Although the pandemic of COVID-19 is not over, the apparent subsiding of new cases has allowed medical practices to begin reopening for some nonessential but clinically necessary patient care. Practices cannot just suddenly open their doors to patient delivery, but they must find ways to see patients while keeping their exposure to the virus minimal.
The Centers for Medicaid and Medicare Services (CMS) has developed a protocol for reopening. The Centers for Disease Control and Protection (CDC) has also provided some instructions for medical practitioners to follow when reopening. For example, everyone must wear face masks, patients, and staff alike.
The American Medical Association has analyzed all protocols and provided A Physician Practice Guide to Reopening. The AMA publication offers details as to what is expected, a checklist really, for a medical practitioner to follow when reopening their medical practices.
Make a Plan
You likely have a backlog of patients who need to be seen in your office. Work with your calendar to set a main reopening day but reopen incrementally. You cannot suddenly book as many patients per hour or per day as you used to.
Consider working longer days so you can stagger patient appointment times with more time between appointments in order to minimize the number of people who will be in your office waiting room at the same time.
Make sure you have enough personal protective equipment (PPE) for your clinicians and your staff. Order more if necessary. Stock up on face masks, so you have some available for the patient who shows up for an appointment without one.
Develop a protocol for how you will respond if a staff member, patient, or other visitor tests positive for COVID-19 after being in your office space.
Establish Safety Measures for Patients
You want to minimize patient exposure and be sure patients do not come into close contact with each other. Some ways you can do that include:
- Modify your workload and schedule to avoid a high volume of patients waiting in the same waiting room at the same time while waiting for your services.
- Designate separate waiting spaces for patients who are feeling sick and for those who are not ill but need to be seen for other health reasons.
- Limit patient companions to only those who are necessarily based on the patient’s needs.
- Require all visitors to wear a cloth mask. If a patient arrives without a face mask, have masks in supply so you can provide one.
- Do not allow vendors, educators, service providers, or salespersons in the office during patient hours. Reroute them to phone calls or videoconferences.
- If a repair person must enter the office space, schedule him or her to repair at a time when you are not seeing patients minimize their exposure to and interactions with patients, staff, and you.
- Screen employees for temperature when they arrive for work. Ask them about possible COVID-19 symptoms they may be experiencing. Keep a log of this information in a confidential file that is separate from the employee’s personnel file.
- Screen patients before an in-person visit. Develop a script following the AMA suggestions with questions for your support personnel to ask patients before making an appointment.
- When patients arrive for their appointment, take their temperature and the temperature of their accompanying support person.
- Establish a sanitation protocol for thoroughly sanitizing and disinfecting spaces used by patients. Make sure all equipment is thoroughly decontaminated according to CDC guidelines.
Coordinate with Testing Centers and Follow Their Protocol
You will see patients who need to be tested for COVID-19. If your patient needs an outpatient hospital service, including a test or surgical procedure of some kind, the hospital will likely require a test.
Know where you can send your patients for testing. Understand the type of test that will be administered so you can explain it to your patient. Also, how long will it take to get the results of the test and how you will provide the information to your patient.
Implement or Continue Telemedicine Triage
A telemedicine triage program will likely continue in many medical practices even after the pandemic no longer requires such a service. A HIPAA compliant telemedicine platform allows for a discussion with a patient who calls for an in-office appointment. The patient can be put on the right path to finding the necessary services by way of a telehealth visit.
CMS is offering reimbursement for some telehealth services so patients can receive these services in their own homes. Ethan Booker M.D., medical director of Maryland-based MedStar Health’s Telehealth Innovation Center and the MedStar eVisit platform, stated, “Telehealth provides the opportunity to move from a highly scheduled and episodic experience to a much more relational experience for both patients and providers. We need to remember that as we move on.”
Doctors can now pivot from managing COVID-19 patients through telemedicine visits to managing patients with chronic care needs. This includes those just released from the hospital but may need some ongoing monitoring or care in their home.
Contact Your Medical Malpractice Insurance Carrier
Congress has provided some protections to shield health care practitioners from liability in some instances when they are treating COVID-19 patients. You need to check with your malpractice insurance carrier to see if there are any heightened risks you need to be aware of when reopening your office. Find out if your current coverage is enough or if you need to add any additional coverage. According to the AMA, “you should protect your practice and your clinicians from liability and lawsuits resulting from current and future unknowns related to the COVID-19 pandemic.”
Monitor developments in your state, so you know if your region remains at a low risk of increased incidences. Be prepared to again stop providing nonessential services and procedures if you learn there is a surge in COVID-19 cases. Also, be ready to resume or expand your telehealth capabilities, which can help provide services to your patients while keeping them safe during this pandemic.
