Editor's note:For the latest news about the COVID-19 pandemic, visit https://www.aappublications.org/news/2020/01/28/coronavirus.
As stay-at-home restrictions are relaxed and more patients return to your practice, you will need to remain vigilant to keep them and your employees safe from COVID-19 infections and to minimize liability risks.
While not an exhaustive list, the following steps are important strategies to help independent practices shield patients and employees from COVID-19-related harm and the practice from possible legal repercussions.
Take care of staff, comply with federal requirements
Protecting your staff is foundational to protecting your patients.
Clearly communicate personal health requirements to all workers. Notify them not to come to work if they have a fever, have lost their sense of taste or smell, have other COVID-19 symptoms or have been in direct contact with a person who has tested positive for COVID-19 in the last 14 days while the worker was without appropriate personal protective equipment (PPE).
Once they are onsite, screen all employees for elevated temperatures and other symptoms of COVID-19 and record results in a confidential employment file (separate from the personnel file). Develop, share and follow policies for when and how long employees exposed to someone who tested positive for COVID-19 must stay away from the office.
The Occupational Safety and Health Administration requires you to provide adequate PPE for staff based on their COVID-19 risk exposure. This requires you to assess your staff’s risk based on their specific duties. For instance, billing staff may not have the same risk exposure as nurses or medical assistants who lay hands on patients. Some practices allow administrative staff to work remotely from home to save PPE.
Retrain staff on infection control practices such as donning, doffing and use of PPE; proper hand hygiene; protocols for collecting, handling and testing clinical specimens; and cleaning the office and equipment.
Waiting room/office management
The Centers for Disease Control and Prevention (CDC) advises practices to require all individuals who visit the office to wear a cloth face covering. Ideally, this expectation should be clearly explained to patients and other visitors before they arrive at the practice. If supplies are available, the practice should provide masks to parents and patients (except children under 2 years old) who arrive without a cloth face covering or mask.
Many pediatric practices now schedule sick and well visits at alternate times or days.
Consider reconfiguring office space to comply with social distancing guidelines and minimize patient-to-patient contact. This may mean changing the traffic flow in the office to one-way ingress/egress. Another option may be to have patients/families wait in their cars, texting them at the appropriate time and bringing them directly to an examination room.
Follow all required environmental cleaning and disinfection procedures consistently and correctly.
Limit nonessential visitors’ access to the office
Post signs on your doors and notices on your website informing visitors who are not patients or employees (e.g., vendors, educators, salespeople, service providers) your policy on who may enter the practice. Consider virtual communications for suppliers, vendors or salespeople.
Arrange for visitors who must enter the practice (e.g., to do repair work) to come during off hours, if possible.
Liability coverage considerations
If you received a premium discount on your medical liability insurance because your office was temporarily closed or you were providing only telehealth visits during the peak of the pandemic, let your carrier know that you have returned to business as usual. This is essential to ensure you have adequate coverage for all the health care services you provide.
Some insurers have offered premium deferrals or other provisions to help financially strapped practices and may extend these accommodations until your cash flow improves.
Many medical liability insurers covered telehealth visits during the public health emergency (PHE) or until a specific deadline. If you continue to provide care via telehealth, verify that your medical liability policy will cover those services.
Also, verify that you are complying with the medical licensure requirements for telehealth beyond the state in which you are licensed. Some states eased those restrictions during the PHE. Since the "site of care" may be the patient's location, you will need to be sure you are licensed in that state. If you are not, your malpractice coverage may not be in effect for those telehealth services and you may be disciplined for practicing medicine without a license.
The enforcement of many Health Insurance Portability and Accountability Act (HIPAA) regulations for telehealth services was relaxed during the PHE. They are likely to go back into effect when the PHE ends. At that point, you will need to use a HIPAA-compliant platform if you decide to continue conducting telehealth visits.
Prevention, diagnosis and management of COVID-19 have changed significantly over the last few months and will continue to change. Keeping up to date on these changes is an essential way to provide the best care for your patients and minimize liability risk.
Dr. Fanaroff is immediate past chair of the AAP Committee on Medical Liability and Risk Management.