It's the number one question being asked at the center of the Coronavirus global pandemic: how does one get tested for it? What do you do if you don't have a primary care? How much will it cost if you don't have insurance? At AFC Urgent Care in Marlborough, Managing Director Bing Yeo and the staff of trained professionals are ready with answers, doing so in a way that protects both the public and themselves.
"The first thing people should do is to ask themselves what causes them to have the fear that they have it. Have they been exposed? Are they experiencing any symptoms?" he asks. These, in fact, will be the first questions you're asked when you come to the locked door at AFC Urgent Care center in Marlborough. Yet a locked door doesn't mean you're being turned away: in fact, it means you're being protected, too. "We're taking extreme precautions here," says Yeo. "You can be walking around, non-symptomatic, spreading it and not know. And we still have people that come in with sprained ankles, injuries, and cuts- so we try to protect ourselves and our patients. We don’t let anybody in who is currently symptomatic, even though most people that come in with the symptoms aren’t COVID-19." Since they've started testing, Yeo reports only 3 positives out of 70 to 80 people, but says that shouldn't mean they take the threat any less seriously. "While the positives are still on the minority, we’re taking the precaution and assuming that because you have symptoms with COVID, that you may have it."
How are locked doors a part of the process? "Our doors are locked to allow us to screen people. There's a sign (on the door) that says you have to call our front desk." Once that call is answered, the first question is: Do you have any of the major symptoms, including fever, coughing, shortness of breath or a sore throat? If the answer is no, the second question is to ask if you have been traveling over the past 14 days or have had been in close contact with anyone who's tested positive. If that answer is also no, you will be advised to self-quarantine, says Yeo, with the exception of healthcare workers who may have potentially been unknowingly exposed to the virus.
However, if any of the answers to your questions are yes, this is a very different story. "If they are there for possible COVID-19 exposure, we register the patient over the phone to be put into our system. Then, we place them in queue to initiate a Telemedicine session with one of our providers who will go into the details, their medical history, and confirm if they are a possible candidate," says Yeo of the call typically lasts between 10-15 minutes. If the patient is a candidate, they will be asked to visit a drive-thru testing site tent that was set up on Thursday that provides free testing from 8am-5pm Monday through Friday. "We test the patient for the flu first," he explains. "If they test positive, we don't test for COVID. If the patient tests negative for the flu, then we do test for COVID-19 and would submit that test to our lab." That lab is Quest Diagnostics in Marlborough, recently visited by Governor Baker and Lt. Gov. Karyn Polito.
How much does getting tested cost, and how long is it to get the results? "Many insurance companies-definitely for Medicare and Medicaid, COVID-19 testing is completely covered," says Yeo. "We expect all the other major ones to follow suit. We shouldn’t let the financial burden stop people from getting tested." Thankfully, Yeo says once the tests are completed the results have been coming in much faster than anticipated. While they received next day results on Sunday, he wants everyone to be aware that this all has to do with the lab's testing capacity at the moment.
Today, offering that virtual Telemedicine appointment instead of walk-in service is certainly a new way of doing things for the local Urgent Care Center. Yeo says the process has fortunately been very smooth using FaceTime for iPhone users and Google for Android users-but it didn't start out that way. "Our wheelhouse is really taking care of people who can’t get access to their PCP (Primary Care Physician). At the beginning, we didn’t know (how it would work) - the CDC guidelines were somewhat spotty and very confusing. It took us a couple of days to realize that the only way to provide services to our patients is through Telemedicine," he explains of the new approach. Given recent changes to make Telemedicine more accessible for healthcare providers such as themselves, Yeo "gives kudos" to the CDC for relaxing the tele-care requirements that have allowed him and his staff to continue to treat while limiting their risk to exposure. "It would have taken us weeks to get on a Telemedicine platform previously," he explains. On top of relaxing the requirements for healthcare professionals to use these services, the game changer for places like AFC Urgent Care also came from it becoming more affordable. "(Previously) the insurance companies have not really allowed telemedicine reimbursements to be on par with a regular visit, which is a reason why I think up until this crisis it hasn’t really picked up in a major way." Before the Coronavirus outbreak, many companies had been only reimbursing doctors for less than 1/3 of the cost of a standard visit. "If you think about if from a doctor standpoint, while they’re not physically putting hands on the patient, they're giving regular advice, examining the patient the same way they would without being face to face," he explains. "Doctors area saying, 'If i take myself away from seeing a person and do Telemedicine, I'm doing the same things but getting 1/3 of the covered cost-which may not even cover the amount to pay the nurse? It may not be worthwhile to do'." Yet as a response to the COVID-19 pandemic, Medicaid and Medicare are now compensating doctors for a telemedicine call the same rate as a regular visit. "We didn’t have Telemedicine capabilities before so we’ve had to ramp that up just in a couple of days, completely change our workflow process in terms of how the patience are seen, but I think that’s what it takes to really be on the front lines."
Even with Telemedicine capabilities, being on those front lines still requires healthcare professionals to continue to use an abundance of caution to protect themselves. "All of our staff is wearing masks at all times, our medical staff doing testing is in full gear. So there are not enough gowns, not enough masks. I've been lucky in that we’ve stocked up on masks before, but right now with our vendors -they’re just allocating them. For now, the weekly allocation of masks for us is good but the gowns are on short order." On top of PPE's (personal protection equipment), Yeo says there's also a second massive shortage: testing supplies. "We’ve been told that testing supplies are coming, so as we receive them we’ll increase our capacity to test our people." As he says these words, Yeo knows the demand for tests continues to rise despite the shortage. Earlier today, Yeo says he received a call from a non-local hospital asking if they could get their own healthcare workers tested, and is trying to find a way to help and understands their concern. "All it takes is just one person being tested positive, and you have people in close contact with them, they all have been exposed."
Yet Yeo says there is hope for relief: his goal is to follow in the footsteps of a local Urgent Care in Waltham that has recently been able to offer larger-scale drive through testing."If we get a supply where we know we won’t run out, we can test more people. Social distancing and testing yourself is where the bottleneck has been, and I’m glad Governor Baker announced the shutdown of non-essential businesses. That would help with social distancing-now let’s get more people tested! If we get a supply where we know we won’t run out, we can test more people."
If you believe you have been in contact with someone confirmed positive or are showing COVID-19 symptoms and should be tested for Coronavirus, and do not have or are unable to set an appointment with a Primary Care Physician, Bing Yeo urges residents to contact the AFC Urgent Care Center in Marlborough at 508-658-0764.