Dr. Howard Korman and Issam Atoussi in the Royal Oak Comprehensive Urology office.
Dr. Howard Korman and Issam Atoussi in the Royal Oak Comprehensive Urology office.

Dr. Howard Korman, along with Comprehensive Urology pathologists, created a way for patients to provide urine samples without leaving their homes and with limited or no contact with another person.

In late April, the son of one of Dr. Howard Korman’s patients called his urology office to describe symptoms of a recurring condition that in the past had been treated with medication.

“I dreaded thinking that in the midst of the COVID situation I would be taking my almost 92-year-old dad from his home in Chesterfield all the way to Royal Oak and have him go inside a doctor’s office,” said his son, who asked to remain anonymous. “We knew the doctor would want to do a urinalysis, and were very pleasantly surprised to learn that he could make arrangements for my dad to be treated without leaving his house.”

After a telemedicine videoconference, Dr. Korman included his patient in what he described as “a grassroots urine specimen home pickup method” provided by Comprehensive Urology, a group of 50 urologists and advanced practice providers, of which Korman is president.

As a urologist, he said most of his patients require urine testing to diagnose possible conditions, some of which, if left untreated, could be life-threatening. “We had many patients who were afraid to come to the office,” Korman said. “But the problem was, how else do we get urine to check for blood, protein, glucose or signs of infection?”

In response to the challenge, Korman, along with Comprehensive Urology pathologist Dr. Rajan Dewar and Issam Atoussi, the group’s COO, created a way for patients to provide urine samples without leaving their homes and with limited or no contact with another person.

Drop Off and Pick Up

After a urinalysis is ordered, patients are contacted by Mai Her, a medical assistant and technical trainer for Comprehensive Urology’s lab who also serves as the office dispatcher. She then arranges for a courier to drop off a urine sample kit on the patient’s front porch. “They are so appreciative that they don’t have to come into the office when they don’t feel well and are concerned about COVID,” Her said.

Jonathan and Dr. Howard Korman
Jonathan and Dr. Howard Korman

In some cases, the courier would wait in their car in front of the patient’s home until the specimen was placed outside. “If they needed more time, the driver would leave and the patient would call when they were ready and I would arrange for the courier to go back, usually within 12-24 hours,” Her said.

At the start of the COVID shutdown, four drivers were making a total of 40 daily trips to patients’ homes, with Her mapping out stops including those in Novi, West Bloomfield, Bloomfield Hills, Dearborn, Troy, Southfield, Oak Park, Grosse Pointe, Macomb, Birmingham, Royal Oak and Rochester.

Now about 75% of the group’s patients are booking appointments in their CDC guideline-adherent offices with appropriate PPE and social distancing.

Home drop offs and pick-ups are down to about 10 daily, with only one individual, Dr. Korman’s son Jonathan, continuing as a courier, having driven as far as 200 miles in a day.
“Samples are picked up within 30 minutes of the time they are placed outside, and I process them immediately in the Comprehensive Urology lab,” said Jonathan Korman, who is also working as a laboratory technician.

“From time to time, I get to talk to the patients from a distance, wearing gloves and a face mask.”

A dipstick analysis is performed on each sample by an automated machine, with results immediately sent to the ordering physician.

“We are also using an innovative kind of urine culture from Pathnostics using PCR techniques which analyze the DNA of the bacteria in the urine to yield identities and sensitivities of bacteria much faster than a conventional urine culture,” Dr. Korman said. “This enhances our ideal of a fast turnaround time for results.”

Staying Safe

Until the COVID-19 outbreak, Dr. Korman primarily saw patients in his Royal Oak and Farmington Hills offices. By April 1, like others in the healthcare sector, he needed to find a way to continue to treat his patients while keeping them — and his staff — safe. He reduced in-office appointments to the 10% with emergency needs.

The rest were seen by telemedicine. “But analyzing urine is a critical part of the checkup for urologists,” Korman said. “The new program allows us to add that to our no-contact patient care.”

The service, provided at no charge to patients, is available to all physicians who are part of the mega multi-specialty Michigan Healthcare Professionals (MHP), of which Comprehensive Urology is a division. There are 328 multi-discipline physicians and 122 advanced practice providers in MHP’s 167 locations.

Korman said the plan is to offer both telemedicine and the courier service long term. “Both eliminate a barrier to care,” he said. “Over 50% of our patients utilizing the home pick up had an abnormal urinalysis and required treatment. They may have gotten septic and even died because they feared going to the hospital or the office and would have missed out on treatment.”

For his 91-year-old patient, the new service not only provided extreme convenience, it also allowed for quick treatment that required medication.

“Once the culture was done and the best course of action was determined, the doctor followed up with the necessary medication,” said the patient’s son. The prescription was filled at one of MHP’s two pharmacies and was delivered to his home at no charge. “This made it doubly easy for us,” said the son, who normally would have driven his father to the doctor’s office and also picked up the prescription.

More than 1,000 patients have been included in the new program since its inception. “Some of them are young, but most are seniors who are really at risk,” Korman said. “This is really a homerun for the elderly. It keeps them out of the ER and urgent care centers.

“There is no reason for someone to come into the office to get tested and then come back again for test results when it is difficult or unsafe for them,” he said. “It should not come down to someone having to decide, ‘Is it more dangerous to come in or to stay home untreated?’”

Contact Comprehensive Urology at: (248) 336-0123 or access the website at: www.urologist.org


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