COVID-SAFE: Strategies for safeguarding your outpatient clinical practice against COVID-19

Strategy 5: Develop a resource plan for practice operations

Assess financial solvency. Because of the mitigation measures taken during the pandemic, physician practices of all sizes are facing financial hardships and instability. As the pandemic progresses, physicians in private practice and those employed by health systems may benefit from existing resources and pandemic relief to help navigate COVID-related challenges.

Frequent revision of your financial plan may safeguard cash flow in the event of fewer patient visits and elective surgeries. Many medical organizations, including ACOG, are advocating for financial relief, fair reimbursement for telehealth and in-person visits, and access to adequate PPE. ACOG provides updated information on practice management.¹

The American Medical Association (AMA) has created resources for physician practices to assist in staying focused on business and financial operations. The AMA has provided a summary of the Health, Economic Assistance, Liability Protection and Schools Act (HEALS Act).² This is the next proposed coronavirus relief fund package, which includes provisions that benefit physicians and physician practices.

Create a plan. Review available resources and establish processes to optimize your practice capacity during the ongoing COVID-19 pandemic. Develop a game plan for patient care with a phased approach to identify and address challenges. This planning will allow your practice to pivot in response to changing local COVID-19 conditions to help you anticipate and prepare for a future surge. Maintain and revise plans as the pandemic shifts. Thinking ahead avoids the need to navigate issues in real time. Communicating clearly and often with all members of the office staff and patients lets everyone know that their safety is the main priority.

Assess staffing for flexible coverage. Frequent needs assessment helps to determine the number of staff needed to maintain a safe work environment for the patient volume.

Staff shortages may occur because of COVID-19 exposure, personal or family member illness, or childcare constraints due to daycare or school availability. Staff readiness includes evaluating individual availability and willingness.

Staff members with health issues, including comorbidities and chronic medical conditions, may not be comfortable working. Nonclinical staff members with health concerns could work remotely, although some may not be able to work from home due to technology-related issues such as WiFi deficiencies.

The CDC has interim guidelines to assist employers with providing a safe workplace and employees with making the best health decisions for themselves and their families.^3,4 The US Office of Personnel Management provides guidance for COVID-19–related leave and benefits for federal employees.⁵

To mitigate staff shortages, approaches include adjusting schedules, cross-training to perform the tasks of other positions, and hiring additional personnel. A needs assessment can help determine if existing personnel could be cross-trained for other purposes or if additional staff should be hired. Understanding the minimum number of staff required for safe and effective patient care will assist in planning for shortages as the pandemic progresses. Understanding the availability of external resources could be a critical part of an office contingency plan.⁶

Proactively manage your supply chain. The pandemic has caused global supply shortages. Solid supply chain management is crucial for practice operations. Take inventory of your PPE and various supplies and place orders in advance. Analyze cash flow and connect with vendors as well as local and state health agencies to understand available resources. Given ongoing PPE shortages, practices should consider preserving PPE and employ appropriate strategies for optimizing supplies of face masks.⁷

Certain medications and vaccines administered in the office setting may be outdated and need to be replaced. Office equipment that has not been used for several months will need to be tested. For equipment used in office electrosurgery procedures, certain safety measures can be taken to reduce the transmission of aerosolized viral particles to the health care team. While currently the risk is theoretical and more research is needed, this potential risk should be mitigated.⁸ Assessing availability of hospital and ambulance or transport services also is recommended as these may change depending on the local COVID-19 status.

Strategy 6: Establish and refine the patient screening process

Patients want reassurance that the health care environment is safe and that their well-being is a priority. In advance of a patient’s visit, relieve any anxiety by explaining the COVID-SAFE measures that your practice has taken.

For employee use, consider telephone and in-person scripting to ensure consistent messaging for patients.

Prescreening. At the time of appointment scheduling and on the day prior to the scheduled appointment, all patients should be screened for symptoms of COVID-19,⁹ fever, exposure within 14 days to someone newly diagnosed with COVID-19, and travel within 14 days from a foreign country or from a US state with a quarantine requirement.

Patients who screen positive for symptoms, exposure, or travel should be referred to a clinician. If possible, asymptomatic patients who report exposure or travel should have their in-person visit deferred until after the required 14-day quarantine.

Consider restricting visitors from accompanying adult patients to their appointment unless they are required for special assistance.

Arrival screening. At the time of presentation for the appointment, all patients and any accompanying visitors should be rescreened. The optimal location for arrival screening should be determined by the local operations team and the infection prevention and control program.

At presentation, all patients and visitors should appropriately don a surgical mask or other face covering. Patients and visitors should have their temperature checked on arrival. Patients who screen positive for symptoms, exposure to COVID-19, and/or travel should be referred to a clinician or the visit deferred and a telehealth visit considered.

Visitors who screen positive for symptoms, fever, or exposure to COVID-19 are not permitted to accompany the patient. Asymptomatic parents or guardians of pediatric patients may serve as support persons.

References

1. American College of Obstetricians and Gynecologists. Financial support for physicians and practices during the COVID-19 pandemic. https://www.acog.org/practice -management/coding/coding-library/financial-support-for-physicians-and-practices-during-the-covid-19-pandemic. Accessed July 23, 2020.
2. American Medical Association. HEALS Act: What physicians and medical students need to know. https://www.ama-assn.org/delivering-care/public-health/heals-act -what-physicians-and-medical-students-need-know. Accessed July 29, 2020.
3. Centers for Disease Control and Prevention. Interim guidance for businesses and employers responding to coronavirus disease 2019 (COVID-19). https://www.cdc.gov /coronavirus/2019-ncov/community/guidance-business-response.html. Accessed July 12, 2020.
4. Centers for Disease Control and Prevention. Criteria for return to work for healthcare personnel with SARS-CoV-2 infection (interim guidance). https://www.cdc.gov /coronavirus/2019-ncov/hcp/return-to-work.html. Accessed July 20, 2020.
5. US Office of Personnel Management. Questions and answers on human resources flexibilities and authorities for coronavirus disease 2019 (COVID-19). https://www .opm.gov/policy-data-oversight/covid-19/questions-and-answers-on-human-resources-flexibilities-and-authorities-for-coronavirus-disease-2019-covid-19.pdf. Accessed July 3, 2020.
6. Centers for Disease Control and Prevention. Strategies to mitigate healthcare personnel staffing shortages. https://www.cdc.gov/coronavirus/2019-ncov/hcp /mitigating-staff-shortages.html. Accessed July 17, 2020.
7. Centers for Disease Control and Prevention. Strategies for optimizing the supply of facemasks. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face -masks.html. Accessed July 3, 2020.
8. Rahman S, Klebanoff J, Moawad G. Smoke evacuation in the age of COVID-19. Contemporary OB/GYN. July 2, 2020. https://www.contemporaryobgyn.net/view/smoke -evacuation-in-the-age-of-covid-19. Accessed July 3, 2020.
9. Centers for Disease Control and Prevention. Symptoms of coronavirus. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. Accessed July 25, 2020.