looking at the news and was so scared with the outbreak in Albany that he went to bed without eating supper. I think about it that that telephone call may have saved this guy's life. How would I have connected with him that day if I hadn't moved to calling patients?

Has this experience changed how you see your role as a doctor? I was doing my patient calls on Good Friday and one of my patients is a minister. He said, 'Doc, do you know what you are right now? You're the good shepherd. In times of storms or crisis, the flock scatters. And what you're doing right now is trying to call the flock and bring them in.'

Population management is the big thing we're supposed to be doing these days. And I thought that that was a great analogy for what population management is — keeping your flock close, keeping them safe.

2020 National Award Winners and Master Recipients 

(April 2020) We are pleased to announce that the following Georgia members are in receipt of a 2020 National award or Mastership.

Anne Schuchat, MD, MACP of Atlanta and Melinda Wharton, MD, MACP of Atlanta have been awarded a Mastership.  Masters are Fellows who have been selected because of "integrity, positions of honor, eminence in practice or in medical research, or other attainments in science or in the art of medicine." Masters must be highly accomplished persons demonstrating eminence in practice, leadership, or in medical research. Evidence of their achievements can come from many types of endeavors such as renown within their field and/or ACP chapter, research, education, health care initiatives, volunteerism, and administrative positions. The Master must be distinguished by the excellence and significance of his or her contributions to the field of medicine.

Benjamin Hayes, MD, is a recipient of the Herbert S. Waxman Chief Resident Teaching Scholarship. This scholarship was established to recognize outstanding Chief Medical Residents and to provide them with an opportunity to assist teaching popular clinical skills workshops under the guidance and mentorship of expert faculty in the Clinical Skills Center, part of ACP’s Internal Medicine Meeting.

Tracey Henry, MD, MPH, MS, FACP of Powder Springs is in receipt of the Walter J. McDonald Award for Early Career Physicians award. The award recognizes outstanding achievement by a physician member who is within 16 years of graduating medical school and who is not an ACP Medical Student Member or Resident/Fellow Member. Nominees must meet these qualifications as of June 30th of each year considered. Areas of achievement may include leadership; academics, including publishing, teaching, and mentoring; and/or volunteerism.

Jean R. Sumner, MD, FACP of Macon is in receipt of the Ralph O. Claypoole Sr. Memorial Award for Devotion of a Career in Internal Medicine to the Care of Patients award.  The award is given to an outstanding practitioner of internal medicine who has devoted his or her career to the care of patients. The practitioner must be a clinician who is highly respected by his or her peers and colleagues for clinical skills and who has been a role model

Rachel Johnson, MD, is a National Winner of the 2020 Research Poster, "Just Because You Narcan, Doesn't Mean You Should."

Past Georgia Chapter National Awardees

Georgia Female Doctors Lead The Charge For Better Healthcare

(February 2020) - On February 18, 2020,  the Georgia House and Senate honored three female Georgia physicians who lead national physicians’ professional organizations with resolutions in their respective chambers.  The  American Medical Association President Patrice Harris, MD, MA, American College of Physicians President Elect Jacqueline Winfield Fincher, MD, MACP, and American Academy of Pediatrics President Sara H. Goza, MD, FAAP.  

Read the full article & watch the interview here 

2019 Chapter Award Winners

(October 2019) The Georgia Chapter of the American College of Physicians would like to congratulate our 2019 Chapter Award Winners

Laureate Award: Danny Allen Newman, MD, FACP

Leadership Award: J. Leonard Lichtenfeld, MD, MACP

Governor's Recognition Award for Outstanding Career: James W. Reed, MD, MACP

J. Willis Hurst Teaching Award: Michelle A. Nuss, MD, FACP

Volunteerism and Service Award: Pamela S. Tipler, DO, FACP

Early Career Volunteerism and Service Award: Jennifer L. Headrick, MD, FACP

Community Based Teaching Award: Thomas W. Wells, MD, FACP

Outstanding Resident in Volunteerism/Advocacy Award: Rachel Johnson, MD

Outstanding Student in Volunteerism/Advocacy Award: Matthew Schwartz and Sahil Angelo 

2019 Georgia Chapter Competition Winners

(October 2019) The Georgia Chapter congratulates the 2019 Chapter Abstract Competition Winners

Faculty Posters: 
1st Clinical Vignette - Barbar Junaidi, MD
1st Research - Cesar Zambrano, MD
1st Quality Improvement - Corie Tewari, MD

Resident Doctor's Dilemma Team: Piedmont

Resident Poster Vignettes:
1st (tied) - Yasameen Muzahim, D (Mercer)
1st (tied) - Felix Rodriguez, MD (Eisenhower)
3rd - Farah Ali, MD (Morehouse)

Resident Poster Research/QI:
1st - Haoran Peng, MD (Northside Gwinnett)
2nd - Mary Stout, MD (Emory)
3rd - Nicole Treadway, MD (Emory)

Resident Oral Research & Quality Improvement:
1st - Rachel Johnson, MD (WellStar Kennestone)
2nd - Nitin Rao, MD (Eisenhower)
3rd - Jonathan Hasnson, DO (Augusta University)

Resident Oral Clinical Vignette:
1st - Faissal Fa'ak, MD (Piedmont Athens)
2nd - Jamila Pham, MD (Augusta University/UGA Partnership)
3rd - Jordann Kokoski, DO (Eisenhower)

Student Quality Improvement
1st - Michael Kimbrell (Emory)
2nd - Daniel Lee (Morehouse)

Student Clinical Vignettes: 
1st - Bari Rosenberg (Emory University)
2nd - Jennifer Hua (PCOM)
3rd - Ciara Hutchison (Emory University)

Student Research:
1st - Viral Patel (Augusta University)
2nd - Kelara Samuel (Morehouse University)

I.M. Proud Spotlight: Frances E. Ferguson, MD, FACP

Frances E. Ferguson, MD, FACP

(June 2019) Read Dr. Ferguson's spotlight


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