On June 9th, CMS released recommendations for facilities to begin providing non-emergent, non-COVID related care. This guidance is meant to direct health systems and clinicians on how to proceed with older adults who have not received the preventative and ongoing care necessary to manage their chronic conditions. As states continue to re-open, CMS says older adults should start to seek in-person care again.
If and when these patients actually will seek care remains unclear. According to a recent poll, 27% of people say they won’t go to a doctor’s office except for emergencies until either a vaccine or a treatment for COVID-19 becomes available. Though many states have seen COVID-19 cases stabilize, many have also seen numbers rise after attempting to re-open. During the pandemic, many providers and health plans have been encouraging patients to use telehealth services to great effect. The long-term applicability of virtual care services have even been expressed by representatives on multiple occasions.
Nevertheless, hospitals and health systems should be prepared for re-opening at any level and implement the recommendations to ensure the health and safety of their patients and staff. Here is a summary of the recommendations set forth by the White House and CMS, and key considerations for your organization.
White House Recommendations for Phase I Re-opening
On April 16th, the White House issued guidelines for the three phases of Opening Up America Again.
Their “gating criteria” for states to re-open include 5 metrics, over a 14-day time period, which must be met before progressing to Phase II. These include:
- The downward trajectory of influenza-like illness.
- The downward trajectory of COVID-like syndromic cases.
- The downward trajectory of documented cases or of positive tests as a percent of total tests.
- The ability of hospitals to treat patients without crisis care.
- A robust testing program in place for healthcare workers, including emerging antibody testing.
According to the Phase I Re-opening, visits to senior living facilities and hospitals are prohibited. Staff and others who will have contact with residents and patients must follow strict hygiene protocol. Additionally, clinically appropriate elective surgeries can resume but on an outpatient basis at facilities that adhere to CMS guidelines.
CMS Recommendations for Phase II Re-Opening
On June 10, CMS issued recommendations for hospitals and healthcare systems located in states who are in Phase II re-opening as well as a new patient guide.
CMS says that as states and local areas start to stabilize, and COVID-19 related healthcare decreases, it’s important to ensure that patients who have ongoing health needs safely receive in-person care and treatment. “Those needing operations, vaccinations, procedures, preventive care, or evaluation for chronic conditions should feel confident seeking in-person care when recommended by their provider,” CMS Administrator Seema Verma said in a statement.
Non-emergent, non-COVID care (NCC) should be offered to patients when clinically appropriate. Should there be a surge in coronavirus cases, facilities should be prepared to respond quickly. Additionally, CMS says healthcare facilities should make their decisions based on Federal, State and local orders, and guidance from the CDC made in collaboration with State and local public health authorities. Adequate facilities, workforce, testing, PPE, and supplies should all be taken into consideration.
Optimize Telehealth Services
While in-person care is important, CMS says providers should still continue to optimize telehealth when available and appropriate. Optimizing telehealth includes ensuring people with disabilities have the tools they need to effectively communicate with their providers.
Evaluate The Need For Care
As facilities look to determine the need for in-person care, CMS recommends they prioritize services, that if postponed, would most likely result in patient harm. Additionally, patients who are at high-risk, including those who don’t have access to telehealth, should be prioritized.
Patients who are at higher risk for severe COVID-19 illness should continue to shelter-in-place unless their conditions require they be cared for in-person.
Safety and Tracking
CMS provides specific guidance around patient and workforce safety which includes recommendations like establishing NCC zones to screen patients, separate floors or dedicated space separate from COVID-19 zones, staff screening procedures, PPE protocols, sufficient healthcare workers, facilities, and supplies, and screening and testing capacity.
Additionally, controls should be put in place to maintain social distancing such as minimizing time in the waiting rooms and maintaining low patient volumes. They also recommend facilities participate in a registry or national data collection system to track patient outcomes, and understand the impact on facilities and systems, and how resources are allocated.
COVID-19 Testing For Hospitalized Patients
CMS recommends, when possible, patients who will undergo a procedure or operation should be tested for the virus 24 hours prior to the procedure or hospital admission. If testing isn’t available, patients should self-isolate for 14 days in advance to reduce the risk of transmission should the person be positive for the virus but asymptomatic.
For patients who test positive, the risks and benefits of moving forward with or delaying the procedure should be taken into consideration. If care is delivered however, it should be done in a COVID-19 care zone and precautions should be taken.
PPE, Supplies and Sanitation
CMS includes specific recommendations about PPE for providers and staff, including the use of surgical face masks, N95 respirators and face shields, conserving PPE, and protection when performing procedures on the mucous membranes. Patients and visitors should wear cloth face coverings and facilities should have a supply of masks or cloth face coverings for them should they arrive without it.
Facilities should also have a plan in place for thorough cleaning and disinfection before caring for patients with NCC needs. Equipment used for patients who tested positive for COVID-19 should be thoroughly decontaminated according to the CDC guidelines.
Should states or local areas experience a surge in COVID-19 cases and hospitalizations, healthcare facilities should be prepared with adequate workforce, and have screening and testing plans in place. Staff who work in NCC zones should not rotate into COVID-19 zones unless absolutely necessary. If they do, they should use appropriate PPE and follow sanitation protocols.
Given these recommendations, Episource has outlined our plan to safely transition back to in-home health assessments. We welcome any feedback or questions that readers may have about our planned strategy.