As America begins assessing the appropriate timing and process for resuming activities that have been limited or restricted during the COVID-19 pandemic period, physician practices will have the challenge of determining when it is appropriate to reopen their offices. For those offices who have remained open but have limited their services or utilized only telemedicine, the process will be very similar.
- MGMA: Checklist to Prepare Physician Offices for COVID-19
Open-source offering to assist practices in organizing preparation for seeing patients in the office
- MGMA: COVID-19 Medical Practice Reopening Checklist
Addressing the various topics that need to be considered when reopening their medical business
- NORCAL Group Risk Management: COVID-19 Checklist for Reopening Your Practice (PDF)
A practical checklist with Risk Management strategies for reopening medical practices following COVID-19
- American Academy of Family Physicians (AAFP) - Checklist to Prepare Physician Offices for COVID-19
- American Medical Association: COVID-19: A physician practice guide to reopening (PDF)
- American College of Physicians: Chapter 19 Resources: Ambulatory Care Reopening and Recovery
Provides practical resources and tools including staffing models, workflow design, templates for communicating with patients and more.
When to Reopen
Knowing when to reopen will be the decision that drives the pace of every action that follows. Awareness of the disease’s progression in your community will be critical. Consult with your local health department or medical society for information regarding the recovery phase for your practice locale. The following resources provide guidance and steps to take in assessing this important first step.
- Guidelines for Opening Up America Again
- The Hospitalist - Infectious disease experts say testing is key to reopening
- National coronavirus response: A road map to reopening
- CMS Issues Recommendations to Re-Open Health Care Systems in Certain Areas
- Opening Up America Again: Centers for Medicare & Medicaid Services (CMS) Recommendations - Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare (updated 06/08/20)
COVID-19 Consent to Treat and Informed Consent Issues
As practices and facilities re-open, physicians and staff must be prepared to address the potential risks for COVID-19 exposure/infection to patients. Learn more on the COVID-19 Consent to Treat and Informed Consent Issues page.
Selecting Patients and Procedures
After deciding to resume onsite patient care activities, consideration should be given to which patients and conditions require the earliest intervention. Resumption of services does not necessarily mean a full return to the normal process that was in place before the pandemic. Formulating a protocol for determining which patients should be scheduled first will aid in triaging appointment requests for limited scheduling slots. Cancelled appointments that occurred as a result of closure should be reviewed in detail with priority given to patients who were unable to substitute a telemedicine visit. A strong follow up and recall system will aid in this process. If your practice has not developed a system, this would be the ideal time to do so in preparation for resumption of activities.
- CMS Non-Emergent, Elective Medical Services, and Treatment Recommendations
- Vaccinations to be completed once circumstances allow
Preparing your Practice Environment
Before consideration can be given to scheduling the reopening of your office location, steps must be taken to assure that your site is well-prepared to function with the continuing threat of exposure for both your patients and your health care providers. Planning for best utilization of your facilities, equipment, and consumables will be critical to successfully resuming services while minimizing the risk of contamination. Steps you take to prepare your clinic for flu also can help protect your patients and healthcare workers from COVID-19.
- CDC: Get Your Clinic Ready for Coronavirus Disease 2019 (COVID-19)
- CDC: Healthcare Facilities: Managing Operations During the COVID-19 Pandemic (updated 06/28/20)
- CDC: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic (updated 07/15/20)
- OSHA – Guidance on Preparing Workplaces for COVID-19
Protecting your Physicians and Staff
In addition to preparing your facilities, preparation for protecting both your clinical and non-clinical staff, while working in the office is critical. The resources below offer guidance on what is required and appropriate with specific attention to the COVID-19 pandemic. While shortages of appropriate personal protective equipment (PPE) continue, best practices for preserving and re-using existing equipment must be addressed. Preparing your providers and staff for returning to work should include ensuring their health and wellness for the safety of your patients and for your other providers and staff.
- HHS and FEMA FACT SHEET Coronavirus (COVID-19) Pandemic: Personal Protective Equipment Preservation Best Practices (updated 07/13/20)
- CDC Transmission-Based Precautions
- American Society of Safety Professionals:
- Society for Human Resource Management Memo: COVID-19 Employee-Screening Procedures
(the sample form requires membership)
- Studies on COVID-19 Decontamination
Resuming onsite services to patients also requires special handling. Patients should be scheduled in a manner that maintains social distancing and minimizes exposure. This may take the form of changing your 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. 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 new processes and procedures. Providing information through various mediums, such as phone calls, email, text and on your practice website may be helpful for reinforcing this information.
- NORCAL Group Quick Tips for Reopening your Medical Practice
- COVID-19 Physician, Staff and Healthcare Operations Resources
- Phone Advice Line Tool for possible COVID-19 patients - Use this script with the accompanying Decision Algorithm and Messages
Ways to Maintain Social Distancing within your Practice
- Place staff outside of entrance to triage patients and non-patient visitors including delivery personnel
- Consider limiting non-patient visitors
- 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 like screens or windows at counters to protect staff
- Place alcohol-based hand rubs at entrance, exit, and check-in areas as well as in patient rooms
- Consider block scheduling methods to separate timing of well and sick visits (ie only well visits in morning hours and only sick visits in afternoon hours)
- Consider designating 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
- Ask staff to stay home when they are sick and go home if symptoms develop while working
- Continue to promote and utilize telehealth services when applicable
Resuming “Elective” Procedures and Surgery
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 for resuming elective surgeries as soon as safely possible. The roadmap, in the form of a joint statement, offers guidance on the various steps necessary to resume provision of those procedures that have been postponed during the most critical stage of the pandemic. The collaborating parties have each presented the information in their own format so more than one option has been provided. The American College of Surgeons has also offered guidance for determining prioritization of non-emergent surgical procedures.
- Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic
- AHA Roadmap for Resuming Elective Surgery after COVID-19 Pandemic PDF
- COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures
- Local Resumption of Elective Surgery Guidance
The American The Association of periOperative Registered Nurses (AORN) publication, Outpatient Surgery, offers guidance and an algorithm designed to assist in selecting the appropriate level of protection based on risk.
Office closures have resulted in significant, and often devastating, financial impact on many practices. Many physicians are anxious to re-open their practices because telemedicine has not been feasible or does not provide sufficient revenue to remain viable. Several federal programs have been implemented to aid small businesses, and specifically physicians in some cases, while revenues have been impacted. These programs have come in the form of advanced payment to physicians, grants and loans offering low interest rate and some repayment forgiveness. The resources below provide more in-depth information regarding these various programs. At the time of access, some of these options may be depleted or are in the process of being replenished, so check back often if you are unable to obtain the funding that best fits your practice needs and circumstances.
- COVID-19-Related Tax Credits for Required Paid Leave Provided by Small and Midsize Businesses FAQs
- US Senate Committee on Small Business & Entrepreneurship: The Small Business Owner’s Guide to the CARES Act (PDF)
- U.S. Small Business Administration
- U.S. Department of Labor: Families First Coronavirus Response Act: Questions and Answers
- BlumShapiro Coronavirus Resources
- Resources include a PPP Loan Forgiveness Toolkit & Calculator (registration required)
- California Medical Association (CMA) COVID-19 Financial Toolkit for Medical Practices
As with any situation that impacts your employees, there are various issues to consider regarding your staffing levels, hiring, firing, furloughing and/or laying people off. These employment actions may still have implications for existing employee protections such as FMLA leave, emergency leave, and workers’ compensation. Changes in regulations have also been implemented during the COVID-19 pandemic with the intention of protecting employees and affording them the greatest possibility of employment protection. Be aware that human resources actions taken during this time may impact your obligations under some federal funding programs. Consult with your payroll company, human resources consultant or employment attorney for additional guidance.
- XpertHR Coronavirus (COVID-19)
- Checklist for What Employers Should Know About Employee Benefits in Response to COVID-19
- CDC: Strategies to Mitigate Healthcare Personnel Staffing Shortages
There is no time when leadership is more needed than during a crisis. The pandemic has created valuable growth and learning opportunities. The following resources may assist your organizational leadership in assessing their own skills as well as providing insights and tools for improving those skills.
- MGMA: Leading through transitions: COVID-19 and medical practices
- Leading SBH During COVID-19: Lessons Worth Learning
- Leadership Communication: Anticipating and Responding to Stressful Events
- MGMA: What Will Reopening America Look Like?
- SOLUTIONREACH 2020 Practice Comeback Playbook (requires registration)
This playbook is broken down into three key sections:
- What you should be doing now while under quarantine guidelines
- What to do when you are ready to reopen and see patients again
- Making sure you have everything in place to thrive once normalcy returns
- COVID-19 Workforce Virtual Toolkit: Resources for Healthcare Decision-Makers Responding to COVID-19 Workforce Concerns
- In age of pandemics, how tough should vaccine mandates get?
- List of Free COVID-19 Health IT Products and Services