Q&A with NP Elizabeth Ellis, Fighting COVID-19 in Rural Texas
Monday, May 18, 2020
Posted by: Erin Cusack
Meet Texas nurse practitioner Elizabeth Ellis, an independent rural health clinic owner in Bedias, Texas serving over 2,000 patients in Grimes County and the six surrounding rural counties. Ellis was recently featured in a CBS 60 minutes special edition highlighting how the pandemic has affected rural health care in the State of Texas. Whether administering COVID-19 tests in her clinic parking lot or taking to dusty country roads to do home health visits for elderly patients, it is far from business as usual for Ellis. And there have been a number of financial and regulatory hurdles along the way. Through these trying times, however, Ellis’s passion for rural health and her deep connection to the patients she calls family is unwavering as she continues to care for her community on the front lines.
Q: How has COVID-19 impacted the way you work with patients in your clinic?
A: COVID-19 had a major impact on our volume and that truly impacted us financially. But we’re back seeing patients again. We’re being very careful about how we’re bringing patients in – scheduling our elderly well check-ups in the morning and our sick visits in the afternoon, screening everyone with COVID-19 questionnaires, taking temperatures before patients come into the clinic, and limiting the number of patients and family members in the waiting room to two patients at a time to allow for social distancing. If we get a COVID-19 patient or patient with COVID-19 symptoms, we are screening and seeing them in the parking lot as we did during the height of the pandemic in full personal protective equipment (PPE). For these patients, we’re flu testing and ruling that out, administering COVID-19 tests, and doing whatever medical management we can in the parking lot. If they are sick, we put a mask on the patient and place them in a quarantine room in the clinic for further care.
Thanks to state and federal regulatory waivers, we are able to do telehealth visits and telecommunication right now for patients who aren’t comfortable getting out and traveling or for patients who are homebound. But oftentimes doing telehealth is difficult because patients don’t have smart phones or access to reliable internet, or they cannot afford smart phones or high-speed internet.
We’re also continuing with well-child visits, which are very important right now, and keeping kids immunized. We’ve been calling parents and trying to ensure that they still bring their kids in for their well-child visits.
Q: If and when a vaccine becomes available for COVID-19, do you think nurse practitioners will play an important role in ensuring that their patients are vaccinated?
A: I think it’s going to be essential. As nurses first and foremost, and as nurse practitioners, we have a tremendous ability to help educate our patients. We communicate with and educate patients differently than other providers and strive to give patients resources and a better understanding of the importance of vaccines. If you look at the numbers, our patients have higher rates of vaccinations. I think it’s going to be critical for all of us -- not just nurse practitioners but all health care providers -- to ensure everyone gets vaccinated. I think this will be a wake-up call for those who didn’t get flu vaccines in the past or who didn’t believe in them. I think these individuals will be more likely to get vaccines in the future and will have a better understanding of the seriousness of viruses and what they can do.
Q: What are the biggest challenges you’ve experienced as a rural health care provider during the pandemic?
A: As a federally designated rural health care clinic, we are not allowed to serve as the ‘originating site’ for telehealth, or the site where a health care provider is located while providing telehealth services to patients. In the beginning, we struggled because the federal waivers for telehealth did not include rural health clinics. Patients were afraid to come in and had orders to stay at home, yet we were not legally allowed to perform telehealth visits with our patients as the initiator. That was a real constraint for us. Eventually, there was an addendum to this waiver through the federal CARES Act, but this was a few weeks into the pandemic. And then we waited another several weeks to get guidance on how to code and get paid for these telehealth visits.
Another big struggle for us was the lack of volume. Patients were doing what they were told to do, and that was to stay at home. This was good for containing the virus, but financially impacted us tremendously. We also had to adjust our clinic hours because of staff issues in relation to childcare. At one point, we even had to shut down for a week because of a Person Under Investigation exposure in our clinic, and the CDC recommended we close. This was extremely difficult because we still did not have the federal waiver to do telehealth with our patients at that point.
Despite these changes, Governor Abbot and our legislators have done a laudable job to ensure that nurse practitioners have the ability to do what they need to do to take care of our patients. In my mind that has made rural health a little easier for us. So, these waivers need to stay and become permanent. Generally healthcare is hard enough, and rural healthcare is really hard. Why continue to make it harder?
Q: Some people have called the COVID-19 pandemic a healthcare 9/11 of healthcare. Can you tell us what that means, and what you think the impact will be on healthcare policy in the future?
A: If you think back on 9/11, it affected everyone across the United States in that it truly changed policies, emergency preparedness for first responders, and the way we think about terrorist attacks in this country. There were temporary policy changes and responses that went into effect very quickly and many of those policies became permanent. As we endure this pandemic, all of the health care waivers and changes made thus far need to continue to move forward and eventually become permanent. In the weeks to come, I hope we will have even more positive healthcare policy and regulatory changes to remove all of the restrictions and barriers to practice for health care providers, making it easier to care for our patients and easier for our patients to access care.
Q: You were just featured by CBS 60 minutes in a special COVID-19 edition on rural health and there’s been a huge outpouring of support from across the country. What is your call to action for those who want to make a difference for rural health?
A: Since the showing of 60 minutes, the outpouring of generosity and support has been tremendous and has renewed my faith in the strong sense of humanity we share in this country. We’ve received notes and cards from people all the way from Maine to California. I think the show really highlighted what rural health is and how hard it is. It’s not just the pandemic; rural healthcare is hard on any given day. There are barriers and restrictions, like the telehealth restriction for rural health clinics, that are very antiquated and date back to 1977. Our laws really haven’t changed since then.
Currently there is a bill in Washington D.C., the Rural Health Modernization Act (S. 1037). I would ask every American, no matter where you live, to support this bill. Twenty percent of American is rural, so every state is affected. We need this bill to pass to remove antiquated rules and regulations, physician supervision requirements, restrictions on telehealth policies. Most importantly, we need this bill to modernize and create parity in our payment system. We should all be getting paid in a more substantial manner that truly helps keep us viable. viable. Currently the way it is payments are not sufficient and this is why so many clinics and critical access hospitals shudder their doors and why we can’t get more providers out here into the rural areas. We need to change that.
Q: You’ve received donations from people across the country and you’ve set up a special fund for your patients. Can you share a little bit about your plans?
A: It’s been truly overwhelming the response. I had no idea this was going to happen and truly am just overwhelmed by it all. We did finally receive federal relief for rural health clinics. Unfortunately, not all rural health clinics did. They initially said they were going to provide funding for all, and then they came back and changed that. There are over 1,000 plus rural health clinics across the nation that did not receive any CAREs Money. I was very fortunate.
With the money that has been received to help us take care of our community, we have set up a community fund and are going to do large scale health initiatives, such as bringing in a dental van to Bedias twice a year in an effort to take care of our uninsured and underinsured patients who have dire dental needs. Out here in the rural community, there is a lack of fluoride. Unfortunately, we also have a lot of patients who are smokers and their teeth are in very poor condition. As you know, this can affect many other health issues and can cause other health problems. That’s one of the big initiatives we’ll be working on. We’re also hopefully going to be able to use some of the funding to provide free flu shuts for our uninsured patients this Fall.