returning to office practice during covid-19: practical
TRANSCRIPT
Returning to Office Practice During COVID-19:
Practical Considerations
ERIC ZACHARIAS, MD
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Overview
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A. The Basics and non-COVID patients
B. COVID patients/sx?
C. Usual risks
D. Telehealth
E. We are all in this together
Remember the Golden Rules
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DO WHAT’S BEST FOR THE PATIENT!
WHAT CASE WOULD YOU RATHER DEFEND?
E.G. CHF
THE WORLD RECENTLY GOT MORE COMPLICATED
Telecommunication is PPE…
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A. The Basics
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Verify with public health that it is ok to open for non-emergency visits
Define what is “essential” by priority—e.g. f/u cancer, ongoing w/u, or close disease monitoring
Daily review of info from CDC, OSHA, and CMS
We ASSUME EVERYONE is adding telehealth
The Basics (cont’d)
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Mandatory OSHA reporting for employee exposure to COVID-19 giving positive test
Follow CDC guidelines on return to work
Advise: check payors regarding telehealth billing and payments
Verify that support services are ready: supplies, laundry, cleaning, labs, couriers, etc.
The Basics (cont’d)
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Process for employee (and self) screening and monitoring for sx—use CDC guidelines re: isolation and return to work
Assess sufficient PPE for self and staff
Optimize ingress/egress self, staff, patients
System for triage patient priority—ER, OV, telehealth
Patient Screening COVID-19
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Phone triage/screening at appt time—recept.
questions
Email triage/screening
questions
Phone nurse triage/screening
questions
Greeter, front office
triage/screening
Telehealth when reasonable is
preferred
Have a process and plan, examples:
Keeping Office Clean and Safe
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Review physical space—add dirty utility, second egress, sterilized –v- disposable
Review CDC guide to cleaning and disinfecting facility; implement
Expectations with cleaning vendor, schedule
Follow CDC Return to Work
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Good health, not recently exposed
Were/are quarantined, if appropriate
Take temps—specific, but not sensitive (won’t catch asx or pre-sx)
Employees masked
Social distancing, no communal congregating
Daily review of CDC/state dept health guidelines
On-Site Controls
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Plexiglass/plastic barriers
Laminated/plastic sleeves signage to clean
Auto door opening, all touchless (if possible)
Distancing in waiting rooms, etc.
Telehealth readiness and preference
Unfortunately: Be ready to close again for second wave
Can’t Be Too Good at Infection Control
Re-educate and re-review protocols and usage:
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PPE
Hand hygiene, face touching
Respiratory hygiene
CDC protocols for clinical specimens
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• Plan regarding age and risk: both staff and providers
• Complex personal: stress, daycare, financial
• HR and staff volume—adjust patient volume to not overwhelm staffing/ensure safety
• Kindness and thanks to team—often!
• Mental health
People
Supply Management
Check expiration datesVerify sufficient and re-supply availableCheck utd inspections biomed: defib, etc.Check refrig/freezer temp to ensure proper ranges Mission critical: soap, hand sanitizer, paper towels, etc.Buyer Beware! Be suspicious of new sources
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Insurance
Verify any coverage inactivated is reactivated: professional liability, general liability, etc.
Verify that clinic providers’ coverage is re-activated and not lapsed
Verify billing procedures with insurance plans (any changes/mandates?)
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Really Resuming (scheduling)
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Nimble/flexible: hours, longer appointment times, weekends and evenings
Prioritize patient need: hospitalized, high-risk baseline
Consider reschedule routine: physicals, med refills, etc.
Telehealth
Signage outside entrance (multilingual): call by telephone if respiratory/infectious sx before entering
Social distancing markers
All staff should always be masked
Resuming (cont’d)
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B. COVID Patients/Resp Sx
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Are you equipped for this?
Can you? Should you?
Separate locations physically, PPE, follow-up
Post-evaluation “decontamination” protocols
Better off elsewhere?
C. Usual Risks
What do we think will get you sued in times of COVID-19?
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Careful of Systems Failures
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Labs, imaging, referrals made prior to closureAsk patients at visits/telehealthReview in-boxes for “hiding” info Careful of insurance status changes: abandonment
risks, fees to charge
Documentation
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We can most easily defend a thought process—e.g. chf pt.
Pandemic actions to improve patient and staff safety
Two faces of regulation
Medicalpractice
Payment
Easy to confuse!
General Philosophy
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Take care of self and each other
Claims will tend to be for the usual issues
D. Telehealth
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PREPARE TO USE AFTER
PANDEMIC TOO
OVER TIME, MIGRATE TO
HIPAA-COMPLIANT PLATFORMS
PATIENT CONSENT, NOT REQUIRED ON
PAPER
COPIC’s COVID-19 Resourceswww.callcopic.com/
covid-19-information-and-resources
OR access from COPIC homepage
• Your COPIC Policy• Risk Mgmt & Clinical• Regulatory/Legal
• Physician/Provider Wellness
• Links to State/National Resources
• HR/Employer Info• COPIC FSG• Communications
Support
Summary for TH Readiness
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WITHIN YOUR STATE
Understand state telehealth rulesCOPIC assumes you are doing telehealth—no need to callCOPIC-insured—You’re already covered
ACROSS STATE LINES
Obtain required telehealth license for each stateUnderstand rules specific to each stateCheck with your professional liability carrier
Summary for TH Visit — CO
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NOT REQUIRED
1.Initial “in person” visit2.Written “consent for
treatment”3.HIPAA
• Notice of Privacy Practices
• Acknowledgment of Receipt of Notice of Privacy Practices
REQUIRED
1.Disclosure of terms and risks
2.Identification of participants on both ends
3.Usual documentation and record retention
4.Follow up and/or contingency plan
TM Platforms
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BEST A commercial Telemedicine app
GOODA “business class” teleconferencing app
Skype for Business, Microsoft Teams, Updox, Vsee, Zoom, Doxy.me, Google Hangouts, GoToMeeting, JoinMe, BlueJeans
OKA “consumer class” teleconferencing app
Skype, WhatsApp, FaceTime, Facebook Messenger, Signal, Jabber, iMessage
NOT OK”Public facing” (e.g., social media) app
Facebook Live, Twitch, TikTok, Slack, Instagram, Snapchat…
Accessorize!
BP monitorGlucose monitorEKGFetal dopplerElectronic scalePulse oximeter
INR coagulation monitorSpirometer24-hr ambulatory BPUrine analyzerElectronic otoscopeElectronic stethoscope
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• Covered health care providers will not be subject to penalties for violations of the HIPAA Privacy, Security, and Breach Notification Rules that occur in the good faith provision of telehealth during the COVID-19 nationwide public health emergency.– This does not affect the application of HIPAA
Rules to areas of health care outside of telehealth during the emergency.
COVID-19
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E. We Are All in This Together
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Return to Patient Care
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callcopic.comEric Zacharias, MD