Audio Transcript
[0:13] Host: Hello and thank you for joining us for this edition of the Valuable Insights podcast. We are recording this podcast on September, 11 2020. And because things are changing quickly, please be sure to reference the latest guidance provided by the US Centers for Disease Control and Prevention and local authorities. Today we have Dr. Armando Hinojosa from Laredo, Texas joining to share some insight on his drive thru option for flu shots as well as other services. To start us off, can you give us a little background about you and your practice?
[0:44] Dr. Armando Hinojosa: Absolutely. So good morning. My name is Dr. Armando Hinojosa. I'm here in Laredo, Texas. I'm an internal medicine doctor. I've been doing this for the last 19 years. Five years ago our clinic went from an all age clinic from 18 to 100 to 65 years and above. For the last five years. We focus on Medicare Advantage patients and Medicare, traditional Medicare patients so 65 and older patients. 1500 of those are Cigna Medicare, about 50 or Blue Cross minute 50 to 60 minute Blue Cross Medicare Advantage and the rest are Traditional Medicare.
[1:24] Host: And I'm sure flu shots are important for this population.
[1:28] Dr. Armando Hinojosa: Absolutely. So we've always tried to push flu vaccines during the flu season. Fortunately, there's been a lot of growth in my practice and so we buy flu shots before so yes, we've always given flu shots but this year we knew it'd be extremely challenging. We also knew it was going to be extremely important for them to get the flu shots.
[1:46] Host: And knowing that is what inspired you to start the drive thru clinic?
[1:51] Dr. Armando Hinojosa: Well we knew we've had a lot of barriers with the pandemic so patients were afraid to come into the facility. The staff was also afraid to accept patients into the facility because as you know, this disease can be asymptomatic. Nobody had really been thinking about the flu. I mean, everybody's been thinking about COVID. We see about 35 patients a day between me and my nurse practitioner. So we started telling our patients a month ago that we were going to have flu shots, and we were going to have a dry process.
[2:22] Host: So before offering this to your patients, what sorts of things did you have to think through in order to fully prepare?
[2:29] Dr. Armando Hinojosa: Right? So we knew that patients are not going to access us the way they did in the past. I mean, it just wasn't an option. So what we did is we were inspired by our local health department. Our local health department has done drive thru flu clinics for probably 10 years plus. So we were inspired by that. But I wanted to do something similar to it for my patients that worked for us because we have our own building. We have our own parking lot. And we have a roof kind of a drop off section that fits two cars. And so our building we can see who's approaching our building. The second thing was we needed the staff. And so we reached out to a local office assistant training school. We said hey, we can teach you then these five students and we have them doing the flu shots. So I trained them, cost effective, it helps them and it helps me to be able to provide the service.
[3:35] Host: So you have a building that works well with the drive thru model and you were able to find additional support. So can you walk me through the actual process of when a patient comes in for a shot?
[3:46] Dr. Armando Hinojosa: So what we do since I mentioned earlier we see about 35 patients a day between me and my nurse practitioner. All this is virtual or telephone. So anytime we have an appointment we notify the patient so we want you to know you don't even have to get your vehicle. We will be able to see that you have driven up and we will go out there and greet you and our nurses have a face shield and they have a surgical mask. You can tell if they have a mask by looking through the glass. If they don't have a mask, they're telling the patient through the glass "Put on your mask" and then the nurse, the student nurse will go and ask them how can I help you today? They say I'm here for a flu shot. So now, they'll approach the vehicle and they'll check the temperature. If they pass the temperature check, then the student will ask for their name and date of birth. And that student carries a clipboard and she'll write down the name and date of birth. And then she'll say okay, just a second. The nurse comes in. She talks to my receptionist slash scheduler and makes sure that they are our patient.
The second thing that we do is we have a metric list. So we're leveraging the flu to take care of other items. We have what we call our prime list. We get that every week. And so if a patient comes in for a flu shot, but I see that she's missing a mammogram or she's missing the microalbumin, we leverage that time. We have the mammogram orders and all that stuff and we walk out and then at that point, we have a questionnaire for an activated injectable influenza vaccination and I got it off vaccineinformation.org. If they are able to get the flu shot, the questionnaire we give them a vaccine information sheet will open the car door. They'll roll up the sleeves, they'll put the alcohol, they'll administer it and put it in the sharp container, and then we say please don't leave just yet. We have other things to talk about.
[5:43] Host: I love the idea of taking the opportunity to close other gaps in care. But is this also a way to keep patients around a little longer? I know in a typical clinic setting that a patient would remain in the office and it would give you the opportunity to catch any sort of reaction.
[6:01] Dr. Armando Hinojosa: That's a fantastic question. In the clinic, you know, we give the flu shot usually as they were waiting for me. And so when I walked into the room, you know, it's already been 5, 10, 15, 20 minutes, whatever if there's any reaction where they're observing them. It's something that's common sense that we all kind of learn that it's not a recommendation that you have to observe them. We do leverage the time. Like I said, usually five to 10 minutes by the time they've driven through when we've done everything we need to do. They always come in with something else so either refilled only this and so again, we get leverage the flu shot time. So it comes up to about 10 or 15 minutes.
[6:39] Host: Oh, perfect. So with the process and the timing working out so well, do you see yourself continuing with this in the future?
[6:48] Dr. Armando Hinojosa: Absolutely. Absolutely. I think we're gonna continue to do this. I think the only thing that would be different if we won't be using our face shields and our face masks in the future. God willing, we get a vaccine, but it's extremely convenient. Remember, these are geriatric patients, if they drive, they're able to access the clinic. If they don't drive, they're able to be brought in by somebody. They don't have to get down. They don't have to wait in a waiting room. We actually go to them and this is a spin off of what we've been doing. Since the pandemic started. Someone needed to get a form signed, do that stuff. Lab orders forms, the enhanced encounter form. We do the virtual visits, I asked them if they can bring the form in person, because we're leveraging the matrix as well. The flu shot was just kind of an extension of what we were already doing. So the answer is yes, we're going to continue to do it. Regardless of the pandemic. Number two, patients love it because it's extremely convenient. Number three, my staff loves it because there's more engagement and the fact that they're moving as opposed to just kind of sitting at a desk and dealing with a phone. So there's a lot of value that's added.
[7:58] Host: So does that mean a lot of your patients have been taking advantage of this?
[8:01] Dr. Armando Hinojosa: So we've done this for about 10 days, I guess today would be day 11. And we administered 70 flu shots as of now. And that's seven a day without actively recruiting. There's just business as usual. But the beauty of this is that we've given the flu shot and we will ever do other things. How can you take a blood pressure that will allow you to do an enhanced encounter with no vital signs and get compensated for that but they're still holding you accountable to metrics? It's a drive thru that offers more than flu shots.
[8:35] Host: Yeah, capturing the blood pressure is a really great call out.
[8:36] Dr. Armando Hinojosa: My wife is the PC office manager here. I mean, I forgot because we're doing so many things that we just did a foot exam out there. We did it today. Two foot exams. We do unfortunately have to get them off the vehicle, get them in a chair, open up a little sheet and we'll go ahead and do that for the exam.
[8:57] Host: I would have never thought of something like that being done through a drive thru. So it sounds like there's a lot of great ideas but also that would come with a lot of changes. Are you getting a lot more questions from patients?
[9:08] Dr. Armando Hinojosa: We've had an influx, I guess, probably a tripling of the incoming calls. We've had to double our capacity to answer phones. We've had to expand the knowledge of our staff in how to deal with the patient reporting that they're positive for COVID. Fortunately we can do virtual and telephone and see them through this drive thru.
[9:34] Host: So with all these new ways to interact with patients, have you run into any other barriers?
[9:39] Dr. Armando Hinojosa: We also figured out very early on that technology is a barrier for 30 to 40% of our patients. So four out of 10 don't have any access to this technology. Our computer system does have a proprietary way for me to interact with patients through our EMR but it's too cumbersome. So that didn't work. And we got into eight electronic transactions which is a lot easier for patients to use. And then finally now have some people that are on an app. It's easy to download. It's very easy to use, and the government allows us to interact with them through that. So we have evolved with our technology. Or basically we want collaboration, of course with the patients and we want convenience and connectivity. So we're leveraging technology, basically, learning as we go. We're there. We're doing our drive thru. We're leveraging our phone systems. Gosh, there's so many things that we've done differently, but those are the big ones.
[10:35] Host: So after implementing all these changes, are there any unexpected things that you might want to share with others who may be interested in implementing something similar?
[10:45] Dr. Armando Hinojosa: You know, it's not an ideal place to be stripping down. So make sure when you're telling them that you're offering the flu shots, please bring a short sleeve shirt so we can administer the flu shot. Also helps with blood pressures as well. So that was a surprise. And then the other thing was how, how grateful the patients are.
[11:03] Host: Well, even if that wasn't expected, I'm sure that's something that listeners will be very glad to hear. And as we wrap up I wanted to see if there were any other words of wisdom you might want to share with listeners.
[11:16] Dr. Armando Hinojosa: Yeah, absolutely. The most important thing again, just to reiterate, is the satisfaction of the patient. You know, our patient really looked to their physician. You know, we have these connections with our patients. They're as stressed out as we are probably more. I think this is an opportunity, but it takes time. It takes patience, it takes vigilance and it takes an attitude of not that it cannot be done, but how it can be done and if you're willing to fail and continue till you get it right. Your patients will be forgiving of that because you're trying to help. So I would encourage any physician to just think creatively and not just accept the status quo. Yes, the pandemic is difficult, but it's an opportunity to leverage what we know and to improve our businesses. The work that you put into doing something like this, it's very rewarding, because you're still adding value to the patient and you're saying that you care about them. You care about yourself and your staff and you still can do the service. So definitely it's extremely fulfilling. So please don't get discouraged. You know, whoever's listening, it can be done. We just need to share best practices with each other and definitely leverage your CareAllies team. Leverage Valuable Insights and share best practice. We can always mimic what other people have. I think that's the value of this information.
[12:34] Host: I completely agree.
[12:36] Dr. Armando Hinojosa: I just want to highlight my wife one more time to go over here because I can't do this by myself. These are just ideas. We put them together collectively.
[12:45] Host: It sounds like you're doing some wonderful things. So thank you again for taking the time to tell us all about this drive thru clinic and share your insights with others.
[12:55] Dr. Armando Hinojosa: Thank you for the opportunity.
