In sum, these government relief programs provide needed assistance to keep our practices open, but the expenses need to be tracked and could be audited, so account for them closely. For those in employed or academic practices, the HHS relief funds were paid to your employer. This could be multiple degrees of separation upstream, maybe even paid in a different state for large healthcare systems. Know that these funds are intended to maintain employment and payroll, although we don’t know how larger employers may direct them. Open lines of communication with administration regarding how they use these funds may be helpful for employed rheumatologists.
Therapeutics
What can be said about our therapeutics during and after this crisis? Several of our drugs (hydroxychloroquine [HCQ], tocilizumab, sarilumab) have received attention as potential COVID-19 treatments. Hype seems to outpace science, especially concerning HCQ, while we await randomized study results.
How will these drugs weather this crisis? How many of us are guilty of having described HCQ to our patients as the safest drug in our armamentarium? Will the previously smooth feathers of HCQ be ruffled by our president’s descriptions of it as a “very powerful drug” or by the observation of arrhythmia and death, especially in older patients when co-administered macrolide antibiotics?16,17 How many of us obtain a baseline electrocardiogram before starting HCQ? (Hint: Not many.) Will we start doing so? I’m not sure yet, but hopefully science will guide us and maybe we will learn something new about an old drug.
Conclusion
Crises bring change. Legislative and regulatory fallout from COVID-19 will continue to impact us long after the virus is gone. Never has the adage, “You’re either at the table or you’re on the menu,” been more germane. We need to advocate on the federal level to maintain the rollback of sequester cuts. We need to advocate on state and federal levels for Medicaid and commercial policies to grandfather patients who are stable on treatment but transitioning from different insurance. We must advocate for CMS and commercial payers to continue to allow telehealth access from home, as well as for payment parity to in-person visits.
As commercial payers look to pass COVID-related losses on to our patients, we need to advocate against the higher out-of-pocket costs, premium increases, specialty tiering and higher deductibles they may seek to implement.
We are living in a unique time. The ways in which we adapt our practices to the current economic and healthcare environment, as well as how we plan for potential changes in the post-COVID world, will be critical to the sustainability of our practices and to our ability to care for the patients who desperately need our care today—and who will still need it tomorrow.
