Under the direction of federal and local governments, healthcare providers locked down their facilities to prevent the spread of the novel coronavirus, shutting down key clinical service lines and canceling patient appointments. But with the pandemic subsiding in some areas, providers are now starting to unlock their doors.
The number of confirmed COVID-19 cases are falling in about half of the states, with another eight states reporting no statistically significant change, according to data compiled by The New York Times at the time of this article’s publication.
According to the Trump administration’s criteria for reopening the economy, communities in these states may be ready to engage in some activities prohibited during shelter-at-home periods, including in-person care for non-COVID-19 symptoms and conditions.
However, healthcare facilities cannot flip the switch and resume normal operations.
COVID-19 has upended how providers deliver care during a crisis. Hospitals and other providers have been all hands on deck with establishing the capacity to serve high numbers of COVID-19 patients, while other facilities mobilized virtual care for the majority of their appointments and some temporarily closed.
Changes in care delivery during the crisis have led to a growing backlog of patients requiring non-emergent, but clinically necessary care. Meanwhile, many patients have been – and still are – hesitant to seek healthcare during the pandemic.
Healthcare facilities will need to consider key factors in order to effectively resume what was once considered standard practice: in-person care.
Just as healthcare facilities made the decision to stop in-person care to reduce coronavirus exposure, providers will also have to consider safety measures to minimize patient and provider contact with the highly contagious virus.
A key first step to reducing exposure and protecting patients is establishing non-COVID care zones. According to CMS guidelines, healthcare facilities in Phases I and II of the White House’s plan for “Opening Up American Again” should create these zones to screen all patients for symptoms of COVID-19, including temperature checks. These areas should be separate from COVID-19 care zones, including in separate buildings or designated rooms or flowers with separate entrances.
Healthcare facilities should also establish social distancing, such as minimizing time in waiting areas, spacing chairs appropriately, and maintaining low volumes, CMS advises for providers in Phase II communities. The limited number of visits allowed in the healthcare facility should also be “actively” assessed for COVID-19 symptom upon entry, the federal agency states.
The American Medical Association (AMA) also recommends that, when in-person care is necessary, facilities contact patients prior to the office visit to review reopening protocols and screen the patient for COVID-19 symptoms. Scripts can help administrative staff efficiently conduct the calls, the association states.
Additionally, per CDC guidance, healthcare facilities should require all individuals who enter the doors to wear a cloth face covering. If available, facilities should provide cloth masks or coverings to individuals presenting with them.
Optimization of telehealth services should be a top priority for healthcare facilities in Phase II of the White House’s plan for reopening the economy, CMS says. Providers should continue to offer virtual care when appropriate to reduce the risk of coronavirus spread, especially among patients with serious or chronic conditions.
But in the event in-person care may be necessary, AMA recommends that healthcare facilities leverage tele-triage services before resuming in-person care.
“Utilize a tele-triage program to ensure that patients seeking appointments are put on the right path by discussing the patient’s condition and symptoms,” the association states. “If the practice had already engaged a tele-triage service to handle after-hours calls pre-COVID, contact this service to see if the service can be expanded to tele-triage daytime calls or consider redeploying the practice’s own clinicians or staff to manage this service.”
Improving remote patient monitoring and other telehealth capabilities can also help providers ensure care access for patients who require medically necessary care but are avoiding healthcare facilities out of fear. “Virtual first” strategies like the one at Kaiser Permanente are addressing patient and public health safety concerns as facilities gradually reopen.
USE DATA ANALYTICS TO ADDRESS BACKLOG OF SERVICES
Healthcare facilities will not be able to go back to business as usual overnight. Facilities that canceled or delayed non-COVID-19, non-emergent care are now facing a backlog of patients who require medically necessary services. Understanding this pent-up demand for care is critical to reopening healthcare facilities safely and efficiently.
At University Hospitals where surgeries are gradually being ramped back up, data helped the Ohio health system prioritize cases and book their operating rooms.
“With the help of Hospital IQ and their performance measurement tools that we have implemented here, we were able to get very granular by provider, by service line, by location to understand what the total number of cases that were postponed due to the COVID event,” Dan Towarnicke, vice president of perioperative services, recently told RevCycleIntelligence.
“That’s how you really get back into your staffing and what you need to do from the standpoint of extending your existing block schedule from eight to ten hours and also opening up all hours on the weekend when ORs are typically not running elective cases,” Towarnicke explained.
Leveraging data on volume, productivity, and even financial clearance will support a facility’s strategy for clearing a backlog of cases efficiently while preparing providers for possible surges in COVID-19.
DEVELOP A ROBUST TESTING PLAN
In addition to safety precautions, healthcare facilities will need a robust COVID-19 testing strategy in plan to safely and effectively reopen.
“There will be instances where your patients require COVID-19 testing,” the AMA says. For instance, patients coming back to healthcare facilities to undergo rescheduled services.
Healthcare facilities like University Hospitals are requiring patients who are being scheduled for elective or high-intensity procedures to get tested before coming in for care. In Ohio, Towarnicke is requiring certain surgical patients to be tested within 72 hours of their procedures and then self-isolate.
To execute COVID-19 testing of this scale, healthcare facilities should contact public health authorities for information on available testing sites to identify multiple testing sites, the AMA recommends.
“Contact them to ensure that tests are available and to understand the turnaround time on testing results. Provide clear and up to date information to patients regarding where they can be tested and how the process works,” guidance states.
Regulations and policies are continuing to adapt to a world in which COVID-19 exists. As temporary policies expire and new flexibilities emerge, healthcare facilities should include compliance as part of their reopening strategy.
On a macro-level, healthcare facilities should look to the White House’s guidelines, which are dictating when communities can resume specific services. CMS has also released guidance on resuming healthcare services for facilities in Phase I and Phase II communities.
State and local governments are also releasing their own plans for reopening communities. Healthcare facilities should look to their governors and local policymakers for community-specific rules and guidelines.
Understanding when payment flexibilities expire will be key to ensuring claims compliance.
Additionally, the AMA suggests that healthcare facilities contact medical malpractice insurance carriers to ensure clinicians are protected during the uncertain time. Congress has granted some medical liability protections for clinicians, but risks may increase as facilities reopen, the association explains. Additional coverage may be necessary as communities reopen.
Reopening healthcare facilities for non-emergent in-person care is a multi-faceted endeavor that requires providers to consider not only their own capabilities, but how the coronavirus is impacting their communities.
But starting the process of resuming in-person care is key to ensuring the health of patients whether they have COVID-19, a chronic condition, or other symptoms requiring medical attention. Safety precautions, telehealth, testing, data analytics, and compliance can help providers ensure safe and efficient care delivery during this next phase of the pandemic.