Reopening Medical Practices after COVID-19: What to Consider

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Recent studies show that one in three Americans delayed medical care as they coped with the financial losses and stress caused by COVID-19. As stay-at-home restrictions loosen nationwide and the economy slowly begins to reawaken, health care providers are contemplating the reopening of their practices.

To assist MIEC members as they prepare to provide care to their waiting patients, MIEC offers the following recommendations, based in part upon guidelines from federal, state, county, and medical specialty societies. See MIEC’s COVID-19 Resource Center for additional information.

Before Reopening:

There are several considerations that providers should explore to be prepared and ultimately successful. First, realize that this is not an instantaneous change, but a process which is likely to take time as patient volume slowly increases. Practices must adjust their financial planning and staffing levels and will need to anticipate the potential ebb/flow of stay-at-home orders in the future.

Use the following prompts to assist you in your evaluation of your practice:

  • Consult with your local public health department
    • Are there any reopening restrictions of which you should be aware?
    • Local public health orders may override state restrictions
  • Review COVID-19 guidelines specific to your specialty
    • Guidance around prioritizing certain treatments or procedures
    • Resumption of elective surgery
  • Review your operation plans
    • Decreased patient volume anticipated?
    • Decreased hours anticipated?
    • Revise patient schedules:
      • Limit number of patients in the office
      • Set aside separate times for vulnerable patients and/or patients >60yo
      • Separate well/sick patient visits
    • Plan for future public health emergencies, opening/closing protocols
  • Evaluate staffing needs
    • Right-size physician and staff workforce to appropriately respond to changing conditions and need for social distancing
    • Stagger staff schedules as appropriate
    • Do you have sufficient PPE for all providers and staff?
    • Consider alternative work arrangements for vulnerable staff members
    • Allow staff working remotely to continue doing so, as appropriate
    • Pay extra attention to emotional/physical well-being of your staff (see California Medical Association’s Care for Caregivers Program)
  • Evaluate business needs
    • What capital do you require? What are the available funding resources?
    • What is needed to meet existing obligations, including monthly budget?
    • Evaluate reimbursement models
      • Determine breakdown of patients between managed care, private pay, Medicare, Medicaid
      • Do you need to adjust your reimbursement approach?
    • Evaluate your accounts receivable and payable
      • Address accounts receivable slowly and methodically
      • Create a plan to collect outstanding receivables
      • Reach out to vendors to negotiate deferrals or alternative payment plans
    • Review/update patient contact and health insurance information
  • Assess your PPE inventory
    • Determine PPE needs for your providers and staff
    • Where are you lacking inventory?
    • Consider advance planning for future surges
    • Contact local medical society for assistance in sourcing PPE
  •  Redefine your safety protocols
    • Develop policy for patients to wear face coverings, symptom checks upon arrival to office (see below for recommended office policies)
    • Staff quarantine policy for those who are symptomatic and/or test positive for COVID-19
    • Personal Protective Equipment (PPE) for providers and staff
      • Train or retrain all staff on the proper use of PPE
      • Follow applicable CDC guidelines for extended use and reuse of PPE (Resource includes posters that you can download and hang in your office, as well as a training video)
      • Consider both face and eye protection
    • Evaluate and update infection control procedures, following CDC guidelines for Standard Precautions and Disinfection & Sterilization
      • Reinforce exceptional hand hygiene
      • Mandate use of gloves, masks, eye protection when indicated
      • Re-train staff on environmental cleaning policies and procedures
    • Evaluate and update biohazardous disposal guidelines
  • Plan for physical separation
    • Evaluate physical space in your practice to determine how many patients and staff members can safely be in the office at one time
    • If possible, enhance physical separation by arranging foot traffic to minimize patient interaction and maximize physical distancing
      • Example – Separate entrance/exit doors: Guide patients to come in one door and exit out another door, similar to what is being done at your local grocery store
      • Example – If only 1-2 patients are in the office at a time, to enhance air flow in the space, open the exam door enabling you to sit closer to the entrance of the room
  • Consider continuing the use of telemedicine
    • What patients can you continue to treat via telemedicine?
    • What patients should come in the office for follow-up exams (e.g., videoconferencing does not allow for an effective examination; control substances refills; etc.)?
    • Is financial reimbursement lucrative enough to continue using telemedicine?
    • See CMA Telehealth Implementation
  • Recommended office policies
    • Reduced visits: Change in office hours and/or scheduling to limit patients visits and minimize individuals (both patients and staff) in the office at one time
    • The reception area is not for waiting: To ensure physical distancing, multiple patients should not be allowed in the reception area. Check-in or check-out areas should have marked social distancing and limited occupancy.
    • Limitations on visitors or family members: With some exceptions, patients should be advised not to bring a visitor or family member into the office unless authorized at check-in. Possible exceptions might include pediatric, third-trimester pregnant, or elderly patients, or those who need physical assistance.
    • Masks are required: Patients cannot enter the practice without wearing a mask (cloth facial covering at a minimum), unless there is a medical reason preventing them from safely doing so. Consider having extra face masks available for patients who do not have them, assuming that adequate supply is available for providers.
    • Patients with a positive COVID-19 diagnosis, or symptoms of COVID-19 (such as fever, cough, or other flu-like symptoms) should not be seen unless medically necessary, and with prior approval of the practice.
    • Temperature check required: Patients should have their temperature checked before entering the office. Patients with a fever will be advised to return home and provided with further instructions.
Preparing for the Initial Patient Visit:
  • Educate patients about new office policies
    • Communicate current public health guidance and steps you are taking for patient safety.
    • Use multiple methods to communicate office policies (e.g., use signs on the front door, post policies on your website, send a letter or email to patients informing them of the changes)
    • Consider producing a “patient experience” video to post on your website to outline safety measures and provide a preview of how of visit will proceed.
  • Communicate consistently individual patients and office staff
    • Be cognizant of external factors affecting patients and staff (e.g., transportation, medication shortages, finances).
    • Create individual patient back-up plans.
    • Conduct training sessions with staff on new office policies
  • On the day of the visit
    • Pre-visit phone call: Call patients in advance of the visit and ask if they are experiencing common COVID-19 flu-like symptoms – such as dry cough, fever, respiratory issues, blisters on their toes.
    • Remote check-in
      • Have patients call the office from the parking lot when they have arrived for their visit.
      • Example – Purchase an office cellphone and give patients the number to call or text when they have arrived for their scheduled visit.
      • Lock your front door to control patient entry.
    • Limit non-patients in office space
    • Require all patients to wear universal masks
    • Perform a temperature check before each patient enters the office.
    • Employ physical distancing as appropriate.
    • Staff and physicians should wear PPE per CDC guidelines.
    • Adhere to universal precautions, disinfection/sterilization, and biohazardous disposal guidelines.
    • Whenever possible and practical, document your efforts to protect patients and staff.
Resources:

American Medical Association Reopening Guidelines

California Medical Association Guidelines and Recommendations for Reopening the Healthcare System

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