The dental industry in Minnesota ground to an abrupt halt last week when Gov. Tim Walz ordered a two-week pause on all non-emergency medical procedures including dental, which is considered one of the highest risks of transmission due to proximity of doctor to patient. Minnesota Head & Neck Pain Clinic in Plymouth stopped seeing patients in person last week and since then, Dr. Cory Herman, an orofacial pain specialist and clinic co-owner, has been working remotely with his team to set up telemedicine services in the interim. He talked to us about the sudden shift and what improvements could come out of it, longterm.
TCB: Tell us a bit about your clinic?
A | We treat people with both acute and chronic oral and facial pain conditions including TMJ and headache disorders. The Minnesota Head & Neck Pain Clinic is an interdisciplinary team of headache specialists, neurologists, nurse practitioners, health psychologists, physical therapists, and dentists all working together to treat complex head and neck pain disorders. We have four partners, 10 non-partner clinicians and about 18 assistants.
TCB: Did you expect to have to shut down your clinic or did it feel sudden?
A | Obviously prior to the virus explosion in China we were not prepared for such a pandemic. Unfortunately, the rate of impact of the virus offered very little time to prepare both clinically and financially. Seeing that we’re an ambulatory (outpatient) care clinic, our clinically activities came to a rather abrupt stop. We recognize that reducing the curve is critically important to maintaining a functional capacity of our hospitals and medical system and therefore we’re fully onboard with the recommendations of the Minnesota Department of Health and the State Medical and Dental Boards to restrict our in-office visits to emergent care only.
It would have been nice to have had 3 to 6 months to research best practices on implementing telemedicine to offer an established and seamless process. Fortunately, our federal government recognized that the access to appropriate health care would become a major public health issue. As a result, regulations which historically added complexity to implementing telemedicine were lifted. At the same time Medicare and other commercial insurers indicated they would cover the cost of care for telemedicine services. Historically, this has been a significant barrier for many of our patients.
We also recognize that this is a very stressful time for everyone. Dealing with chronic pain can also be stressful and, sadly, can be exacerbated by stress. The combination can send our patients into an acute crisis. Therefore, we’re making all attempts to stay connected with our patients, to offer care when necessary and ensure that our pain patients aren’t seeking care at the local emergency departments as they’re already overwhelmed with Covid-19 related concerns.
Q. Have you lost work because of the Covid-19 pandemic?
A | Absolutely, with the mandate to cease all non-emergent care, our clinical productivity has greatly dropped off. Thankfully, we’ve implemented a telemedicine process which may help to continue to generate clinical revenue, however it by no means will cover the loss seen by having the clinic doors closed.
Q. What about your staff?
A | Some are working from home, some are working part time, and some aren’t working at all. Most have had hours cut to some degree. Many have applied for unemployment benefits because of the significant reduction in hours. We hope as our need for telemedicine picks up and after the quarantines are lifted, we can get back to more regular staff schedules.
Q. How is telemedicine working—is it something you might continue to offer even after the clinic reopens?
A | We’re now able to see new patient consultations as well as provide care for our existing patients. I’m hopeful that the government will recognize that telemedicine options improved better access of care. With the deregulation and commitment of insurers to cover the cost of telehealth visits this has the potential to continue an outreach clinic for those in rural or outstate areas or for those that don’t have easy access to care. The nature of what we offer for orofacial pain, TMJ disorders and headaches is unique. I hope that once the acute public health issues that we’re experiencing with the Covid-19 virus subside, we’ll be able to continue to offer these services and improve access to care.
Q. Do you anticipate your practice bouncing back quickly or are you bracing for the worst?
A | I expect that our clinical practice will bounce back quickly. Seeing that our practice is so specialized in what we do there’s a significant need for our services. We want to make sure that we continue to be there for our patients, to help our referring physicians and dentists and to ensure proper access to care for the state of Minnesota.
Q. Any bright spots in this crisis?
A | I’ve spoken with many people including our landlords, bankers and other venders. Everyone realizes that we’re all in the same situation. Everyone has been super kind and understanding. Recognizing that our revenue has significantly decreased, everyone’s been quite flexible.
Q. What’s your work setup at home?
A | We now have a platform which offers HIPAA compliant audio and video. Fortunately, I’ve spent the last several years ensure that our electronic health records, practice management and day-to-day operations were cloud based and for the most part paperless. Therefore, my home office consists of my laptop, iPad and iPhone. Very much paperless.
Q. Best advice to work productively at home?
A | Somehow for me there never seems to be downtime. I’m putting in more hours now than I was previously! Maybe that’s because I’m still in a “survival” mode, making sure that we continue to offer proper patient care and access to care while at the same time I wade through the many confusing government stimulus options to help get us through financially.