Medical Offices of Manhattan’s Internist, Dr. Robert Segal speaks to Capsule about integrating virtual care and the short and long-term implications of COVID-19 on his businesses.
Growing up, we talked about two things around the dinner table: family and work. I come from a long line of physicians and from an early age saw how passionate my family was about helping people. My parents immigrated to this country from humble beginnings and worked tirelessly to follow their dreams. My father assimilated as a reputable psychiatrist who gave back to his newfound community with compassion, which I suspect was a difficult period in time for him. Yet after each long day, I’d see a graceful smile on his face when he returned home. His compassion for and commitment to others’ well-being inspired me to do the same.
Not long after entering medical school, I discovered that I had a natural talent for reading EKGs. I helped my attending physicians diagnose all sorts of cardiac diseases like heart attacks and arrhythmias, and ultimately helped save many lives. As a result, I quickly gravitated to cardiology. After graduating in 2003, I became a full-time cardiologist at a multi-specialty practice on the Upper East Side where I served the community with pride just like my father did.
However, creating a business from scratch centered on providing exceptional care was a dream that had motivated me through medical school. So in 2009, I founded Manhattan Cardiology, echoing the philosophy that early detection is the best form of prevention. We distinguish ourselves by providing a personalized approach to patient care and a hyperfocus of attention on early detection to prevent cardiac conditions such as heart attacks, strokes, and clots.
Once Manhattan Cardiology was established, a growing demand for quality primary care physicians in New York City became too concerning to ignore. I was inspired to build a primary care group that would cater to New Yorkers in an improved way by creating the Medical Offices of Manhattan. Ever since its inception, we’ve aspired to be the best private practice in New York City.
The patient experience is a priority at Medical Offices of Manhattan. We understand that one satisfied patient equals eight new patients, which is why everyone is treated with a personalized level of care. The most rewarding thing for me to hear is when one of our staff members refers their own family or friends to our offices. My staff has been with me since 2009, and they have put their blood, sweat, and tears into growing the practices as much as I have. Their devotion is unmatched and I take great pride in their extraordinary efforts. The trust we have built together over the years is an unbreakable bond, and I’m delighted to have their own family members come to our office for their medical needs.
In 2011, one of my patients died tragically of metastatic lung cancer. Prior to her diagnosis a few years earlier, she was unable to get the results of a cat scan that had been ordered by another physician. Had she received the results in time, she would have learned of a newly developed solitary nodule in her lungs that could have been resected. Instead, the tumor had metastasized because she was not notified of her results. By the time she came into my office, her cancer had spread and, unfortunately, it was too late.
Her experience inspired me to create LabFinder, a free online platform that enables people to book their medical tests with convenient access to their results without receiving surprise bills from insurance companies. I wanted to ensure that what happened to her would never happen to another one of my patients again. From day 1, my goal has been to empower patients to be the first person in line to have access to their medical test results — not the last.
As physicians, our duty is to our patients. In order to facilitate the most optimal level of care, 70% of our medical decisions are based on lab and diagnostic testing. By giving patients control over their health and testing, we’re not only helping them get the results they need, but also empowering them to have more meaningful, data-driven visits with their providers in a secure way.
With LabFinder, patients can simply search for the test they need — ranging from mammograms to blood tests — select their date of choice along with their insurance carrier, and choose a test center in their network that’s close to home. Once an appointment is scheduled, patients can visit the lab directly with their doctor’s script. If the patient doesn’t have the doctor’s script, LabFinder can connect them with a provider to source approved scripts for the top 50 most common tests. LabFinder has been diligent in the response to COVID-19 by offering telehealth appointments to discern whether or not the COVID-19 antibody test is right for a patient.
Our hope is that LabFinder can pave the way for a new standard of medicine that prioritizes patient autonomy, empowerment, and convenience.
We’re evolving our strategy as new information comes in and the landscape continues to change. So far, we’ve implemented temperature checks for in-office visits, as well as online questionnaires, social distancing, and virtual platforms to check-in patients before they arrive so they don’t spend any time in the waiting room. The health and safety of my patients and my staff are paramount, and implementing virtual care enables us to prioritize pre-screening via video or phone to determine whether or not an in-office visit is necessary.
Incorporating a more substantial virtual care element into our practice has helped our patients feel confident that we’re not putting their health at risk. There has also been a significant ideological shift for us, as the patient demand for virtual care has increased tenfold. The considerable increase in demand for virtual care was a surprise. Still, it makes complete sense, given that no one wants to spend time in the waiting room anymore unless an in-office visit is necessary. Our physicians and our patients have embraced virtual care and the ability to use technology to triage and prioritize those individuals seeking care.
More people realize the importance of diagnostic testing. It’s always been my belief that testing should precede any visit with a provider. When you meet with your doctor with your test results in hand, you can ensure a meaningful visit. But for many years, the process has often gone in the reverse order. A patient visits their doctor first, gets their script, finds a test center, gets tested, waits for the results to come in, and finally schedules another appointment with their doctor to review the results. Now, COVID has put the existing process into question. By limiting in-person visits and shifting our focus to virtual care, patients and providers are recognizing the advantages of putting diagnostic testing first — especially when it comes to antibody tests.
Platforms like LabFinder serve as an intermediary in the collaborative effort between patient and physician to help make informed decisions regarding care. As antibody testing becomes more widespread, this approach will help doctors confidently determine who can come out of shelter and who should continue staying home.
One of the biggest challenges of transitioning to virtual care over the last month has been creating a call center that’s robust, reliable, and experienced enough to handle the increased volume of patient calls. We’re still in hiring mode and doing what we can to ensure that we’re able to manage the bandwidth of requests, particularly for antibody screening.
Another serious challenge has been securing enough personal protective equipment for my staff. Most of the available equipment goes to the hospitals first, so in the landscape of private practice, it’s not easy to source from your regular supplier. I’ve spent many hours searching for gloves, gowns, face shields, and booties to make sure that my staff doesn’t feel at risk. I don’t think I’ve ever placed this many Amazon orders before.
We’re very proud to be one of the first medical practices in New York to offer COVID-19 antibody screening. We’re doing what we can to help New York City get back on its feet and are proud to have partnered with a lab that does reliable and accurate testing. It’s so important to test not only those who may have experienced known symptoms of COVID-19, but also those who could have been asymptomatic carriers. Having access to the antibody screen has given our patients a renewed sense of confidence and safety, especially if they have to come into the office for a visit.
I think virtual care is here to stay. The sudden rush to providing virtual care has been great for the simple stuff, like low complexity prescription refills, reviewing test results, and minor issues like urinary tract infections. In the long haul, it may be unsafe to rely on virtual care for the moderate-to-high complexity issues, but I think continuing to offer both virtual and in-person care will be essential. Though there’s nothing better than human-to-human interaction with your physician, virtual care will enable us to concentrate our in-person efforts where they are needed most.
In regards to LabFinder, I think we will see a permanent shift into a testing-first approach to medical care not only because it will provide more meaningful visits, but also because it will save hundreds of millions of dollars in wasteful initial consultations. Offering virtual screenings first will be crucial to reaping the rewards of this testing-first approach.
As for the practices, I think many changes will remain in place post-COVID. It’s no surprise that the shift has been emotionally, financially, and spiritually challenging for all of us. But I believe in long-term solutions and investments rather than short-term fixes. In that light, I think several of the creative solutions we’ve implemented for the crisis will remain relevant.
For example, we’ve implemented temperature screening cameras that quickly and efficiently read the body temperature of every person entering the office. We’ve also looked at UV sensors that only turn on when the office is closed. These UV lights help to kill germs in the air and on surfaces. In conjunction with healthy cleaning habits, the lights will help prevent any virus from lingering in the space. We’re also using antimicrobial desk and room dividers in the office to ensure that my staff feels protected, and I believe these dividers will continue to be a useful defense. Whatever happens, we will do everything we can in the post-COVID era to make sure that the office is a healthy workplace for all.
The loosening restriction of physician licenses that binds a doctor’s treatment within state lines will be a huge advantage for patients domestically as well as globally. In other words, a doctor licensed in New York would be able to treat a patient in the Midwest, where access to healthcare is limited. This change is already noticeable through LabFinder and Minute Med, which is our telehealth portal. With access to virtual care, I’ve been able to treat patients in other states outside of New York, especially addressing concerns about the COVID-19 antibody screening.
In general, I think telehealth triage programs will continue to be paramount in the post-COVID healthcare landscape. Additionally, supporting remote working and providing more individualization and privatization toward susceptible individuals will be particularly important. I’m most concerned about how the elderly will get their care post-COVID. Their demographic will likely be the hardest-hit even after the worst of the pandemic is over, so we will have to come up with creative solutions to serve them. We may have to implement strategies that have long been used in pediatric offices — for example, isolating sick patients at one end of the waiting room. We may also shift our scheduling strategy so that we see the more susceptible patients at a specific time of day.
Finally, we will have to make severe changes to the medical equipment supply chain. I’m stocking up and replenishing my stockpiles as often as I can, but it’s clear that there isn’t enough supply for the demand. New platforms may arise that offer private practices and other providers more options so that we don’t have to depend on one distributor for all our supplies.
It’s hard to be unbiased about your product. Still, I genuinely believe that platforms like LabFinder will be crucial to helping patients get their tests before connecting with their doctor for a more meaningful virtual or in-person visit. LabFinder and other platforms that bridge the communication gaps among insurance companies, hospitals, and the private sector will be immensely helpful resources when navigating how to provide safe and efficient medical care in these uncertain times.
I also think preparing for a higher demand regarding mental health support for patients and staff will be very important. The shock of today’s pandemic has been devastating to our global culture and economy and has affected thousands of families. Even after the worst of the pandemic passes, everyone will continue to need outlets for mental health support.
We also need to think about the boomer generation and the challenges they will face when a more socially-distant form of medicine becomes the new normal. How can we offer video therapy and telehealth appointments that they feel confident using? How do we serve the increased unemployed population that has lost access to their health insurance? Regardless of how we answer these questions, I think it’s going to open exciting opportunities for new virtual platforms.
View the original piece placement on Capsule.