Practical Pointers For Addressing the Impact of COVID-19 on Medical Staffs Jennifer A. Hansen, Ruby W. Wood, and Emily L. Brinkman Hooper, Lundy & Bookman, PC www.health-law.com
Presenter Information Jennifer A. Hansen Ruby W. Wood Emily L. Brinkman Co-Chair Medical Staff Practice Co-Chair Medical Staff Practice Senior Counsel Partner Partner Ebrinkman@health-law.com Jhansen@health-law.com rwood@health-law.com (415) 875-8482 (619) 744-7310 (415) 875-8514
Overview • Common Questions facing Medical Staffs regarding impact of COVID-19 • Effective Use of Communications, Policies, and Practices • Responding to Practitioners • Safety Complaints, Social Media, and Collaboration • Questions?
COVID-19 and Medical Staffs
COMMON QUESTIONS FACING MEDICAL STAFFS IN LIGHT OF COVID-19
Common Questions for Medical Staffs • Elective v. Essential Procedures • Credentialing and Privileging (Disaster, Emergency, Temporary) • Use of Tele-Technology • Committee Meetings, Voting, Officer Terms • Confidentiality and Peer Review Issues • Pending Corrective Actions and Judicial Review Committee Proceedings • Allocation of Critical Care Resources
Elective vs. Essential Does delaying treatment worsen a life-threatening or debilitating prognosis? • Each hospital should make its own determinations: • CMS recommends a tiered approach: https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf • Industry leaders urge against blanket bar of elective procedures: https://www.aha.org/system/files/media/file/2020/03/aha-to-surgeon-general-elective-surgeries- and-covid-19-3-15-2020.pdf • Ongoing patient consideration • Weigh (and re-weigh) critical care resources
Credentialing and Privileging KNOW YOUR CHECK YOUR TRACK OPTIONS BYLAWS GUIDANCE Disaster Rules and Blanket Regs Waivers Emergency Policies Federal Temporary Practices State Boards Other? Reasonable?
Use of Tele-Technology
It's Not Business As Usual • Impact of COVID-19 on: • Committee Meetings • Annual Meetings • Officer Terms • Voting Issues • Board Meetings / Approval • Reappointments • Peer Review But keep calm lm anyway! yway!
Impact on Peer Review Proceedings • Consider impact of COVID-19 measures on • Standard Peer Review • Provisional Proctoring Requirements • FPPE • "FPPE should continue per the defined medical staff process" (TJC FAQs) • Corrective Actions • Reporting Requirements • Pending JRC Proceedings
Keep It Confidential • Federal Laws • Health Care Quality Improvement Act ("HCQIA") • Patient Safety Quality Improvement Act ("PSQIA") • HIPAA • State Laws ( for example ) • CA Evidence Code section 1157 • MN Code sections 145.61-145.66 • TX Health and Safety Code sections 161.031-161.934 • WA Revised Code section 4.24.250(1)
Allocation of Critical Care Resources • Patient Care vs. Public Health • Avoid inclusion of potentially discriminatory criteria • Collaborate with Medical Staff Leaders and Administration • Look to Healthcare Community • Federal and State Guidance? • Must be flexible • Evolving issue
COVID-19 Medical Immunity Protections • Connecticut : Emergency Order (March 10) • Michigan : Executive Order 2020-30 (March 29) • Illinois : Executive Order 2020-19 (April 1) • New York : Emergency Disaster Treatment Protection Act (April 2) • New Jersey : S.B. 2333 (April 13, retroactive to March 13) • Massachusetts : S.2630 (passed Legislature April 17) • Florida and Pennsylvania are in the midst of active discussions
COVID-19 AND EFFECTIVE COMMUNICATION WITH MEDICAL STAFFS
Identify Available Tools • Set expectations and protocols • Set up a notification system • Review remote work policies and resources • Call Coverage Agreements • Behavior Policies and Procedures • Think critically about how prior practices have been impacted by COVID-19 pandemic
COVID-19 Communications • Goals: • Provide Resources • Identify Existing Policies • Open Communication • Safe Practice Pointers • Set Expectations • Think about including: • Efforts to Address COVID-19 • Notes of Appreciation
COVID-19 Specific Protocols • CDC Guidance • Test-based • Non-test based • Symptoms and Screening measures • Quarantine Protocols • Reporting Mechanisms
RESPONDING TO PRACTITIONERS
Ensuring a Culture of Wellness • COVID-19 adds to existing concerns regarding Physician Burnout • Respond to Heightened Stress Levels • Pay attention to basic needs (food, water, bathroom, sleep) • Mental health support resources • Compassion and empathy from leadership https://www.ama-assn.org/delivering-care/public-health/6-ways-address-physician-stress- during-covid-19-pandemic
Flu, Allergies or COVID-19? CDC Human Infection with 2019 Novel Coronavirus Person Under Investigation Case Report Form
COVID-19 Exposure and Infections • Develop protocols for reporting *Think about your existing practices *Get input from your own Medical Staff • Consistency • Investigate reports *Think about patient protections • Be flexible: evolving expertise regarding COVID-19 • Balance Rumors with Fact
Other Considerations • Consistency (where possible) with existing protocols • Self-reporting compared to reporting by others • Behavior issues • Corrective Action options • Patient Safety AND • Fairness to Practitioner
SAFETY COMPLAINTS, SOCIAL MEDIA, AND COLLABORATION
In the News ...
Patient Safety Complaints • Recognize high public awareness regarding COVID-19 • Work collaboratively • Reduce risks for claims of retaliation
Track Ongoing Developments HLB: https://www.hlbcovid19.com NAMSS: https://www.namss.org/COVID-19 TJC: https://www.jointcommission.org/covid-19 CMS: https://www.cms.gov
Questions?
Presenter Information Jennifer A. Hansen Ruby W. Wood Emily L. Brinkman Co-Chair Medical Staff Practice Co-Chair Medical Staff Practice Senior Counsel Partner Partner Ebrinkman@health-law.com Jhansen@health-law.com rwood@health-law.com (415) 875-8482 (619) 744-7310 (415) 875-8514
NAMSS Resources NAMSS: • Phone: 202-367-1196 | E-mail: info@namss.org | education@namss.org COVID-19 Resource Page COVID-19 Discussion forum • Register for live webinars NAMSS Facebook NAMSS Twitter NAMSS YouTube NAMSS Linkedin
THANK YOU!
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