How a New York family medical practice went to battle against COVID-19 — and won
BINGHAMTON, N.Y. – In the early, uncertain days of the COVID-19 pandemic, the primary care facilities that people had always counted upon were ill-equipped to help patients showing symptoms of the frightening new virus.
Not only did they not have the infrastructure, they were actively told not to: The battle against COVID, many believed then, would be won and lost inside hospital emergency rooms.
So when a longtime patient of Endwell Family Physicians — a man in his 80s — came into the office in March 2020 with a mysterious runny nose and symptoms consistent with dehydration, the team there followed protocol and sent him to the hospital.
Later, they would learn he had died.
His loss was part of an overwhelming sense of frustration from the Endwell team of health care providers and administrators, who felt hamstrung to help the very people it had been their mission to protect.
It was time to fight back. And the battle plan was revolutionary.
The ambitious, unprecedented approach: A complete overhaul of the practice’s operations to see, test and treat COVID patients on-site. A private family practice transformed into a COVID-fighting base.
The end result would gain attention from across the state and beyond. It would build an even tighter knit staff.
And, most importantly, it would save their patients’ lives.
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Pandemic sidelined primary care
In the beginning, it was the Super 7: A handpicked group of Endwell Family Physicians’ department leaders determined to change the status quo.
Their skill set spanned every facet of the practice, from office management to lab and clinical coordination, reception, nursing, vaccination, safety, billing and patient advocacy.
As things stood, their physicians couldn’t see COVID patients in person and examine them. They could only send them for testing off-site, and that delay could forfeit precious time in their treatment window. Personal protective equipment shortages and safety measures forced much of primary care into telemedicine.
“We went through the spring feeling like this is a disease that we weren’t able to be a part of treating,” said Dr. Lazarus Gehring, who is a partner physician at the practice, “which seems completely off for all of us to be trained to take care of people primarily and to not be able to do anything.”
The Super 7, who quickly recruited more staff to become a group of 10, made it their mission to get COVID patients into their practice, and to figure out how to do it safely.
It was a tall order: To rework office flow and implement dozens of new safety measures to add a respiratory clinic with in-house testing. They would develop ways to safely examine, test and treat COVID-19 patients in house, from their cars and at their homes.
It would involve twice weekly morning meetings, weekend shifts and late nights along with an evolving list of extra duties. Pulling it off would mean alleviating the burden on local hospitals and helping their patients.
“We knew what our end goal was and then we all got together and step by step, right from the very beginning, decided what we needed and how we were going to get there,” said clinical coordinator Rachel Osborn. “I think we could all agree that it was challenging, but the end result basically was we were doing something that a lot of places weren’t able to do.”
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By October, Endwell Family Physicians was transformed and, Gehring says, “a one-of-a-kind clinic was born.”
Inside outpatient COVID care model
It’s early one afternoon during Endwell Family Physicians’ clinic study. The clinic is open on weekday evenings and weekends, but test orders come in at all hours.
Clinic patients call the office when they arrive in the parking lot. A runner brings them in through a side door — only COVID patients are brought through here — passing a whiteboard with the latest numbers on their test results, down a winding set of empty hallways to an exam room where they’ll meet their provider.
To a patient the route is a maze, but the carefully constructed labyrinth is something staff members like Osborn and office manager Pam Ravener have spent months perfecting. Business continues all around the building, but here on the COVID route, a patient sees only two people: The runner and the doctor.
Outside, a car pulls up near the back door of the facility. A 44-year-old patient has arrived as scheduled, 35 minutes after he called and left a message for his doctor.
He has a cough, he said, and a fever. The symptoms began two days ago. A COVID test has been ordered. Timing, physicians have learned, is key with COVID.
Inside, doctors gown up at a PPE station. Nadine Kennedy, with the Vaccines For Children program, tirelessly tracked prices, reached out to the state health department and private vendors and scoured Amazon to make sure they had enough protective equipment to make this clinic work.
In the new testing wing at the front of the office, one doctor grabs his gear: A sleeved swab from a plastic tub, which has been placed in a bag with the test order, a pulse oximeter, a thermometer and a patient care plan.
The doctor heads out to the parking lot to check the 44-year-old’s vitals in his car, discuss his condition and administer the swab — some patients prefer drive-thru testing. Inside an exam room turned lab, a technician donning full PPE will test it for COVID-19, using one of the rapid test devices lab coordinator Tricia Holbert relentlessly asked medical device companies for access to.
The drive-thru patient heads home, and within 45 minutes he has a result: Positive. His doctor calls with the care plan: Quarantine, a monoclonal antibody infusion at a local hospital the next day and a follow-up video visit two days after that.
Depending on his condition, the outcome may have been different. The patient could have entered Endwell Family Physicians’ COVID at Home program, where Heather Chermak, RN, helps patients receive oxygen, have diagnostics taken and receive needed support without going to the hospital.
If the patient were severely ill, they may have been sent to the hospital. There have only been 10 patients who met that criteria.
Results of Endwell Family Physicians model
Endwell Family Physicians tested about 2,200 patients in its clinic from Oct. 5, 2020 to Feb. 28, 2021, with 1,146 testing positive for COVID-19.
They expected 138 hospitalizations. Of the patients seen in their office, they had 10. The practice had 20 patients in its COVID at Home program. They expected up to 28 deaths. There were five.
Endwell Family Physicians also saw zero transmission of the virus between staff and patients.
The model has generated attention. Gehring has given presentations for health care systems, medical companies, local hospitals and colleagues around the state.
“As we started marching forward it was clear that we had advanced in battle, turned around and looked, and there was nobody there,” Gehring said. “People know what we’re doing because we were really aggressive with lab companies and with other physicians asking, ‘What do you think about this or that?’ “
Gehring received one call from a commander in the U.S. Navy in charge of organizing COVID care on naval bases.
“Can you walk me through what you’ve done at your office?” he asked.
Dr. Wallace Johnson, Ralph W. Prince professor of medicine and director of University of Rochester Medicine Primary Care Network, equated Endwell’s rapid testing model to “state-of-the-art turnaround.”
Duplicating it to scale may not have been feasible for the University of Rochester — the health care system has 250,000 patients across seven counties — but Johnson said the key to pulling off this effort likely lies with the practice’s leadership team.
“That’s crucially important,” he said. “They took it upon themselves, in a time of great uncertainty to step up and create a model and really put a lot of thought and effort into this. I’m sure it was very time consuming. I’m sure their staff was very stressed by this, but again, I think it was a hugely commendable effort.”
Dr. Tom LaClair, clerkship director and family medicine course director at Upstate College of Medicine, called Endwell Family Physicians “a good role model for what a family practice can do for the health care system.”
“If you’re willing to let your family physicians play a role in your health care system,” he said, “the point is you can save money, save your hospital headaches, save unnecessary admissions and take care of the people within your practice who ultimately don’t need hospitalization.”
‘It’s not just a job’
In sparse groupings of office chairs around the room that now doubles as physicians’ offices and staff break room, 10 women have gathered early on a Wednesday morning.
They’re the architects of this care model: Pam Ravener, Rachel Osborn, Tricia Holbert, Kristina Bensely, Heather Chermak, Nadine Kennedy, Tracey Louden, who’s the practice’s representative for Occupational Safety and Health Administration; Bridget Spinelli and Tricia Detreville, who work in billing; Jennifer Green, who’s a patient advocate.
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These are the women their colleagues have dubbed the Super 7, which is really Super 10. And if you ask them, it’s actually Super 105.
“This group might have started all that,” Green says, “(but) we still would have fallen on our face if not for the other 100 employees, buying in and really doing their job well.”
One of Ravener’s desk drawers has quickly filled with the many thank you notes the practice has been sent over the past year. She’s taped several of them up on her office door, something every member of this staff can see when the walk by, “so they know how important what we do is to our patients.”
That is, after all, how this all started. When Louden thinks back on those early days, having to tell some patients “No,” they couldn’t see them, she can’t believe how far they’ve come.
It hasn’t been easy. Every week, this group continues to meet to adapt and refine the model they’ve created. There are still weekend shifts and late shifts, hours of research and communication. Every person in this room has done more in this past year than any other time in their career.
It’s all worth it, these women say, for a simple reason.
“We’re family,” said lab coordinator Holbert. “It’s not just a job, we love each other. We’re here for our patients. That’s why (we did this). It’s our patients and our work family.”
Follow Katie Sullivan Borrelli on Twitter: @ByKatieBorrelli.