More Changes Nearly Every Day

Kerry Lavigne • Mar 25, 2020

Camden Dermatology & Mohs Surgery will remain "open", but with significant changes and protections.

Please review the following information closely & carefully for details.

Tonight at midnight all non-essential businesses in Maine are subject to closure for at least 2 weeks time.

Medical practices like Camden Dermatology & Mohs Surgery are exempt from this mandate, although I assure you nothing is business as usual.

I have made a promise to my staff to protect them, their health and the health of those closest to them, and with this commitment in mind, I am relocating all my staff to work from home, excluding myself.

This is a challenging endeavor which requires us switching to a internet based phone system, moving computers, creating and refining workflows. If you call the office between Wed, March 25 to Friday, March 27th and are unable to reach someone directly, please leave a message with the voicemail system (Klara) we have in place. These messages can be retrieved virtually by my staff who can attempt to reach you back in a rather timely manner.

I will continue to see very specific appointment types (detailed below) in the office with significant advanced coordination as I will be working with my staff in only a virtual fashion from their respective remote locations. We will not for example have someone at the front desk nor will I have MAs assisting me in person in the exam room.

The American Academy of Dermatology has issued the following recommendations regarding how to classify types of visits which may require in-person evaluation and we are electing to apply these to our workflow:

A visit which will decrease the chance that a patient with a severe dermatologic condition would need to seek care in an emergency room as this would contribute to unnecessary burdens on a portion of the system which is already struggling.
As an aside, I obviously take great pride in the work that dermatologists do and unlike Jerry's opinion famously expressed in a long-ago Seinfeld episode, there are actual dermatology emergencies. Its not always just about putting aloe on it :-)
A visit which will decrease the risk of a poor outcome such as progression of a high risk skin cancer, risk of metastatic disease, monitoring for melanoma or other serious condition.
A visit in which an urgent biopsy is indicated or other urgent therapeutic intervention is indicated.
I would add that I will continue to see suture removal/post-operative patients, complex wound checks which cannot be performed in a telederm setting, and any urgent concerns directly referred to me from primary care physicians or other medical providers in the community for either new patients or existing patients.

Encounters for focused concerns such as pre-cancerous lesion management, ongoing follow ups for certain concerns such as acne, psoriasis, eczema and preliminary screening of specific "worrisome lesions" shall be rescheduled as teledermatology encounters.

Our experienced dermatology PA, Mr. Sam Cohen will be available two full days a week to facilitate teledermatology encounters and Dr. Lavigne will also be providing this service as well on a yet to be determined basis.

Given the decision by Gov. Mills, we are choosing to reschedule all Mohs and excisional surgeries for a minimum of two weeks. These procedures require at least the presence of medical assistants, and I do not believe it is appropriate to put my staff in this situation. We had previously made the decision to reschedule all cosmetic encounters when directed to do so last week.

Telederm Visit Details

We are fortunate that our communications system Klara has made it relatively easy for those with the following to have a telederm visit:

Either a smartphone type cell phone (Apple or Android will work) or a laptop/PC with microphone & camera capabilities
Strong internet connection or WiFi service (be aware of any restrictions in your calling plan if you elect to use cellular data)
Iphone users will need to have Safari browser as the active browser; Android users will need to utilize a Chrome browser
Shortly before the visit, situate yourself in a quiet, private, well lit area for ideal communication

If you are using a laptop/PC, you will need to go to the following website: patient.klara.com

At the time of the telederm visit, you will receive a text message prompt to your cell phone:

"Dr. Lavigne / Sam Cohen, PA-C started a video visit with you."
Please follow the link to join now: https://klara.com, etcetc
You can also join from your computer by going to patient.klara.com

You will then be asked to verify your date of birth.
Once this is completed, you can join the video encounter.

(Please be sure to click "allow permission" for Klara to use your microphone and camera as this is fundamental for the telederm visit.)

We will be documenting the details of the encounter within our electronic medical record as well as to process prescriptions.

Policies related to billing and reimbursment for teledermatology/telemedicine visits were modified last week for Medicare as well as Medicaid, and numerous commercial insurers are offering expanded telemedicine serivces.

Please understand that these visits will be processed similarly to in-person visits and degrees of coverage may vary depending upon your carriers policy.

It remains to be seen at this time how long we will need to operate in this fashion. However "DON'T GIVE UP" as we will all do what is absolutely necessary to continue to take excellent care of you, our patients as well as to preserve the health & wellness of our staff.

Special Note

As an independent medical practice, I operate just as other small businesses do, and we share similar concerns related to ongoing operations due to the financial impact of this dreadful situation. My ability to ensure the preservation of jobs for my staff, fulfilling my own family's needs as a more or less single income household and to support the other business we depend upon daily is reliant upon the successful adoption of primarily teledermatology encounters by our patients at this time. I wholly understand that it may be new and somewhat cumbersome to consider initially, but it is my hope that with the resources we have at hand, we can make it a successful bridge to the other side of this devastating situation. I am very grateful for your ongoing support, patience and understanding during this stressful time.

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