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CEO Perspectives: The Pandemic’s Impact On Texas Health Systems

Eighteen months after COVID-19 began wreaking havoc, North Texas healthcare CEOs share how their experiences battling the disease have changed their organizations.
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COVID-19 began taking hold of the nation in the spring of 2020, putting those in the healthcare sector on the front lines of the battle against it. Leaders were called upon to be more agile, innovative, and resilient. As their frontline workers fought to save lives, administrators scrambled to develop and implement policies that would protect patients—and their own personnel. The challenge tested them like nothing had before. For D CEO’s healthcare news site, I recently sat down with system leaders to get their thoughts on the last year-and-a-half—how it forever changed them, their companies, and the industry. Here’s what they had to say.

Erol Akdamar


Medical City Healthcare


“It quickly became evident that the COVID-19 pandemic was not a sprint. As the North Texas cases began to multiply over time, the dynamic nature of the situation was going to be more like a marathon. As we moved through the pandemic, we moved through several different phases. Initially, we were in the preparation phase. And then, as we began to see the spike, there was a response phase— and I am proud of how our team stepped up to the challenge there. What we learned was that there were going to be spikes and valleys as we move through this pandemic and that we needed to be prepared to respond in both scenarios. We relied on data science and projection models to the best of our ability, and because we are part of HCA, a nationwide company. We had the visibility to see what was happening in other markets as they spiked, accelerated, and decelerated.”

Barclay Berdan


Texas Health Resources


“Back in 2014, when we had our experience with Ebola, we observed the environment moving from science, to social science, to science fiction. We knew that was going to happen with COVID-19 because we’ve seen it happen before. That helped us anticipate how we could deal with some of the lack of information or misinformation picked up in the media and on social media. We’re seeing the same kinds of things now, so we had to put in place a way to vet information and decide whether that would impact how we were caring for patients. What advice were we giving to physicians and employees as well as the public? We had a way to ingest that information daily and then, on a very rapid turnaround basis, get information out about what was truth and what wasn’t. We spent time thinking about the essential institutions for communities.”

Dr. Fred Cerise


Parkland Health and Hospital System


“The situation called us to quickly adapt in two big ways. The first was the scientific response: Trying new drugs, expedited trials, and the early authorizations to push out the drug. To go from a new disease to a vaccine within a year is just unheard of. The other part of the speed of response is how services are structured and delivered. We all had to adapt as we got information— whether it was how to cohort patients or what your PPE policy will be. What do you do beyond the walls of the hospital in terms of public health measures? What I learned when I went through Katrina was that during a crisis, there is no time to be hesitant and guarded in your response—you have got to jump in. What has impressed me is people’s willingness to do what has to be done. People get into healthcare to make a difference, and this is a defining moment in our careers.”

Chris Durovich


Children’s Health


“When the pandemic started, our organization was already focusing on continual improvement as a pediatric care provider. We have invested further in technology and processes to support our patients and team members during these challenging times. The pandemic accelerated our development of technology and its use. We are leaders in using telemedicine. Prior to the pandemic, we were already partnering with nearly 30 independent school districts and more than 220 schools across North Texas as part of our school-based telehealth programs. As COVID-19 began to spread in the U.S. and across North Texas, we were well-positioned to expand these services, which became vital at a time when many children and families were not able to come on site for care. We rapidly converted 74 clinics that normally see patients in-person to virtual appointments.”

Robert Earley


JPS Health Network


“How do you create a preliminary telehealth visit with the home- less population, or the most vulnerable populations, or a community that doesn’t have the fiber optics and capabilities that technology affords them? COVID was almost a discriminatory virus in the sense that it hit the weakest, so if you had challenges going into COVID, your chances of adverse or difficult outcomes were far greater. It amplified the challenges we have in communities where we’re not offering the healthcare that’s readily available. It made us at JPS look at issues that are corollary to healthcare, such as these people living in a food desert where they have no vehicle to transport them. COVID said, ‘OK, I’m going to show you your societal problems.’ If we don’t learn our proper lessons from COVID, then that’s a huge mistake. COVID points to the frailties of the human and in healthcare.”

Rick Merrill


Cook Children’s Health Care System


“Our organization is comprised of local board members and leadership. We don’t have to raise up the flag to someone at corporate to get approvals—we can make quick decisions when we need to. Our board gave me and our executive team carte blanche to do what we needed to do when we needed to do it: They supported us when we needed to pivot to en- sure that our patients were given the best possible care and that our employees were safe. That also was part of that decision to make sure we gave everyone full pay through this pandemic—even our 450 employed physicians, some of whom were at home for a period of time. We did not have any layoffs or staff reductions. That was a big plus for us, and it speaks volumes to our culture and who we are. When we come to work, we leave our personal selves at the door and walk into this organization.”

Jim Scoggin Jr.


Methodist Health System


“The pace, magnitude, and duration of this pandemic were and, frankly, still are, unprecedented. When I think back to the beginning of the pandemic, I am amazed by the sheer number of decisions that had to be made in almost real-time. We would make a decision and communicate that decision based upon the best information at that moment. Often, we would then get different directions from various national and local health officials requiring significant modifications, some- times the same or the next day. Everybody was doing the best they could with the information they had; however, it was all staggering, at times. This is the closest thing to a prolonged crisis that I have ever dealt with in my healthcare career, and in the case of this pandemic, I’m proud to say that the Methodist Health System family grew even closer and stronger.”

The Pandemic’s Impact on DFW Health Systems

Eighteen months after COVID-19 began wreaking havoc, North Texas healthcare CEOs share how their experiences battling the disease have changed their organizations.

COVID-19 began taking hold of the nation in the spring of 2020, putting those in the healthcare sector on the front lines of the battle against it. Leaders were called upon to be more agile, innovative, and resilient. As their frontline workers fought to save lives, administrators scrambled to develop and implement policies that would protect patients—and their own personnel. The challenge tested them like nothing had before. For D CEO’s healthcare news site, I recently sat down with system leaders to get their thoughts on the last year-and-a-half—how it forever changed them, their companies, and the industry. Here’s what they had to say.

Erol Akdamar


Medical City Healthcare

“It quickly became evident that the COVID-19 pandemic was not a sprint. As the North Texas cases began to multiply over time, the dynamic nature of the situation was going to be more like a marathon. As we moved through the pandemic, we moved through several different phases. Initially, we were in the preparation phase. And then, as we began to see the spike, there was a response phase— and I am proud of how our team stepped up to the challenge there. What we learned was that there were going to be spikes and valleys as we move through this pandemic and that we needed to be prepared to respond in both scenarios. We relied on data science and projection models to the best of our ability, and because we are part of HCA, a nationwide company. We had the visibility to see what was happening in other markets as they spiked, accelerated, and decelerated.”

Barclay Berdan


Texas Health Resources

“Back in 2014, when we had our experience with Ebola, we observed the environment moving from science, to social science, to science fiction. We knew that was going to happen with COVID-19 because we’ve seen it happen before. That helped us anticipate how we could deal with some of the lack of information or misinformation picked up in the media and on social media. We’re seeing the same kinds of things now, so we had to put in place a way to vet information and decide whether that would impact how we were caring for patients. What advice were we giving to physicians and employees as well as the public? We had a way to ingest that information daily and then, on a very rapid turnaround basis, get information out about what was truth and what wasn’t. We spent time thinking about the essential institutions for communities.”

Dr. Fred Cerise


Parkland Health and Hospital System



“The situation called us to quickly adapt in two big ways. The first was the scientific response: Trying new drugs, expedited trials, and the early authorizations to push out the drug. To go from a new disease to a vaccine within a year is just unheard of. The other part of the speed of response is how services are structured and delivered. We all had to adapt as we got information— whether it was how to cohort patients or what your PPE policy will be. What do you do beyond the walls of the hospital in terms of public health measures? What I learned when I went through Katrina was that during a crisis, there is no time to be hesitant and guarded in your response—you have got to jump in. What has impressed me is people’s willingness to do what has to be done. People get into healthcare to make a difference, and this is a defining moment in our careers.”

Chris Durovich


Children’s Health

“When the pandemic started, our organization was already focusing on continual improvement as a pediatric care provider. We have invested further in technology and processes to support our patients and team members during these challenging times. The pandemic accelerated our development of technology and its use. We are leaders in using telemedicine. Prior to the pandemic, we were already partnering with nearly 30 independent school districts and more than 220 schools across North Texas as part of our school-based telehealth programs. As COVID-19 began to spread in the U.S. and across North Texas, we were well-positioned to expand these services, which became vital at a time when many children and families were not able to come on site for care. We rapidly converted 74 clinics that normally see patients in-person to virtual appointments.”

Robert Earley


JPS Health Network

“How do you create a preliminary telehealth visit with the home- less population, or the most vulnerable populations, or a community that doesn’t have the fiber optics and capabilities that technology affords them? COVID was almost a discriminatory virus in the sense that it hit the weakest, so if you had challenges going into COVID, your chances of adverse or difficult outcomes were far greater. It amplified the challenges we have in communities where we’re not offering the healthcare that’s readily available. It made us at JPS look at issues that are corollary to healthcare, such as these people living in a food desert where they have no vehicle to transport them. COVID said, ‘OK, I’m going to show you your societal problems.’ If we don’t learn our proper lessons from COVID, then that’s a huge mistake. COVID points to the frailties of the human and in healthcare.”

Rick Merrill


Cook Children’s Health Care System

“Our organization is comprised of local board members and leadership. We don’t have to raise up the flag to someone at corporate to get approvals—we can make quick decisions when we need to. Our board gave me and our executive team carte blanche to do what we needed to do when we needed to do it: They supported us when we needed to pivot to en- sure that our patients were given the best possible care and that our employees were safe. That also was part of that decision to make sure we gave everyone full pay through this pandemic—even our 450 employed physicians, some of whom were at home for a period of time. We did not have any layoffs or staff reductions. That was a big plus for us, and it speaks volumes to our culture and who we are. When we come to work, we leave our personal selves at the door and walk into this organization.”

Jim Scoggin Jr.


Methodist Health System

“The pace, magnitude, and duration of this pandemic were and, frankly, still are, unprecedented. When I think back to the beginning of the pandemic, I am amazed by the sheer number of decisions that had to be made in almost real-time. We would make a decision and communicate that decision based upon the best information at that moment. Often, we would then get different directions from various national and local health officials requiring significant modifications, some- times the same or the next day. Everybody was doing the best they could with the information they had; however, it was all staggering, at times. This is the closest thing to a prolonged crisis that I have ever dealt with in my healthcare career, and in the case of this pandemic, I’m proud to say that the Methodist Health System family grew even closer and stronger.”

Breaking Barriers, One Heart at a Time

Women are stepping into leadership at the congenital heart surgery program at Medical City Children’s Hospital.

Monday meetings with the congenital heart surgery team at Medical City Children’s Hospital are not like those at a typical office. Sure, some of it might look familiar: More than a dozen physicians, surgeons, clinic managers, and other staff gather around 7:30 a.m. to discuss the week ahead. Some of the team calls in virtually; others sit around a conference table. But that’s where the similarities end.

When I visited there in July, several people jumped up to leave the room about halfway through the meeting. They weren’t refill- ing their coffee or using the restroom. One of their patients needed immediate resuscitation. (The team was successful, and the patient survived). When the doctors returned, they sat back in their seats as if they simply stepped away to grab a snack. Typical, this is not.

At the meeting, what looks like an indecipherable bloody mass of flesh is shown on the screen, but it speaks volumes to the team. They point out malformations and results of past procedures and create a plan for each of the children upstairs in the team’s intensive care unit. Walking past the patient rooms, I am struck by just how small the children look in the full-sized hospital beds. Machines loom large on either side, pumping in fluids and antibiotics, beeping as par- ents huddle nearby. Laying on their backs, many have patches over their eyes, their chests rising and falling almost imperceptibly.

Dr. Kristine Guleserian performs heart surgery on a child at Medical City Children’s Hospital.


Meanwhile, downstairs at the meeting, Dr. Kristine Guleserian leads the discussion from the head of the table. She is the first and only woman to lead a congenital heart team in the country, and her comprehensive knowledge of the patients, their families, and the condition of their hearts is on full display as the group discusses each case.

She and the team work efficiently with input from all directions. Guleserian is the head of the program, but it is not a one-woman show. Pediatric cardiologists, general surgeons, and clinic managers alike chime in to add their perspective, weighing on the imaging, family, mental health, and medical history. It is no coincidence that the group functions so well; Guleserian built the team with moments like this in mind.

Getting the Band Back Together


After more than a decade at UT Southwestern and a spell in Miami, Guleserian was hungry to lead and more than capable. Although she is not much more than five feet tall, she looms large in the con- genital heart surgery world, serving on leadership in numerous organizations, and is a coveted speaker at conferences. While at UT Southwestern, she made headlines when she performed a heart transplant on what was at the time the world’s smallest patient, a five-pound newborn.

When she arrived at Medical City in September 2019, the hospital invested in assembling her ideal team, a collection of cardiologists who balanced all the qualities she looked for in colleagues— and they just all happened to be women. “It’s like fantasy football. You pick everybody who you would dream about working with, and you change the whole atmosphere,” Guleserian says. “You get rid of the toxic work environment that so many of us have been subjected to, and you build a team with all the best people, the most talented, and the ones who have the best bedside manner and personality.”

Finding a physician who is gifted technically, great with patients, and lacks a disruptive ego is no easy task. But Guleserian is confident that she has found a crew that checks all her boxes. Over the years, she made mental notes of who she would want to work with if she were given the resources to build her own crew and bring in her preferred talent.

Within the last year, Guleserian has recruited four physicians to join her at Medical City Children’s. All of them came from UT Southwestern, though they all were at different stages in their ca- reer. Usually, it would take years for the resources to open for such a significant talent acquisition, but Medical City made it happen.

Guleserian’s real-life fantasy line-up includes Dr. Vivian Dimas, the medical director of adult congenital heart disease at Medical City Children’s Hospital who specializes in minimally invasive treatments of complex heart conditions. She is joined by Dr. Carrie Herbert, a pediatric interventional cardiologist who also focuses on minimally invasive procedures.

Dr. Poonam Thankavel is a pediatric cardiologist and the medical director of pediatric cardiac imaging specializing in imaging and diagnosis. Dr. Ilana Zeltser is a pediatric cardiologist and the medical director of pediatric electrophysiology and specializes in diagnoses.

Having that many women leaders in a cardiology program is rare, but Guleserian didn’t set out with that intention. “I picked them for their talent,” she says. “They just so happen to have two X chromosomes.”

“I picked them for their talent. They just so happen to have two X chromosomes.”

Dr. Kristine Guleserian


Guleserian also brought in her surgery partner, Dr. Janier Brenes, from Costa Rica, and the team’s intensive care unit director, Dr. Mark Clay. “It’s al- ways been my dream since I was a medical student to build a team of all the people who I liked to work with. That’s been the vision here—to bring the best of the best who are people you like to work with,” Guleserian says. “They are more than just clinical experts. They have a great bed- side manner, personalities, and outside interests that make them multi-dimensional.”

Many of us have experienced that special team or group of col- leagues where everything just clicked. Together you did great work, you got along, and you cared about each other. Time, money, families, partners, and other opportunities eventually get in the way. But you stay in touch in case there’s a way to work together again. That’s what Guleserian made happen. “It’s hard to believe how much we’ve done, but it is a case of getting the band back together with a bunch of people who respect each other, like each other, and work well together,” Dimas says.

Those who were part of the pediatric cardiology team before Guleserian arrived say they’ve noticed a marked difference in the ambition of the program and the innovation it embraces. “Dr. G thinks outside the box, and she’s a perfectionist, which is absolutely vital in terms of what we’re doing,” says Dr. Jane Kao, a pediatric cardiologist who has been at Medical City since 1995. “She never says it can’t be done. She asks, ‘Why not?’”

Bringing in that many new leaders in a short time isn’t easy in any business setting, but in just six months, the team is already functioning at a high level. Keeping the focus on the patient is critical. “Every person that’s part of this team comes together for the sake of the patient,” Kao says. “We always put the patient first.” Guleserian believes she is having her cardiology cake and eating it too. “People sometimes ask, ‘If you had to have a technically excel- lent surgeon or a surgeon with great bedside manner, which would you choose?’ And I always said, ‘Why can’t I have both?’”

Operating in a Man’s World


Several of the physicians I spoke with shared a similar story. It goes something like this: As women at the top of their field, who often present and speak at conferences, they tend to see the same audience while peering over the podium. Before them could be 100 physicians from all over the world, but only about eight of them would be women.

Interventional cardiology is still a bastion for male physicians. Even though gender parity has improved from a generation ago, women still experience a lingering disparity. At the last in-person conference that Dimas attended, prior to the pandemic, she approached the faculty check-in table. A woman seated behind the table told her, “Vendor check-in is down there.” Dimas says, “I told her, ‘I’m checking in for faculty.’ That [kind of] stuff is still out there.”

Guleserian once implanted a pacemaker in a baby born at just 32 weeks.


The double standards don’t end at international conferences. Women surgeons and cardiologists are still subjected to assumptions that affect women in multiple professions. “There is that undertone that as women, they will never be as dedicated as men because they are dedicated to their families and can’t give everything to their job,” Dimas says.

But around the conference table at Medical City Children’s Hospital, floors below the impossibly small infants preparing for or re- covering from heart surgery, Guleserian is working to change the paradigm. “We’ve all been subjected to some form of harassment in the workplace,” she says. “What we’re trying to do is set the example and have a zero-tolerance policy.”

In addition to building her dream team, breaking barriers of medical leadership, and performing some of the most complex and delicate surgeries on the planet, Guleserian seeks out mentorship opportunities with young women at all stages of their medical education. She embraces her role and leans into the opportunity. A few years back, before moving to Miami, she invited some medical students over for dinner. As they finished their meal, the students pleaded with her to keep empowering women, building teams, and fearlessly sharing her story. “I said, ‘You know what? From here on, I am going to make a stand. Because if we can make it better for the next generation, then that’s what we need to do.”

●●●


Dr. Kristine Guleserian became the first woman to lead a congenital heart surgery program in the U.S. when she was named medical director of Medical City Children’s Hospital Heart Center last year. She has since built a cardiac surgery “dream team” whose members include:

The Hospital of Tomorrow

Innovations we can only dream of today may become commonplace within a decade.

Imagine that you make a trip to the hospital for a simple annual check-up. When you arrive, you enter the specialized area where you need care—but it isn’t any part of your human body that needs attention. You have an appointment at the hospital’s implantables clinic, where the technology implanted into your eye—which guided you through the hospital to the clinic—needs a quick tune-up. In this seemingly alternate reality, the line between the repair shop and hospital is as thin as the line between body and machine. This fantastical exercise is closer to reality than it may seem. The hospital model is now being pulled in contradictory directions: Hospitals are expected to provide consumer-focused experiences for patients—similar to those created within the hospitality sector—and protect employees’ mental health and value, all while continuing to operate within the highest safety and cleanliness standards. They need to create welcoming and uplifting spaces with natural lighting and design elements, while ensuring many areas are safe, sterile, and able to support the latest technology. “Hospitals have moved from transactional to an experiential world, which affects operations and design,” says Jeffrey Stouffer, principal, executive vice president, and health group global director at architecture firm HKS. “It drives patient choice and drives a much more competitive market.” Competing goals are already fostering technological advancement to help meet these new market demands, and soon, as new developments roll out, the hospital of the future will become the hospital of today. Several North Texas healthcare experts shared their thoughts on what the hospital of the future might look like—just 10 years down the road.

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1. AI Could Deliver Diagnostics


Technology is eliminating the need for doctors to memorize massive amounts of medical information, and, as a result, their role is changing. “Physicians will become more of a broker of care and will be more high-touch, more relationship- driven,” says Ashley Dias, associate principal of health at Perkins & Will in Dallas. “AI will support a lot of the information breakdown and diagnosis space.” Technology also improving accuracy.

With robotic surgery and 3-D modeling, the ability to precisely target problems and avoid invasive surgery will make surgeries more successful and infections more rare. “Providers can 3D model hearts and use AI to detect issues beforehand,” says James Griffin, CEO Invene.

2. Analytics Will Continue to Drive Innovation


Major hospital systems are connecting with data giants so AI can predict health outcomes, find treatments with the best results, and improve hospital protocols. For example, Medical City Healthcare and its parent company HCA Healthcare, with 185 hospitals across the country, are partnering with Google Cloud to lean on Google’s data analytics availability to make workflows more efficient and give providers treatment guidance. Texas Health Resources and Baylor Scott & White Health are also getting on the big data train, too, partnering with health provider-led data platform Truveta. The new partnership gives Truveta access to depersonalized medical records representing 15 percent of the nation’s patient care. The goal is to eliminate fragmented health data and make conclusions from the millions of patient care visits represented in the partner- ships. As these organizations unearth new patterns and develop new protocols, patient care will become guided by amounts of data larger than hospitals could previously imagine. “We have these economies of scale here that serve a huge population of people and a wide cross-section of our nation,” says Dias. “And we have a major powerhouse in the technology world that can work that data.”

3. Flexibility at Hospitals Will Be Paramount


The hospital of the future may have patient rooms that can convert from low to high acuity—able to serve as a room where patients can visit with family, then quickly transition to an intensive care unit if needed. Under this design, care teams and technology would travel between rooms rather than the patient. Design could also feature elements to address physician burnout, which has been an issue since long before COVID-19. Many hospitals currently do not feature much natural light or offer relaxing spaces for staff to take a breath—elements that will likely shift in years to come. “We can provide for [hospital staff] so that the load they carry doesn’t go beyond their human limits,” says Deborah Wingler, health research lead at HKS.

4. Wearable and VR Technology Will Rule


The next decade may bring an increase in wearable technology could move wayfinding into hospital apps and perhaps even into ocular technology that augments reality and directs patients to their treatment area. They could also connect with physicians and learn about their conditions. Once admitted, patients may be able to visit with loved ones via virtual reality platforms, reducing contagion while providing a welcomed diversion. “That transportation to another environment is a positive distraction and brings stress reduction, which we know is great for improved outcomes,” says Dias of Perkins & Will

5. Stays May Become Much Shorter


Increases in in-home care technology might soon make for shorter hospital stays, bringing doctors and nurses to patients whenever possible. “If technology can get us closer to that, and I think it is, then it is certainly desired by the patient and potentially could save costs as well for systems or payers,” says Dr. Hubert Zajicek, CEO and co-founder of healthcare accelerator Health Wildcatters. Monitoring technology would instantly connect providers to patients, enabling constant updates on vital signs or diagnostics. “The boundaries are blurring between where care is delivered and how care is delivered,” Wingler says. “The lines are getting blurry between home health, home care, and healthcare.”

Powering an Evolution in Care

Primary care physicians may provide the answer to skyrocketing healthcare costs and the depersonalization of medicine.


The medical home has expanded beyond the primary care physician’s office walls, upending the idea of the traditional doctor’s visit for physicians and patients alike. Additionally, the shift to telehealth, the focus on population health management, and medical technology acceleration have all impacted patient flow, finances, and communication. 


When it comes down to it, primary care physicians, and the proactive and preventive services they provide, hold the key for healthcare cost containment and more personalized care. We recently spoke with four Dallas-Fort Worth primary care physicians about the challenges they face, the changes they’ve seen, and the opportunities ahead.


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How did COVID-19 change your perspective on your career?


Dr. Angela Moemeka: “I launched my private practice as the Sars-CoV-2 virus was identified and began to spread. Direct patient care and office workflow would need a revamp to preserve access to care. I began to wonder about the stability of private practice as I witnessed well-established practices struggle and even close during the first few months of the pandemic.”


Dr. Jeff Bullard: “With the onset of the pandemic, suddenly the grander ‘we’ came into vision. Every day felt like a population healthcare delivery day. I am a family medicine physician, and COVID reminded me of the importance of my role as a community health connector.”


Dr. Marcial Oquendo: “COVID humbled me and everyone into understanding that there is no such thing as a ‘sure thing.’ Right as the COVID pandemic started, I was in the midst of a major transition in my career, going from employee physician to business owner and entrepreneur. For the first few months after the lockdown began, I realized that opening a traditional office was not going to be a good idea. So, I branched out and formed coalitions and mutually beneficial partnerships with other doctors that needed someone to keep things afloat during the trying times.”


Dr. Beth Kassanoff-Piper: “The pandemic gave me a new appreciation for my work team, especially my nurse and my partners, and their ability to adapt to change. COVID-19 reinforced how important it is to have a solid connection with patients so they know they can rely on my guidance in confusing times.”


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What challenges did you face in shifting to remote visits?


Bullard: “The biggest challenges were around establishing new workflows, combining in-person with virtual visit scheduling and staffing assignments. We wanted our patients to have a great experience. They were stressed, and most were also experiencing telehealth for the first time.”


Oquendo: “During 2020, I went from 100 percent in-person practice to 100 percent telemedicine at the beginning of the lockdown to now a hybrid of mostly in-person visits but with a strong telehealth component. I have found that it is a great way to keep open communications with patients, even if it’s a ‘last patient of the day,’ last-minute appointment, or a ‘mother has a quick question.’”


Kassanoff-Piper: “I was concerned that both the patients and I would find telehealth to be inferior to in-person visits, but I was very pleasantly surprised at the outcome. Being able to see my patients, even if not in person, made assessing their health, and especially their mental health, much easier than just hearing them on a phone call.”


Moemeka: “We did begin offering virtual well-child visits, but many families preferred to wait it out, not wanting to risk taking children outside the home. We began to incorporate synchronous and asynchronous methodologies into our practice. I worked with our billing company to understand the coding and payment processes for these visits. Texas Medicaid led the way in paying for telemedicine visits in a very expansive sense.”


●●●



How has the pandemic changed chronic disease management?


Oquendo: “Chronic condition management via telemedicine has its pros and cons. We can continue to see the patient on a regular basis for a quick check-up and status update without them having to make a visit. However, telemedicine can limit a physician’s ability to pick up on subtle nuances that can only be seen in person—things as simple as moles or skin color, new tattoos, cutting behaviors, and scars that the trained eye would notice and would dig into.”


Kassanoff-Piper: “I stress the importance of preventive healthcare. Many patients missed their routine screenings for breast and colon cancer during the pandemic, and I continue to work with those patients to get them caught up.”


“Doctors today spend more time clicking boxes, looking up billing codes, and chasing metrics than spending time with patients and their families.”

Dr. Marcial Oquendo, Oak Cliff Pediatrics

Moemeka: “In pediatrics, ADHD and asthma are the primary chronic diseases. These are all easily done remotely. New tools have also emerged to allow virtual chronic disease management to thrive, the most notable being remote patient monitoring devices. In asthma, for example, digital inhalers allow patients to track symptoms and inhaler use then share this information with their physician via portals.”


Bullard: “Physicians will typically recommend home blood pressure, blood sugar, and weight monitoring for our hypertensive, diabetic, and heart failure patients, respectively, but I believe we likely placed more value on those measurements that took place in our offices. During COVID, that shifted. As a result, we recognized the value of upping our game on home management and monitoring efforts, including increasing the time spent on disease state education with patients, coaching on the ideal way to measure and record home collected data, and helping patients navigate app selection for managing weight, diet, and exercise.”


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How do you see technology impacting your practice in the future?


Kassanoff-Piper: “The greatest advantage I have seen so far is in patients who can share their glucose readings with me remotely, so we can catch up on their progress several times weekly, if necessary, rather than waiting longer periods to make adjustments. This is already improving patient outcomes.”


Moemeka: “I see the increase in wearable devices increasing health literacy for my patients and families. It eases discussions on disease management and gives a common objective language for symptoms. For example, a child using a digital inhaler can say their asthma has been worse than usual over the past two weeks but can now also show me their tracked inhaler usage each day, which tells a measurable story.”


Bullard: “I see a day in the near future when doctors and patients will be discussing the patients’ progress in their lifestyle app, reviewing data from their remote monitoring blood pressure device, and having a group video visit that includes the doctor, the patient, a spouse or caregiver, and a care team member such as  a dietician or a specialist.”


Oquendo: “I believe in the not-too-distant future people will have their own digital-first-aid-kit, with digital otoscope that can send pictures to the pediatricians to check for ear infections, inexpensive Bluetooth stethoscope adapters for phones through which parents can stream of a child’s breathing by following a simple interface app on the screen, and thermometers that can share today’s temperature trends so doctors can look for improvement.”


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How will a shift to value-based care impact your practice?


Bullard: “We are champing at the bit for this type of change. The impact of COVID was that it shined a bright light on so many of the things that are wrong with the way care is delivered. The disconnect between what works and what’s valuable to the doctor-patient relationship and those that make decisions about how the business of healthcare will operate is unfortunate; I think the shift to value-based care can narrow that gap.”


Oquendo: “The reality is that the current system is designed for big players; more than half of the physicians in Texas are employed and not independent. The incentive to include small groups or solo practices has not yet been felt. New models will have to emerge to bridge that gap while also navigating the legal barriers that keep offices from gaining any leverage in the value-based contracting model.”


“Value-based care has been the theme for decades; the new shift is to value-based payments.”

Dr. Angela Moemeka, Mark9 Pediatrics

Moemeka: “As a general pediatrician, value-based care has been the theme for decades. The new shift is to value-based payments. For my practice, this means streamlining population health management—not only understanding the who, what, and when of gaps in care but also linking with community partners to address the why.”


Kassanoff-Piper: “I work hard in my practice to provide care tailored to each patient’s specific situation and to create that unique relationship with patients that encourages them to work with me toward better health. This, in turn, leads to better management of their chronic health conditions and, ultimately, better care overall, which is recognized in value-based care payments.” how do you incorporate mental health and whole-person health into your practice?


Oquendo: “A combination of different interactions is how we achieve a true whole-person health approach. Rarely before have we had a window inside a patient’s home. This is important in getting the whole picture, especially as socioeconomic determinants of health are directly linked to your home, your internet access, and living conditions. Mental health has been the biggest sequelae from this pandemic, particularly in teens and young adults. Telemedicine for mental health is going to stay and will be the main form of accessing therapy and treatment moving forward.”


Moemeka: “I take into consideration the family background and psychosocial environment affecting my patients. It is difficult to care for my patients otherwise. A 2-year-old doesn’t just walk into my office alone and leave with antibiotics for their ear infection. Instead, that 2-year-old comes in with a parent who is tired from not sleeping for several nights due to their child’s ear pain and irritability, and possibly a parent who is worried about missing another day of work to care for a febrile child who cannot return to daycare. Similarly, an 11-year-old with chronic abdominal pain may be challenged by the transition to middle school and manifesting symptoms of anxiety and stress.”


Kassanoff-Piper: “It is so important to understand the whole person, including their home environment and their stressors. I get to know my patients very well and ask detailed questions about these factors and their mental health so that I can give advice that fits them specifically. Many patients will not bring up the subject unless directly questioned. A large number of my patients have had increased anxiety and depression through the pandemic, and not all realize how great that impact is on their health.”


Bullard: “We have taken an integrative approach to care, including fully integrated mental health. In 2007, we started a brain health center, which now includes a counselor and psychologist, treatments for difficult-to-treat depression patients, and a full suite of assessment and treatments for the most common mental health and cognitive issues our patients face.”


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What area of medicine is not getting enough attention, and why?


Oquendo: “Physician burnout. Doctors today spend more time clicking boxes, looking up billing codes, and chasing metrics than spending time with patients and their families. Primary care and preventive medicine have become a numbers game and all about economy of scale, when it should be the other way around. Making doctors become computer clerks and having them spend several hours a day entering data into templates—for insurance companies to decide what gets reimbursed and what doesn’t—will only lead to more burnout, with worse outcomes for both the medical community and patients.”


“We could do a much better job dealing with the health of our communities if we focused on proactive versus reactive care.”

Dr. Jeff Bullard, MaxHealth Medical Associates

Moemeka: “Health equity for children does not get the attention it needs, mainly because people see children as primarily healthy. We know hundreds of millions of children are uninsured and underinsured, lacking access to the basic care that’s needed to maintain health. We know trauma impacts children in ways that lead to chronic disease and morbidity as adults. We know the first 1,000 days of a child’s life are critical for brain growth and development. These facts all float around us as health inequities that do not get the policy focus needed to effect change.”


Kassanoff-Piper: “Doctors must address patients’ anxiety and depression, as well as underlying circumstances, such as their work and home responsibilities, what help they have at home, and whether they can afford medications, to help them achieve better health.”


Bullard: “We could do a much better job of dealing with the health of our communities if we focused on proactive versus reactive care. We do what we are paid to do; as a result, we primarily see patients when they are already sick. Suppose we could instead spend our energies understanding a patient’s daily behavior or situational challenges that impact their health, and work with them before they develop a chronic disease. That could help bend the cost curve. To do this, we must invest more in primary care.”  

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