As the pandemic continues, medical practices must balance the need to provide necessary services while minimizing risks to patients and healthcare providers and mitigating financial impact. Awareness of COVID-19’s progression in your community remains critical. Health care organizations must remain prepared to meet patient needs to the greatest extent possible. As the situation changes, continue planning for best utilization of your facilities, equipment, and consumables while minimizing the risk of infection.
Providing Vaccinations, Essential Surgery and Procedures, and Preventative Care
In response to the COVID-19 pandemic, patients have cancelled preventative care appointments and surgery, and have fallen behind on vaccinations. After the first surge subsided, many practices resumed healthcare services in response to patient needs; however, the recent resurgence of the virus may cause increased disruption to healthcare delivery. Appointments that were cancelled as a result of previous practice closure and appointments that were postponed (possibly due to fear of presenting in person for healthcare) should be reviewed in detail to ensure patient safety. A strong follow-up and recall system will aid in this process. If your practice has not yet developed a system, this is highly recommended as a means of assuring important chronic conditions are managed, and screenings, vaccinations and other preventive care services continue on schedule. Protocols should be in place to guide which patient conditions should be prioritized when triaging appointment requests for on-site visits, while minimizing infection risks. The CDC Phone Advice Line Tool, Algorithm and Messages for Patients with possible COVID-19 can be used to facilitate triage of patients with and without COVID-19 symptoms.
- NORCAL Group: Routine and Influenza Vaccination Compliance During the Pandemic
This webpage includes patient safety recommendations, vaccination strategies and additional vaccination resource links.
- American College of Surgeons: Joint Statement: Roadmap for Maintaining Essential Surgery during COVID-19 Pandemic
The American College of Surgeons, American Society of Anesthesiologists, the Association of periOperative Registered Nurses and the American Hospital Association collaborated to develop a roadmap (in the form of a joint statement) for resuming elective surgeries. The roadmap offers guidance on the various challenges and issues associated with surgical services that may be considered “elective” from a reimbursement perspective, but are medically necessary for the ongoing health and well-being of affected patients.
Patient Protection and Exposure
Enforcing mask-wearing, changing waiting area furniture arrangements, reducing the number of patients scheduled from the number seen pre-pandemic, and separating well-patient services and sick patient services, either by facility set-up or through scheduling are all strategies for reducing potential exposure among patients, healthcare providers, and visitors. Communicating with patients at the time the appointment is made, and closer to the time of the appointment date and time is critical for assuring patients understand infection control processes and procedures. Providing information through various mediums, such as phone calls, email, text, and your practice website may be helpful for reinforcing this information. Consider the following recommendations:
- Enforce mask-wearing
- Place staff outside of entrance to triage patients and limit non-patient visitors including delivery personnel.
- Allow symptomatic patients to wait outside or in cars if possible, otherwise create a separate waiting room inside, or place patient directly in private room upon check-in.
- Place chairs for patients and staff 3–6 feet apart and add barriers at counters where staff and patients interact.
- Place alcohol-based hand rubs at entrance, exit, and check-in areas as well as in patient rooms.
- Use block scheduling methods to separate timing of well and sick visits (i.e., only well visits in morning hours and only sick visits in afternoon hours).
- Designate certain exam rooms for well visits only or sick visits only.
- Remove communal objects in waiting areas and exam rooms that cannot be cleaned, such as reading materials and communal toys if cleaning after each use not possible.
- Leverage technology such as mobile payment apps, patient portal billing, or online bill pay to allow for contactless transactions.
- Promote and utilize telehealth services when applicable.
- NORCAL Group: Facemask Guidance
This webpage provides guidance on mask use recommendations and patient requests for exceptions and includes a sample mask policy for patients and visitors, mask policy recommendations and resource links.
- NORCAL Group: Potential Patient Exposure to COVID-19 by a Healthcare Provider
This webpage provides strategies for responding to potential exposure to patients when a healthcare provider tests positive for COVID-19.
- NORCAL Group: COVID-19 Informed Consent Issues
This webpage includes recommendations for educating patients about the COVID-19 infection risks inherent in healthcare delivery and sample COVID-19 infection risk statements for informed consent forms.
- NORCAL Group: Mobile COVID-19 Testing Units
This webpage provides strategies for deploying mobile testing units in a manner designed to safeguard patient safety and minimize liability risk.
Your practice may have remained open continually throughout the public health emergency or may have reopened months ago. As the pace of COVID-19 exposures and deaths ebbs and flows in various areas of the country, it is important to prepare for new challenges on the horizon and address reopening issues that were not considered or are not resolved.
(Some of the resources below were developed with reopening in mind are still relevant for the ongoing evaluation of services)
- AMA: COVID-19: A physician guide to keeping your practice open
This guide builds on the AMA’s "Physician Practice Reopening Guide", and includes a detailed pre-visit screening script and frequently asked questions around privacy and confidentiality concerns for practices.
- CDC: Healthcare Facilities: Managing Operations During the COVID-19 Pandemic
This guidance outlines goals and strategies for U.S. healthcare facilities to operate effectively and safely during the COVID-19 pandemic and provides links to CDC guidance on providing care in different settings and situations.
- CDC: COVID-19 Pandemic Planning Scenarios
This guidance presents five COVID-19 Pandemic Planning Scenarios that may be useful to hospital administrators in assessing resource needs and can be used in conjunction with the COVID-19 Surge Tool.
- American College of Physicians: COVID-19: An ACP Physician’s Guide. Chapter 24: Resources: Ambulatory Care Reopening and Recovery
This coursebook chapter provides practical resources and tools including staffing models, workflow design, and templates for communicating with patients.
- MGMA: COVID-19 Medical Practice Reopening Checklist
This checklist addresses the various issues that should be considered when reopening a medical practice.
Healthcare Workforce Protection, Exposure and Wellness
In addition to managing interruptions to healthcare operations and healthcare delivery, and reducing the risk of patient infection, protecting both your clinical and non-clinical staff remains critical. While shortages of appropriate personal protective equipment (PPE) continue in some areas, best practices for preserving and re-using existing equipment are still relevant. Providers and staff providing onsite services must ensure their health and wellness for the safety of your patients and for other members of the workforce.
- NORCAL Group: Healthcare Workforce Protection and Exposure
This webpage provides strategies for preventing and responding to healthcare provider infection, including guidance for work restrictions.
- NORCAL Group: Workforce Wellness
This webpage provides strategies for leadership and administrators to support the health and well-being of physicians and staff.
The pandemic has affected hiring, firing, furloughing and/or laying people off as well as re-hiring and returning furloughed employees to work, which may implicate employee protections such as FMLA leave, emergency leave, and workers’ compensation. Accommodating additional time off for illness and dependent care and facilitating remote work strategies are new challenges that can make maintaining safe staffing levels challenging.
- NORCAL Group: Human Resources
This webpage contains links to COVID-19 resources from OSHA, US Department of Labor, and National Law Firm analyses of relevant workforce laws.
Disruptions to healthcare delivery have resulted in significant, and often devastating, financial impact on many practices.
- NORCAL Group: Financial Operations
This webpage includes links to resources addressing federal business funding programs (e.g., CARES Act), billing and reimbursement.