As thousands of physicians are working to get their practices up and running again many are thinking about safety measures to keep patients and employees safe.
But what about potential medical malpractice risks and privacy protocols? As stay-at-home restrictions are relaxed, physician practices are strategically planning when and how best to reopen and there are several factors that physicians need to consider, according to the American Medical Association (AMA).
First, as practices look to reopen, they will need to comply with governmental guidance from states and the federal government. On the federal level, the White House has published guidelines for Opening Up America Again. At the state level, governors have begun to detail what reopening will look like and city guidelines also should be closely reviewed and followed. The AMA offers resources (PDF) detailing state-specific delays and resumption of elective or non-urgent procedures.
The Centers for Medicare & Medicaid Services (CMS) published a Phase 1 guide (PDF) for reopening healthcare facilities. Building upon that guidance, the AMA developed a comprehensive checklist (PDF) for providers to follow to ensure medical practices are ready for reopening.
From legal implications to safety measures, here are some best practices the AMA recommends:
1. Make a plan: Sit down with a calendar and chart out the expected reopening day and, ideally, a period of “soft reopening” where the practice can reopen incrementally. Practices should assess their personal protective equipment (PPE) needs and alternatives such as cloth masks, current stockpiles and future needs and place the necessary orders. As much as possible, have supplies delivered in advance before reopening so that sporadic deliveries and other visitors do not disrupt the order of the daily plan, AMA said.
Plan in advance how to handle staffing and cleaning if an employee or patient or visitor is diagnosed with COVID-19 after being in the clinic.
2. Open incrementally: Consider a step-wise approach to reopening so that the practice may quickly identify and address any practical challenges presented. Identify what visits can be done via telehealth and continue to perform those visits remotely. Begin with a few in-person visits a day, working on a modified schedule. Consider bringing employees back in phases, or working on alternating days or different parts of the day, as this will reduce contact. Communicate the weekly schedule clearly to the practice’s patients, clinicians, and staff.
3. Safety measures for patients and employees: Develop a modified schedule to avoid a high volume or density of patients. Designate separate waiting areas for “well” and “sick” patients in practices where sick patients need to continue to be seen. Consider a flexible schedule, with perhaps a longer span of the day with more time in between visits to avoid backups. Limit patient companions to individuals whose participation in the appointment is necessary, such as parents of children, offspring, spouse, or other companions of a vulnerable adult.
Consistent with U.S. Centers for Disease Control and Prevention (CDC) guidance, practices should require all individuals who visit the office to wear a cloth face covering.
For visits that must take place in person, administrative staff should call the patient within 24 hours before the office visit to review the logistics of the reopening practice protocol and screen the patient for COVID-19 symptoms. Patients also should be screened before entering the office. Some practices may utilize text messaging for screening while others may deploy staff in a designated part of the parking lot or an anteroom of the practice to screen patients before they enter the practice itself.
Employees should know that they should not come to work if they have a fever, have lost their sense of taste or smell, have other symptoms of COVID-19, or have recently been in direct contact with a person who has tested positive for COVID-19. Screen employees for high temperatures and other symptoms of COVID-19. Records of employee screening results should be kept in a confidential employment file separate from the personnel file.
Consider rearranging open work areas to increase the distance between people who are working. Also, consider having dedicated workstations and patient rooms to minimize the number of people touching the same equipment.
󠇉4. Contact your medical malpractice insurance carrier: To ensure that clinicians on the front line of treating COVID-19 patients are protected from medical malpractice litigation, Congress has shielded clinicians from liability in certain instances. As the practice reopens, however, there may be heightened risks caused by the pandemic which do not fall under these protections. The AMA advises practice leaders to contact their medical malpractice liability insurance carrier to discuss current coverage and whether any additional coverage may be warranted.
5󠇉. Establish confidentiality/privacy: Update confidentiality, privacy, and data security protocols. Remember that HIPAA authorizations are necessary for sharing information about patients for employment purposes. Similarly, coworkers and patients can be informed that they came into contact with an employee who tested positive for COVID-19, but the identity of the employee and details about an employee’s symptoms cannot be shared with patients or co-workers without consent.
While certain HIPAA requirements related to telemedicine are not being enforced during the COVID-19 public health emergency, generally, HIPAA privacy, security, and breach notification requirements must continue to be followed.
󠇉6. Consider legal implications: New legal issues and obligations may arise as practices reopen. For example, some practices may not have had to make decisions about paid sick leave (per the Families First Coronavirus Response Act) because they were on furlough. As the practice reopens, these sorts of employment obligations should be considered and decisions about opting out or procedures for requesting these leaves communicated to employees.