Practice Management Alert

You’ve thought of the big-picture elements, but don’t forget these details.

As states reopen, physicians’ offices and clinics are eager to try and recoup business with a more intensive schedule and the ability to generate more revenue. The Centers for Disease Control and Prevention (CDC) has guidance for healthcare practitioners who want to utilize face-to-face encounters for nonemergent care.

However, the danger of COVID-19, the infection caused by the SARS-CoV-2 virus, hasn’t diminished, and CDC guidance emphasizes that telehealth should be used whenever appropriate in situations where the potential for patient harm is low, even when community transmission is low.

Stay in Touch With Local Authorities

Even though reopening is being conducted on a state and regional basis, offices should keep in touch with their local public health departments. Local public health officials will have the most accurate and active monitoring of COVID-19 infection and transmission in your area. The CDC recommendations are broken down by the potential for patient harm and the amount of active community transmission in your area.

Keep in mind that you may need to start providing services again on a gradual basis. Prioritize care for in-person encounters that, if delayed, might result in patient harm. The CDC provides examples of this kind of care as evaluation of symptoms that could indicate medical emergencies, such as stroke or heart attack or acute abdominal pain, as well as routine care for newborns or patients requiring certain cancer treatments. If your area has a higher incidence of COVID-19 transmission, transfer care to a less affected area if possible, the CDC says.

Once community transmission is minimal to moderate, practices can begin to resume in-person care for care that could cause patient harm if deferred but is less emergent, like pediatric vaccinations and certain surgical repairs and physical or occupational therapy. Note, too, that patients who cannot access or utilize telehealth should be considered priority for in-person care as well.

The CDC deems routine visits, including those for management of controlled chronic conditions; elective surgeries; and screening for asymptomatic conditions as unlikely to cause patient harm if deferred, so you should wait to resume in-person encounters for these situations until the transmission of COVID-19 has stopped or is minimal.

Implement Screening for Everyone

Fortify the entrances to your practice. Screen both patients and staff with questions and symptom checks. The CDC offers a questionnaire practices can adopt for intensive screening, which includes questions about whether patients or their household members have experienced certain symptoms in the past 21 days.

Instruct your staff responsible for scheduling to ask patients about any potential symptoms when confirming appointments. Encourage patients to reschedule nonurgent appointments and make telehealth an option whenever possible. The AMA recommends doing an additional check-in 24 hours before the visit if you must see the patient in person. In this call, you or staff should review the protocols for entering the practice, which may have changed, and confirm again that the patient is not experiencing COVID-19 symptoms. Screen again the day of, using a text messaging service if the patient consents and the method is compliant with state and federal regulations. Or you can post a staff member outside the practice physically, either in the parking lot or foyer, to screen patients before they enter the practice. Limit nonpatient individuals, but make sure you screen any individuals who must accompany the patient (like the parent or guardian of a child), with the same questions and symptom checks, the AMA says.

Limit the entry to patients and other necessary accompanying individuals, the AMA says. You can reroute meetings with vendors, salespeople, or service providers, including for education, to videoconferencing technology. If someone must enter the practice to perform repairs or other necessary in-person services, schedule the visit for a time when the clinic is closed to minimize patient and staff exposure.

Evaluate Your HR Policies

Some of the federal regulations enacted for the public health emergency may affect how and when your staff work. Minimizing — and, ideally, halting — transmission should be the goal for all employers. Although healthcare providers are specifically excluded from these regulations, the U.S. Department of Labor (DOL) recommends flexibility in your policies to help reduce the spread.

“To minimize the spread of the virus associated with COVID-19, the Department encourages employers to be judicious when using this definition to exempt health care providers from the provisions of the FFCRA [Families First Coronavirus Response Act]. For example, an employer may decide to exempt these employees from leave for caring for a family member, but choose to provide them paid sick leave in the case of their own COVID-19 illness,” the DOL says.

See this DOL question and answer resource for the FFCRA at: www.dol.gov/agencies/whd/pandemic/ffcra-questions.