By Emily Maxson

We’ve been thrilled to see that shipments of PPE have begun arriving at our partner practices across the country. We know it’s needed. We have been in conversation with several physicians seeing the first signs of illness in rural communities and as a company, we are hard at work on surveillance to provide early warning to the communities who have yet to experience surges.

As practices prepare for (or battle through) the virus’s intrusion, we are amazed by the advances they are making in telehealth visits – we’re now seeing roughly 40% of all billed visits performed virtually in Aledade ACO practices. Transitional Care Management visits have never been more important and telehealth provides a portal into the patient’s home circumstances that may actually enrich the visit – and those practices with insight into hospital and SNF discharges are continuing their work.

Across the country, physicians’ inboxes are being flooded by advertisements for new point of care tests touting impressively high accuracy and precision. Our patients are not spared, either – just yesterday, my parents called me to ask whether they should buy a direct-to-consumer test to “make sure they were okay,” operating under the false assumption that a negative test could establish the safety of visiting with others. Over the past few weeks, Aledade has done a deep dive of available resources in response to questions we’ve heard from our practices about testing. A few components are worth highlighting:

1. Although there have been more than 20 point of care tests authorized under the Emergency Use Authorization by the FDA, only 3 have CLIA-waived designation, deeming them appropriate for use in outpatient clinics. Only one of these three (Mesa) does not require expensive hardware to administer. We’re working with manufacturers and sales offices to get good information on pricing.
2. There is a paucity of published information on sensitivity, specificity, false positive and false negative rates for Point of Care tests. It is imperative that we educate patients with negative tests that this does not mean they are safe to eschew social isolation recommendations. They may actually be positive, or they may be truly negative and at risk of contracting the virus if they fail to socially distance.
3. Right now, the World Health Organization does not recommend the use of POC tests because of insufficient information on performance and accuracy. That said, there may come a time in this epidemic when primary care clinics are asked to play a vital role in testing and contact tracing, even of asymptomatic individuals. For this reason, practices should be aware of the limitations and opportunities in the testing landscape.
4. A practice’s own protection is so important to the health of its community. Adequate personal protective equipment (PPE) is a prerequisite for testing of any methodology.

We are so thankful for the herculean efforts so many primary care practices are taking to keep their communities safe. We hope they all stay safe themselves.