The Daily Signal - How a Nurse Practitioner Is Using Telemedicine to Treat Patients

Episode Date: May 12, 2020

Medical practices have been forced to quickly adjust the way they care for patients during the COVID-19 pandemic. In just one week, Dede Chism, the co-founder of Bella Health and Wellness in Englewood, Colorado, successfully shifted her practice to see half of patients using telemedicine in an effort to keep patients and doctors safe during COVID-19.  Chism joins the podcast to explain how telemedicine works, whether or not it is here to stay, and the benefits of antibody testing. Also on today's show: President Trump speaks out in support of Pennsylvania reopening.  The Department of Justice is examining if hate crime charges should be filed in the shooting of Amhaud Arbery.  China threatens to retaliate as the Department of Homeland Security tightens guidelines for Chinese journalists. Enjoy the show! Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

This is the Daily Signal podcast for Tuesday, May 12th. I'm Rachel Dahl Judis. And I'm Virginia Allen. Doctors and nurses have had to quickly adjust the way in which they practice medicine during COVID-19. D.D. Chisholm is the co-founder of Bella Health and Wellness in Englewood, Colorado. Chisholm joins the show to share how her practice transitioned from offering no telemedicine to half of their appointments being conducted over the phone and through video call in just one. week. We also discuss if telemedicine is here to stay and the benefits of antibody testing. Don't forget, if you're enjoying this podcast, please be sure to leave a review or a five-star rating on Apple podcasts and encourage others to subscribe. Now on to our top news. President Trump is speaking in support of Pennsylvania reopening. Democrat Governor Tom Wolfe has been slowly opening the state, with 13 counties getting some restrictions lifted, but another.

for not given permission to reopen. On Monday, Trump tweeted, the great people of Pennsylvania want their freedom now, and they are fully aware of what that entails. The Democrats are moving slowly, all over the USA, for political purposes. The Department of Justice is currently reviewing the evidence in the killing of Ahmaud Arbery to determine whether or not federal hate crime charges should be made. Arbery was the Georgia African-American man who was killed. and February, video recently surfaced that appears to be of Arbery's death that raised new questions and led to the arrest of two men Gregory and Travis McMichael, a father and son. On Monday, DOJ spokeswoman Carrie Kupik posted on Twitter saying, the Civil Rights Division

of the Department of Justice, the FBI, and the U.S. attorney for the Southern District of Georgia have been supporting and will continue fully to support and participate in the state investigation. And she added that we will continue to assess all information and we will take any appropriate action that is warranted by the facts and the law. The Supreme Court heard oral arguments virtually for a religious liberty case called Our Lady of Guadalupe School v. Morrissey Bureau and St. James School v. B.L. The Heritage Foundation's Tom Jipping writes that the two cases involve fifth grade teachers in Catholic parish schools whose contracts were not renewed. In one case, Our Lady of Guadalupe v. Muracy Bureau, the teacher claimed the decision was based on her age.

In the other case, St. James School v. BL, the teacher was let go when the school said her substandard teaching performance did not improve. She sued, claiming the real reason, was that she had to be. to take time off for cancer treatments. In each case, the school said that its teachers play an important religious function, and therefore the government should not second-guess such personal decisions. Jipping also wrote that by protecting the free exercise of religion and prohibiting government establishment of religion, the First Amendment requires that churches or religious schools have a different relationship with the government than secular employers. The challenge is where to draw the line. America and China are in a verbal battle over journalistic rights. On Friday,

the Department of Homeland Security announced that they would only offer 90-day non-renewable visas to Chinese journalists. But in the past, Chinese journalists receive open-ended visas from America that did not require an extension. The announcement from DHS is the latest action in a string of events in a journalistic battle between the U.S. and China. The conflict began in February. February, when the State Department said it would treat five different Chinese state-run news organizations as, quote, foreign missions. The next day, China expelled three Wall Street Journal reporters based in Beijing, two of whom were American. During a press conference on Monday, Chinese foreign ministry spokesperson, Charlie Dong, said, quote, the U.S. is using reciprocity

as an excuse to continuously escalate its political suppression of Chinese media. He warned that if the U.S. did not alter its decision on this matter, China would have to take countermeasures. A restaurant in Colorado has made headlines after it opened illegally. The restaurant, CNC coffee and kitchen in Castle Rock, Colorado, dismissed the stay-at-home order of Governor Jared Polis's, a Democrat, and opened anyway. Every table was nearly full, according to the footage from Colorado Community Media Reporter Nick Bucket, the Washington Post reported, customers crowded along the counter waiting for their orders. The line to place them went out the door, wrapping around the side of the building. The restaurant tweeted on Saturday,

At real Donald Trump, we are standing for America, small businesses, the Constitution, and against the overreach of our governor in Colorado. A spokeswoman for the governor's office told the Washington Post in a statement that the restaurant's behavior is endangering the lives of their staff, customers, and community. Now stay tuned for my conversation with Didi Chisholm, co-founder of Bella Health and Wellness, about telemedicine during COVID-19. Conservative women. Conservative feminists. It's true. We do exist. I'm Virginia Allen, and every Thursday morning on problematic women, Lauren Evans and I sort through the news to bring you stories and interviews that are particular interest to conservative leaning or problematic women. That is women whose views and opinions are often excluded or mocked by those on the so-called feminist left.

We talk about everything from pop culture to policy and politics. Search for problematic women wherever you get your podcast. I am joined by D.D. Chisholm, the co-founder and executive director of Bella Health, Natural Women's Care and Family Wellness. Didi, thank you so much for joining me. Oh, it is so great to be here this morning, Virginia. Now, you have spent decades working in the medical field, and today I'm just so excited to talk with you, specifically about telemedicine and how your practice has so quickly adapted to meet the needs of your patients during COVID-19. To get started, can you just tell me a little bit about your practice, Bella, and how you all have navigated really how to practice medicine in this very, very unique season of life?

Sure. It's actually a great question. So my daughter and I actually opened our practice about five and a half years ago. We're both nurse practitioners. And we both came from a hospital type setting. But what we wanted, even back then, and it took us about two years prior to that to get open. But what we wanted was a different kind of practice that was highly relational. And it allowed us to give the patient's time,

enough time so that they could tell their story because everyone has a story and we really believe that if you just take a minute and listen to people, they will actually tell you what they need. So we started by opening a women's clinic. So initially, it was Bella Natural Women's Care. And right from the beginning, we had this huge response, like 100 new people a month joined in the practice, registering and being a part of the practice. Within a very short amount of time, we had men saying, well, could you just take care of me just today? Could you like take care of my sore throat? Or could you help me with my hormones or whatever? And so that started. And so within less than two years, we had set up and made plans and we became Bella Natural Women's Care

and family wellness. And then over the next few years, we just continued to grow and having again, this continued response of many, many people registering every month. So then back in 2019, which seems like a long, long time ago, we were registering 150 new people a month. And it was, the trend was not going down at all. It was going up. And so as we're going into 2020, we actually softly rebranded to kind of tighten up that name and became just plain old Bella health and wellness. And as that is launching, so is COVID-19. It was the craziest thing. I mean, it did seem like just yesterday that we were ringing in 2020.

And yet everything in our life and everything in our world has really, really changed. And, you know, regardless of how people feel about, about the severity of the virus, you know, and the response, the media and the direction and all that kind of stuff. Despite that, these are the cards we have been dealt, and we needed to respond to that. Our patient numbers had grown and we had registered in January over 200 new patients. Now, as we're hitting into COVID-19, we are in an interesting situation because so many people wanted to stay home. And yet we had this huge demand to see people as well. So it was this crazy kind of push-me-pull-you sort of situation with people wanting to be safe. We honestly didn't know

at that time in early March how this virus was going to play out what it looked like for the majority of people and how it was going to, you know, run its course. And so we had, we've had nearly 500 people register in a six-week period of time. So the numbers have been crazy, but the need to be able to see the people who are well and balance it out still remained. And so literally overnight, we made a decision. I mean, it was a Monday, and we just looked at each other and it was like, if we're going to see patients, if we're going to help people,

be comfortable, we need to do telemedicine. And literally, I got a health care Zoom account that night. It's a lot more layers of safety when you have a health care account. And so I got a health care account that night. We started telemedicine the next day. Wow. And within within one week, we were over 50% all telemedicine. Wow. And in many ways, we had to, learn how just actually how thorough we could be on telemedicine, which is actually pretty darn amazing. You know, obviously, I've talked with patients on the phone and after hours or in the midst of concerns and worries and different types of triage, you know, for 30 years. But in this moment in time, actually being able to see people on the computer screen,

You know, which, again, in days past, you know, I mean, I had people send me all kinds of pictures of all kinds of things you probably don't want on the air. And I've done FaceTime, you know, with patients when I'm trying to determine what's going on with them. But now, you know, now that we're at this new level of actually having an appointment, you know, a virtual exam with a patient. And it's a new, interesting take on that. You actually can sit and talk with your patient about what they're feeling, capture their history, review any labs because we may have had some labs drawn and we can review labs or chest x-ray findings. Even just looking at a person, especially when we're talking about someone who has, you know, right now during the season of COVID-19 influenza.

strep throat, common cold. You know, you have these acute upper respiratory infections. But when you're, you can learn a lot just by looking at somebody. You can tell a lot about their color. I, myself and my colleagues at Bella, we all agree that COVID has a certain color. And, you know, and you can capture some of that by looking at someone on the, you know, just on the screen. You can see how they're breathing. You can see if, you know, kind of around their collarbones if they're, if they're retracting and really trying hard to get air.

And so, yes, it's not the same as listening to somebody's heart and lungs. That tells us so much. But it's definitely a place to start and it's a place to be able to say, gosh, you know, I'm concerned about what I'm seeing here. I really feel like I need you to come in. I need to put my hands on you. I need to listen to you. And in that case, at Bella, what we also started when we started telemedicine is we started a drive-through clinic for the sick.

And we had the healthy patients come inside the clinic. And that way we were making sure that people weren't exposed to other people's germs, especially when we have so many different viruses going on, but that we're keeping the healthy as healthy as we could by having them have masks, be screened at the door, and then be seen inside the clinic, but then actually see people in their cars, like listen to their heart and lungs,

you know, bang on their kidneys, you know, listen, look down their throats, and certainly, you know, doing, you know, swabs for strep, swabs for influenza, swabs for COVID-19. Our office also does rapid antibody tests for COVID-19, checking for the immediate antibodies, which are the IGM, antibodies and the IGG are the more permanent, hopefully what we hope to be the permanent immunity antibodies for,

COVID-19. So we can do a lot in the car. It's amazing. I had a pregnant mom who was getting close to term, but she was sick with COVID-like symptoms, but she also needed a non-stress test, which is a test to monitor the well-being of the baby. So where we listen to the baby's heart, we also need to watch for contractions in the mom. But this mom was sick, and so I needed her not to come in the clinic. And crazy, you know, when we're in the midst of this COVID-19, hospitals, seriously, they don't want anybody to come in. They don't want anybody on their unit if they got symptoms.

You know, so it's this kind of fine line, like you have to be super sick for the hospital to want you. And so the hospital didn't necessarily want to monitor this mom. So we just had a recline in our seat. We brought the fetal monitor out into the hospital. the parking lot with an extension cord and strapped her up and we're monitoring her baby and at the same time that we could also evaluate her and her upper respiratory infection at the same time. But the telemedicine has served a great purpose for us because it can cue us up and

it can help patients to know, do you need to come in? Is it okay to stay home? And for a lot of routine things like diabetic follow-ups or hypertension follow-ups, medication follow-ups, following up on labs. It's been a way for people to not have to come in and be exposed to any kind of contagion and yet have a good touch base with their provider and talk about how they're doing, talk about their hopes and their goals, and make a plan, refill medications. And it's been a very, very effective tool.

Yeah. I mean, it's just, it's amazing to see how you all have so quickly implemented telemedicine and seeing patients in your parking lot. When you consider these things, do you think that COVID-19 is permanently shifting the way medicine is practiced to where, you know, telemedicine really might not disappear? And, you know, seeing patients and sort of a drive-through, manner might be here to stay. You know, it's a great question. And I've actually submitted some of those questions to our state when they're reaching out to us. Bella is considered, there's a subset of

clinics that are not federally qualified health clinics. We don't receive money, but we do take care of a fair number of indigent. In Colorado, that's called the safety net clinics. In Colorado, there's 42 of us that are not federally qualified health clinics, but we do not. turn away anyone because of their ability or inability to pay. And for us, I mean, before going into COVID, that was about one in five patients did not have the money that they need to pay their bills for their health care. And we are seeing that number go up. Now, the interesting thing with telemedicine is it is self-limiting to a patient's connectivity, right? So if you're trying to make that for, you know, kind of like a generalized first step in seeing people or in some

circumstances, sometimes it's just not possible because a lack of connectivity. Now, most people have connectivity with the telephone and or their cell phones. So during this COVID-19 period, there has been a lift on restrictions for, for telemedicine so that patients could actually have an appointment on their phone and it doesn't necessarily have to be like a Zoom conference or a FaceTime or WebEx or however they were going to do their telemedicine platform. I do not think of that will continue to stay because there is a very important aspect of a care of a patient which is actually face to face and laying eyes on and seeing seeing a patient. So, you know, the one thing that we are, you know, somewhat strapped to in

medicine is that we still need our revenues. And revenues actually are not great. And on telemedicine, they are horrible. So you could have a 30-minute visit with somebody. I had, this is just recently, I had the same thing. I had a 30-minute visit. And, went through the multiple problems, had clinical decision making of medications and lab orders, imaging orders. And our reimbursement on that was $45. So if you could imagine, you know, any dog's office, you can't pay your bills with a $45 reimbursement for a patient being seen. So I think when we look at obstacles to telemedicine, it's going to lie in the connectivity of the patients, but it's also going to lie in the reimbursements by the insurance companies. Now, granted, the government has really, really encouraged insurance companies to reimburse similar to a patient being actually in the exam room.

with a provider. That would be, that'll be awesome if they can actually pull that off. We haven't seen that yet. Now, insurance companies are saying that they're going to go back and they're going to fix these things in their system. So we do hope that that's going to, but that's going to work out in the long run. And I do hope that we'll be able to use telemedicine and that there will be something that can be remain lifted from the restrictions one of those being taking care of

somebody who's in another state so give you an example we have patients who could be oh you know maybe in Louisiana or in Texas or Kansas or wherever because they went they went home to be closer to family during this this COVID-19 period well if that patient was pregnant or perhaps that patient was trying to get pregnant or maybe they were following up on on labs or medications. Right now what they would say is that the provider needs to have a license in the state where the patient is. So again, that's been lifted during the COVID-19 time. But I don't know how that will, I don't know. know how that will play out. I'm not sure if they will allow if a patient has been seen,

you know, in your actual clinic at some time if there will be some lifting of those restrictions. Another thing, too, that was a restriction and that the insurance companies would like to see happen is that if you're doing a telemedicine visit, you're not doing it with a patient who is at home, you're doing it with a patient who is in another medical facility. So perhaps they're in a clinic that is a lower specialty or a clinic of some sort. So that's one of the things that the insurance companies that also set up is that it had to be, the patients needed to be in a clinic and the provider had to be in another clinic physically in that facility in order to do the telemedicine.

Now, clearly, that doesn't make much sense. It doesn't make sense for especially what we've all learned during the COVID-19 time. You know, we've learned that there's a lot that we can do in caring for patients. There's now apps that for patients who need to be seen regularly who need to have their vital science monitored, you know, there's, there's apps that connect in, you know, blood pressure and weight and oxygenation. And those things could, I think that we're going to see a growth in those things and that the patients will find that they will invest in their home kind of monitoring system so that they can have better convenience, you know, for their, you know, again, we're talking

about, you know, more limited needs and yet it's still important follow-up, but it keeps, you know, patients out of the clinic. It keeps perhaps patients who are immunocompromised or have, you know, are more susceptible to catch germs and catch illness, that it would be. it would be an opportunity to have those patients who are otherwise stable be monitored and managed at home. So I think that telemedicine should be here to stay. It should be here with many of these restrictions that have been lifted to remain lifted. And when it's taking a provider's time, it's taking a true assessment, it's involving, you know, clinical decision making. that the providers should be reimbursed in a similar way as to when the patients were in the office. Yeah, yeah.

Thank you, Dedy. Now, one of the things that you mentioned earlier was the antibody test. And we're hearing quite a lot about this antibody test and, you know, who should receive it. And could you just tell us a little bit more about it? And, I mean, is this something that you think eventually everyone should receive? Is that not necessary? what is kind of the best practice here? Great question.

So the antibody testing, you know, people have been talking about it. And actually, if we look at it, people have been talking about antibody testing for a couple of months since, at least in the United States. But the countries, China, South Korea, Indonesia, many of these countries, they were right on. on board and ready with those antibody testing from the beginning. And I think a lot of that is what did slow the spread of, you know, of the disease. Now, China did a lot of antibody testing. South Korea, man, they were out of the gate with antibody testing. Now, granted, I am not a fan of the tracking system.

you get your antibody test and there's this app that goes on to your phone and you know if you're positive it's going to track everywhere you've been and it's going to continue to track you I just feel like that is it's not very it doesn't seem very constitutional in our privacy and I and I don't think that tracking is the right thing but I do think individual tracking to be able to find out is important So let's talk about the antibodies, the antibody testing itself. So the pros and cons of it will start with the cons is that there's been a lot of tests that have come out. And just like anything else that comes out on the market, especially when it's a lot of one thing that's similar enough, you're going to have some that work well and some that do not work well.

And when you have anything that is based on medicine and it's giving you the, wrong answer. So whether it's telling you something is a false positive or it's telling you it's a false negative that and you're trying to make decisions about that like going back to work or taking groceries to grandma or whatever. It's pretty important that that's dialed in. And I know that, you know, the powers at B are trying to test. The FDA is trying to go through and test lots and lots of these different antibody testing, especially we're talking specifically about the rapid antibody testing that is done at clinics such as mine, at the county level, university level. You know, Johns Hopkins is doing a big study right now where they're comparing many of the

different rapid antibody testing and seeing which ones are the most consistent. you know, with the least falsees, false negatives, false positives. So we talk about antibodies. The IGM antibodies are the antibodies that come on the scene as we get sick. So we're going to start to get, let's use chickenpox as an example. a person gets exposed to chicken pox and so they're exposed and their body is starting they've never had chicken pox before and their body is starting to respond and we can't see anything we don't see any dots or anything but maybe that person is feeling a little lethargic maybe a little bit feverish just not feeling

themselves and then you know and then you start to see some spots coming around and then those spots start to get you know get that kind of classic look of chicken pox which is kind of like a little bit of a pussy type of a bump you know and then and then as that progresses those open they break they get hard and then they start to go away well as we're in several days into that from the time of exposure to the time that we're getting the first dots and then when they're starting to get more prevalent and more pronounced, around the time they're getting pronounced, which could be somewhere around day five, six, seven, maybe even eight, nine, ten. That's when the IGM antibodies are coming on board. They're coming on and they're starting to fight and they're starting to

lay ground of where they are. But they are, the IGMs are coming on board. when you're in the midst of your illness. Okay? And so when we're doing an IGM antibody test, is telling us, is someone actively ill? In the world of COVID-19, where we've all been so surprised is when someone, remember, I told you, in my office,

I have my sick people outside, I have my healthy people inside. But when we have someone who is otherwise entirely healthy, no symptoms that they can perceive, no symptoms by vital signs or anything that we can perceive, and we're talking, and maybe because of history or places they've been, we choose to do an antibody test,

and we test that person, and they have actively strong IGM antibodies. Now, I have every reason to believe that that is a true test. Now, what we would do in our office is we would back that up with a swab and send that to the lab and see if the lab also shows them having active antibodies. The problem, I mean, active disease where you have the RNA, that's the kind with the nasal swab. The problem with that is if somebody doesn't have any symptoms that could be negative. And so, but nonetheless, we have many people who have zero symptoms and they are positive on their antibodies.

And then we repeat those antibodies in a couple of weeks. And the IGM antibodies are very, very weak. And we see that the IGG antibodies are now very, very strong. And IGG are the antibodies that come in when we are past the disease, the active disease part. Those are the ones that are coming in. And they're kind of like, it's like the little army that lays throughout our body and says, I am not letting this disease come back. And so with chicken pox, you know, you've got all of those chicken pox that have hardened.

Almost all of them are gone now. You may have a couple. your IGB army has arrived and they have laid down all of their, they've got all their weapons already, and they are not going to let the chickenpox virus come back into that body because they are going to fight that. And how we would see that on the antibody test is we would see, on a rapid antibody test, we would see that just in a little line

where the IG, where the IG is on the little consent. In the laboratory, they can actually measure that in quantitatively in how strong are your antibodies. So anyway, when we're looking at antibody testing, it is very important because we can have people who are asymptomatic. They don't feel anything at all or have something mild. And they're just being a part of life. and if we can capture that, we can at least let them know, let's repeat and get a negative. And when you have a negative that maybe, you know, again, you could be around grandma, you feel like you're safe to be around people.

Or in some cases, you know, there's a lot of studies that are going on where people could donate plasma that can actually help people who are very sick from the virus. So antibody testing has a big role. I feel like it is what has been successful in curbing not only this virus, but other viruses in other countries. And so I think that we've learned a lot from China and South Korea and some of the other countries in being aggressive. Now, I don't feel like we've done great about getting good antibody tests that we could rely on across the nation. we're very blessed here at Bella because we did get a really good antibody test that is consistent that tests time after time is validated by the labs. So we feel very confident in the product

that we're using, but I know not everybody is that way. And I think that within the next two weeks, I would guess we're going to have a pretty good idea of which are the best tests. And it seems like there's pretty good availability for the antibody tests. So I don't think we're going to have near the issue with getting those out. I think that there's a lot, you know, there's a lot of product. It's just more a matter of getting them in the right hand so people can more widely test. DD, thank you. That was such a helpful explanation and just great to hear that background and kind of the whole whole picture unfolded. So we just so appreciate your time today. And, all the work that you're doing at Bella and how you're just setting really such a good example

for the medical community of how we can adjust and how we can still be meeting patients' needs so well and effectively even during COVID-19. So thank you so much. We just really appreciate all the work that you're doing. It's just been a joy to be with you guys. I love the everyone that and all the work that's done at the Heritage Foundation. I was just there. I mean, I'm in Colorado, but whenever I'm in D.C., I do like to stop in,

and I do have enough opportunities of people that I know that we can end up having meetings there. And you guys are such a, just a great spoke, pulling all of us together in all of our different places, you know, to make our country strong. Well, thank you. We love to be a resource for people like yourself all over the country. And that will do it for today's episode. Thank you for listening to the deal. Signal podcast. We do appreciate your patience as we record remotely during these weeks.

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