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COVID-19: Helping Functional Medicine Practices Achieve Their Duty to Serve

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Published April 15, 2020

The Importance of Functional Medicine

The COVID-19 pandemic is producing challenges that threaten the health and safety of all individuals and significantly compromise Functional Medicine practices as well as the healthcare system worldwide.

Functional Medicine Patients Among Those Most in Need

As the CDC directs people to limit healthcare visits to emergency needs, the calendars of most practices are clearing, and some are closing their doors for an indefinite amount of time. In addition to the economic threat to their practices, the sidelining of this substantial and highly skilled healthcare workforce—and the separation of these practitioners from their patient populations—is particularly dangerous at this time for several reasons:

  • The average Functional Medicine patient is 44 years old and has three disease diagnoses, including a significant concentration of cardiovascular, metabolic, and autoimmune disease burdens, according to an analysis of data collected by LivingMatrix.
  • This multi-chronic patient group comprises the highest COVID-19 complication and mortality risk segment of the working-age population and requires the most attentive professional support possible, both to protect these patients from the virus and to mitigate the effects if infection occurs.
  • These health-challenged patients are also at greatest risk of additionally compromised health status in the event of disrupted care regimens.

It is unacceptable to have thousands of healthcare practitioners sidelined and separated from their patients for the duration of the largest pandemic in modern history.

To date, many of the care guidelines that have emerged for COVID-19 have focused heavily on treating patients once they have arrived at the hospital. Those who are not yet hospitalized, including known infected patients as well as those who suspect they have the virus, are being provided with little guidance on what to do on their own before their symptoms force them into the emergency department. Advice is limited to self-isolation, hand washing, hydration, and watchfully waiting for dangerous symptoms to emerge that would prompt them to utilize emergency care.

Functional Medicine Practitioners Offer More

Functional Medicine practitioners are the best trained professionals to address the needs of asymptomatic and symptomatic COVID-19 patients prior to a potential hospitalization. Trained in providing personalized guidance to patients in the use of nutrition, nutraceuticals, and lifestyle to prevent, reverse, and decrease the burden of complex, chronic disease, Functional Medicine practitioners are also particularly qualified to support the majority of those infected by, or seeking to avoid, COVID-19.

Properly equipped to engage patients with virtual visits, these practitioners can address a great unmet need faced by patients in this pandemic, and also serve as catalysts to expose new audiences, as well as the broader health system, to the long-term benefits of Functional Medicine.

Key Shifts Important to Patients and Practitioners

As necessary requirements for social distancing continue, the need to serve patients remotely during the crisis grows dramatically within the rapidly changing health practice environment.

Through the relaxation of a number of key telehealth regulations and payer policies, the stage is set for practitioners to sustain their practices and continue to serve by providing invaluable service and support to both existing patients and others in their communities and beyond.

Four Steps to Sustained Patient Care and Long Term Impact During and Beyond the COVID-19 Pandemic

With the proper tools in place, Functional Medicine practitioners are well equipped to contain the pandemic with very little time and expense. The process can be broken down into four clear steps:

Step 1: Implement telehealth tools.

Functional Medicine practices that have not put telehealth tools into place already will need to expand or transition from their brick-and-mortar operating model to include virtual patient care. Ready-to-use tools are available and affordable, and the telehealth regulatory environment is recognizing the importance of physicians’ ability to treat current patients virtually, as well as those beyond the borders of the states in which they are licensed.

Federal and state governments continue to announce new ways for doctors to reach patients so they can help address the COVID-19 pandemic. Given the ever-changing status of regulatory activity, practitioners are advised to remain current on their state-level COVID-19 actions and to take the necessary steps to manage their liability.

In addition to moving from onsite to telehealth platforms, practices need to equip themselves to:

  • Schedule virtual visits (possibly allowing patients to self-schedule).
  • Conduct an effective virtual visit.
  • Learn how to appropriately bill, code, and collect for a virtual visit.

It is important for practitioners to recognize that in the current climate, the implementation of telehealth tools is a necessity, though it may not be sufficient to enable individual practices to optimize their value in the COVID-19 pandemic.

Step 2. Provide Functional Medicine episodes of care.

In order to offer the greatest possible care for patients, practitioners should expand care beyond chronic disease to include acute care in the prevention, treatment, and recovery of COVID-19 to engage and serve their communities.

Most practitioners clearly recognize that they have valuable advice to offer anyone seeking to mitigate the risks and the potential impact of the SARS-CoV-2 infection. Many have distilled that advice into the form of thorough and thoughtful email newsletters that they broadcast to patients and others. While this is a tremendous service, it underrepresents the value that Functional Medicine has to offer.

Rather than limiting advice to email newsletters, practitioners are encouraged to bundle their services into an episode of care path that tracks and addresses the needs of the patient from the initiation of their request until a defined end-point at which, ideally, the targeted health objective is met. COVID-19 represents an opportune starting point for practitioners who see the merits of this approach.

An episode of care similar to the example provided can be delivered remotely and should provide a persistent sense of connection to an expert who is providing personalized guidance and support. This guidance will continue beyond illness to recovery and returning to work. Currently, there is ambiguity in antigen and antibody testing to determine when individuals are ready to “return to work.” As a gold standard of testing emerges, Functional Medicine practitioners are particularly well suited to understand its application in the real world.

The episode of care path should integrate certain new tools and technologies beyond the basic telehealth platform, including:

  1. An intake questionnaire. This questionnaire must be tailored to COVID-19, its known risk factors, and the current reality of lifestyle factors—now taking place in the confines of our homes (which could potentially increase risk).
  2. A COVID-19 risk assessment. A simple, objective tool to assess COVID-19 risk prior to testing, accounting for the ever-expanding base of knowledge pertaining to the virus.
  3. A symptom tracker. An interactive tool to follow the symptom progression of patients. Tools are readily available, free, and easy to use.
  4. Testing. Ideally, practitioners would be equipped to order and facilitate home-collection COVID-19 testing. Test orders should be initiated by an appropriately licensed healthcare provider. Note that while many lab kits have received the FDA Emergency Use Authorization (EUA), their quality (i.e., sensitivity and specificity) is highly variable; thus, appropriate curation of these tests is essential.
  5. Safe, valid, and effective clinical recommendations. Well-defined Functional Medicine clinical recommendations for patients that can be implemented in the home. Two recently released examples include:

Step 3: Make the back office work.

With bundled episodes of care defined and the tools in place to implement them, practices can package and price these episodes of care for purchase by consumers and employers. Approaches to pricing will vary based on practice revenue models; however, when possible, practitioners should strongly consider bundling the episodes into defined packages for patients rather than charging patients by the encounter or unit of time or service.

In the effort to minimize the financial impact of COVID-19 on consumers, an important accommodation has been made that is relevant to Functional Medicine practitioners. Section 3701 of the CARES Act allows a high-deductible health plan (HDHP) with an HSA to cover telehealth services prior to a patient reaching the deductible. (You will find a thorough listing of the key telehealth provision of the CARES Act from the American Telemedicine Association.)

With this change in effect, along with a host of others from health insurance providers in response to COVID-19, many patients, if given the proper documentation, can submit their own out-of-network claims and receive reimbursement for virtual care. This enables physicians providing a bundled COVID-19-related episode of care to deconstruct the bundle into its reimbursable components and equip patients with the documentation to be reimbursed in full or in part based on care package specifics.

Practices that are contracted with payers may take a different approach to bundled pricing. As they are obligated to bill payers for covered services, their bundled price should be documented, and they should strictly account for non-covered services included in the bundle.

Step 4: Communicate with patients and the public.

By filling a significant gap in care, practices can announce the availability of their virtual COVID-19 clinic to their patients and extended communities. While this is a familiar marketing and communications exercise, the climate created by the pandemic has likely left some patients in need of practitioner care.

Depending on the objectives for patient volume, practitioners may consider three new possibilities as they plan their outreach:

  1. Local community needs. Filling community needs should take first priority. Practitioners may consider introducing their programs to local community leaders in order to assist in fulfilling unmet needs.
  2. Local employers. Practices should consider outreach to area employers to assist during the pandemic. While under ordinary circumstances, it is difficult for independent practices to engage directly with employers, circumstances surrounding the pandemic appear to have opened the minds of some business leaders to innovative approaches to meet the needs of their employees and other health plan members.
  3. Out-of-state friends and family of patients. In light of the relaxation of telehealth regulations for the COVID-19 pandemic, practices may engage patients outside of the state in which they are currently licensed. With this in mind, practices should consider inviting patients to refer family members and friends to utilize the virtual COVID-19 clinic as needs arise.
Creating Your Virtual COVID-19 Clinic

The needs of communities are clear, and Functional Medicine practitioners have the right training to fill a critical need for existing patients and others in their community. The role of Functional Medicine is ongoing and essential to recovery. Functional Medicine practitioners are especially qualified to use their training to sustain their practices while having a profound impact on the health of their communities and beyond.

Every resource mentioned in this article and many more are now available to you at no cost at VirtualPractices.org.

Webinar

In this live presentation, IFM Strategic Advisor - Industry, Tom Blue and IFM Certified Practitioner Kristine Burke, MD, discuss PI strategies during COVID-19 with Patrick Hanaway, MD.

SPECIAL THANKS

We would like to thank the IFM COVID-19 Task Force, members of the IFM staff, and consultants working with IFM for their contributions to this article.