Returning to Office Practice During COVID-19:

Practical Considerations

ERIC ZACHARIAS, MD

1

Overview

2

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

3

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…

4

A. The Basics

5

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)

6

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)

7

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

8

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

9

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

10

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

11

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:

12

PPE

Hand hygiene, face touching

Respiratory hygiene

CDC protocols for clinical specimens

13

• 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

14

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?)

15

Really Resuming (scheduling)

16

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)

17

B. COVID Patients/Resp Sx

18

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?

19

Careful of Systems Failures

20

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

21

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

23

Take care of self and each other

Claims will tend to be for the usual issues

D. Telehealth

24

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

266

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

27

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

28

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

29

• 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

30

E. We Are All in This Together

31

Return to Patient Care

32

callcopic.comEric Zacharias, MD