Webinar: Managing Complex Clinical Cases and Virtual Group Visits During COVID-19

Apr 17, 2020 • Focus Area: Population Health • Program: Addiction Treatment Starts Here: Primary Care

Written by: Center for Care Innovations

On this webinar, Addiction Treatment Starts Here Coach Joe Sepulveda, MD, discusses how to manage complex clinical scenarios and remote prescribing. Dr. Sepulveda also facilitates a panel discussion on managing virtual group visits, featuring Kylie Timmerman of Chapa De Indian Health, Cheryl Whittle of Fresno New Connections, and Grace Xu of KCS Health Center.

WHO SHOULD WATCH THIS VIDEO?

Those who provide MAT services to patients during the COVID-19 pandemic.

OUR TAKEAWAYS:

By prescribing Suboxone or buprenorphine, you significantly reduce the rate of use, relapse, infectious disease transmission and mortality even in those with co-occurring disorders.
Chapa De Indian Health, Fresno New Connections, and KCS Health Center described the importance of communicating as much as possible with patients when conducting virtual group visits. Their process involves sending written instructions, calling patients prior to the visit to make sure they get acclimated to using the virtual platform, and sending reminders.
Lack of access to Wi-Fi can be a challenge when conducting virtual group visits. To combat this, Chapa-De Indian Health and Fresno New Connections stated they provide their patients with information on local organizations in their communities that provide free Wi-Fi access.

For more MAT-related COVID-19 resources, click here or scroll down.

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MAT and COVID-19 Resources

CCI’s Addiction Treatment Starts Here (ATSH) team is compiling COVID-19 resources to support clinics and other health professionals in continuing to care for patients with opioid use disorder. These resources include recent guidance from the federal and state government about the delivery of and payment for remote services (e.g., telehealth), links to virtual recovery supports for patients with substance use disorder, approaches to team care and self-care, and links to key content from other programs — such as California Bridge — that we hope you will find useful. Items with a yellow star are protocols, tools and templates that ATSH participants have shared.

Addiction Treatment Starts Here Team Resources

Marin City shared their MAT COVID-19 protocol which includes clinic rules, phases of care, and a one-page guide for patients.

Santa Cruz shared their MAT COVID-19 protocol which includes a patient flyer and MAT weekly follow-up workflow.

La Clinica de La Raza shared their COVID-19 script for outreach.

Informed Consent for Telemedicine from KCS

CCI COVID-19 Webinar Series Materials

March 25: Slides, webinar recording, and 6 key takeaways

April 1: Slides and webinar recording

April 8: Slides and webinar recording

April 15: Slides and webinar recording

California Guidance

DHCS shares updated Frequently Asked Questions about MAT and Telehealth, released April 7, 2020.

DHCS COVID-19 Response landing page

DHCS guidance around Medi-Cal Payment for Telehealth and Virtual/Telephonic Communications. Released March 24, 2020

CA Office of Health Information Integrity (CalOHII) Disaster Response and Information Sharing during Emergencies, including specific references to SUD and MAT data sharing. (March 18, 2020)

DHCS guidance around Medi-Cal Payment for Telehealh and Virtual/Telephonic Communications. Released March 18, 2020.

DHCS guidance for behavioral health programs on providing behavioral health services via telephone and telehealth, adapting oversight requirements, and access to prescription medications. Released March 14, 2020.

DHCS FAQ on Behavioral Health Services in light of COVID-19, updated on March 13, 2020.

California’s “One-Stop Coronavirus Website” (not MAT specific)

Federal Guidance

DEA guidance on allowing prescriptions of buprenorphine to new and existing patients with OUD via telephone.

SAMHSA FAQ on prescribing buprenorphine (see question 4, which indicates that new patients can be prescribed buprenorphine via telephone outside an OTP). FAQ released on March 19, 2020.

SAMSHA guidance on the application of 42 CFR Part 2 in a public health emergency (released March 19, 2020).

SAMSHA MAT resource page including various guidance documents for OTPs.

HHS Health Information Privacy Page, including a notice allowing for enforcement discretion for remote communications (e.g., allowing use of non-HIPAA compliant devices for telehealth).

DEA COVID-19 Information Page

Changes to EMTALA regulations, in light of the public health emergency (updated March 15, 2020).

In a March 17, 2020 news release, CMS indicates that Medicare can pay for office, hospital and other visits furnished via telehealth starting March 6, 2020 and for the duration of the COVID-19 public health emergency.

Remote Care Best Practices

The California Telehealth Resource Center has created a COVID-19 page, offering resources such as a Telehealth 101 webinar and slides, a toolkit, sample forms and guidelines, and more.

The California Telehealth Resource Center has developed a telehealth needs assessment form. The assessment will facilitate the ability of health centers to understand various logistics and develop a telehealth plan that fits specific provider, specialty, patient and payor needs.

The California Telehealth Resource Center provides sample forms and guidelines for implementing a telehealth program. It also recently updated its Telehealth Reimbursement Guide, which includes telehealth reimbursement policies for Medicare, Medi-Cal Fee-For-Service, and Managed Care.

Elizabeth Morrison Consulting developed Empathic Communication on the Phone, a guide that consists of tips and tricks for engaging in high quality, connected conversations over the phone.

Resources from Other Organizations

California Bridge Program

CA Bridge Example MAT COVID Patient Flyer download Word Version
Slides and recording from 60-minute webinar which reviews key steps for keeping patients and providers safe while providing MAT. Webinar recorded on March 18, 2020
Link to legal analysis of four hypothetical scenarios for prescribing buprenorphine during COVID-19, prepared for the Foundation for Opioid Response Efforts. (March 19, 2020)
CA Bridge Home Start Guide, Buprenorphine After Overdose
CA Bridge COVID-19 information page and resources.

Yale Program in Addiction Medicine: Guidance for People Who Use Substances on COVID-19, focusing on harm reduction strategies.

Harm Reduction Coalition’s COVID-19 Virtual Office Hours (March 18, 2020).

Harm Reduction Coalition: Syringe Services and Harm Reduction During COVID-19 (updated March 11, 2020) and Safer Drug Use During the COVID-19 Outbreak (updated March 11, 2020).

Team Care and Self-Care

The California Surgeon General’s Playbook: Stress Relief During COVID-19 offers stress management information, specific “stress busting” strategies that can be used at home, and a self-care template for adults.

The California Surgeon General’s Playbook: Stress Relief for Caregivers and Kids During COVID-19 offers information on stress management for kids, specific “stress busting” strategies, and a self-care template for kids.

Guidance for Medi-Cal fee-for-service providers on Mitigating Health Impacts of Secondary Stress Due to the COVID-19 Emergency.

ACEs Aware hosted a webinar, Taking Care of Our Patients, Our Teams, and Ourselves: Trauma-Informed Practices to Address Stress Related to COVID-19, which reached more than 3,000 people. Future webinars will continue to offer practical information to help providers as they respond to the stress caused by the COVID-19 emergency.

Virtual Recovery Resources

SAMHSA Virtual Recovery Resource

Physical distancing poses some risk for on-going patients with opioid use disorder because the usual recommendation is “use with a buddy”. If a patient uses alone, there is a project called Never Use Alone. When patients call Never Use Alone, they will be connected to a phone operator who will ask about their location, possible allergies and medical conditions, then stay on the call with them while they use. If the patient doesn’t respond within a set time, they will notify emergency services about a possible overdose.