COVID 19: Best Practices and Thought Leadership
This document summarizes the federal stimulus packages established in response to the COVID-19 pandemic and details the specific actions (including useful links) required by healthcare providers to take advantage of the various funding allocations. (Note: The information contained in this document is dynamic and is being updated weekly.)
The healthcare industry’s response to COVID-19, or coronavirus, is rapidly changing. This pandemic presents a new set of challenges for our clients and their staff. Impact Advisors’ leadership team is meeting daily to monitor the latest developments, share best practices, and develop new ways to serve our clients in their time of need. We are communicating with you here to share what we have learned to-date from our clients’ on-the-ground experiences. We hope some of this information may be relevant to you. In our role as your trusted advisor, we will continue to share lessons learned and best practices from the front line to aid in your response to this situation. We welcome your input and organization’s experiences in this shared journey.
Best Practices from the Front Line
Here are the operational and IT best practices we’ve identified as you continue to prepare for your COVID-19 response:
- Clinical Screening and Best Practice Alerts
- Telemedicine and Other Tools for Virtual/Remote Care
- Capacity Management, Patient Flow and Infection Control
- Network Infrastructure, Security and Other IT Support for Command Center/Response Management, Collaboration and Remote Work
- Workforce Communication
- HIM/Coding, Patient Billing and Payment
- Supply Chain and Staffing
- Appointment Access, Management
This is an uncertain time for all of us, so we hope this information helps cut through the anxiety and provides useful guidance. Should you need help, Impact Advisors can support your organization’s urgent needs in several key areas:
- Crisis response coordination and management across the clinical, patient access, EHR and IT domains;
- Telehealth strategies and configuration to deliver safe, efficient, remote patient care; and
- Risk evaluation and management to sustain revenue flow.
As always, we’re here when you need us.
Clinical Screening and Best Practice Alerts
- COVID-19 updates and responses incorporated into daily safety huddles.
- Best practices Clinical Alert Team convening regularly to identify and “ratify” clinical criteria and triggers from CDC and elsewhere.
- Single, unified online repository for clinical protocols, best practices, policies and procedures, and communication tools (internal and external).
- Online clinical references on website and patient portals, with links to up-to-date CDC guidelines and/or organizational content.
- Online clinical triage protocols with chatbots and nurse triage hotline for patients experiencing symptoms.
- Remote third-party resource support to triage patient portal clinical questions.
- Chatbots and online questionnaires for screening patients booking appointments and seeking visit to hospital or clinic.
- Configured best practice advisories and alerts in EHR (via mobilized, highly responsive, 24/7 IT “SWAT” team) for clinical screening of at-risk patients based on CDC criteria.
- Bundled order sets by diagnostic presentation/patient type.
- E-Learning tools and videos for staff education.
- Analytical reports and algorithms identifying at-risk patients based on risk factors.
Telemedicine and Other Tools for Virtual/Remote Care
Note: Significant changes in telehealth reimbursement recently became effective. CMS has now expanded Medicare coverage for telehealth/virtual visits through the duration of the COVID-19 public health emergency. Geographic restrictions on patient location have been removed, CMS will not enforce the requirement for an existing provider-patient relationship, and everyday video communication tools such as FaceTime and Skype are now permitted during this public health emergency.
- Virtual patient consultations with remote physicians within health delivery network, partnered provider networks and/or rural geographies.
- Telehealth for ambulatory care consultations, admissions triaging, and “hospital care at home,” including:
- Video, phone and text-based e-visits for patient triaging
- Structured, clinical, protocol-driven screening capabilities
- Remote monitoring capabilities (weight, blood pressure, temperature) for high-risk patients
- Provider/specialist teleconsult capabilities within and across care areas and facilities to enhance internal, non-face-to-face clinical consultations.
- TeleHospitalist services for virtual patient rounding to minimize caregiver exposure to infected patients.
- TeleICU services for remote monitoring of the most critical patients to help reduce the threat to on-site ICU care providers.
- Online scheduling and coordination of all virtual/telehealth visits – internal and external – or instructions and support for on-the-fly usage.
- Configuration (including wireless access, network bandwidth, security and EHR access) of adjacent/remote care sites and/or drive-through locations – separate from ED – for triage screening of patients with suspected symptoms.
Capacity Management, Patient Flow and Infection Control
- Capacity Command Center or Rapid Response Team with physical or virtual co-located departments utilizing shared dashboards to identify bottlenecks and control patient flow.
- Mandatory procedures to speed discharge of patients early in the day and on weekends, coupled with tracking/reporting of timely discharge orders.
- Identification and flagging in EHR and on room-tracking/ED dashboards of diagnosed or at-risk/suspected patients.
- Active management of ICU and negative pressure rooms.
- Creation in EHR of designated overflow/surge areas.
- Use of iPads, videoconferencing, hands-free technologies (e.g., Vocera) in inpatient setting for nurse-patient communication to minimize exposure to infected patients.
- Hand hygiene monitoring systems to track caregiver compliance with hand-washing.
- CDC guidelines for COVID-19 incorporated into room disinfection/turnover policies.
- Capacity management system updated with COVID-19 disinfecting protocols.
- Policies and alerts/restrictions for IT access to infected patient rooms, if required.
- Conversion of unused rooms to ICU beds with requisite IT equipment and application reconfiguration.
Network Infrastructure, Security and Other IT Support for Command Center/Response Management, Collaboration and Remote Work
- Real-time emergency response communication tools, including email distribution lists, asynchronous text-based provider messaging, and other tools for targeted/segmented communication to managers/caregivers/stakeholders.
- Configured Command Center with application access, projection equipment, service desk support, access to clinical triage, telecommunications tools, incident tracking and knowledge database/portal.
- Automated Command Center/emergency response dashboard with stats for:
- COVID-19 patients
- Appointment volumes
- Ambulatory visits
- Telemedicine visits
- ED visits/turnaround
- Laboratory test volumes – including positive/negative COVID-19 results
- Portal visits/queries
- Phone calls – including hold times, abandoned, time to resolution, resolved on first attempt, requiring nurse triage
- Appointment cancellations/no-shows
- Critical inventory supplies
- Increased network bandwidth and remote access licenses to accommodate more employees working remotely.
- Considerations for employee usage of cellphones, including data limits.
- Reconfiguration of at-home workstations for thin-client, dual-screen setups.
- IP addresses configured to allow remote employee access to secure websites of vendor partners.
- Procurement/configuration of laptops to support remote work, including access to shared drives, secure intranet and instant messenger.
- Online tools to support team collaboration, group presentations and team chats – including training and tip sheets for employees not well-versed in these tools.
- Beefed-up security monitoring for fraud, network penetration.
- Employee updates/alerts regarding security penetration risks.
Note: While communication is critical, we are all adapting to this “new reality” – sometimes on a minute-to-minute basis. Consider the following tips as you develop your communication plan.
- Information overload is a real risk – keep your communications clear, concise and fact based.
- Establish a communications cadence and centralized distribution plan so information-sharing occurs on a regular, predictable schedule.
- Identify what you are intending/needing to communicate in a given moment, state that up-front and then stick to that message to avoid confusion.
- Include a few key points with links to more detailed materials/information.
- Recognize that colleagues on the front lines providing direct patient care will be exhausted and will not have time to seek out and read lengthy communications. Consider alternative ways of sharing information with them and protect them from unneeded noise.
- Daily newsletter, email, internal portal communication or WebEx/teleconference.
- Text communications/alerts.
- Policies, procedures and use of tools for working remotely
- Employee hotline for questions.
HIM/Coding, Patient Billing and Payment
- Configuration for temporary bill holds for COVID-19 cases, if warranted pending federal mandates/legislation.
- Configuration for telemedicine billing, including multistate payers and federal emergency funding.
- Remote access to payer systems for eligibility, authorizations and referral management.
- Remote access to coding tools.
- Rapid assessment of financial risk, modeling scenarios with variations based on:
- Inpatient and outpatient volume
- Changes in payment patterns relative to patient balances
- Increase in premium staffing when/if surge comes
- Changes in elective vs. nonelective procedural volume
- Potential expense related to new labor laws
- Likely implications to cash balances (e.g., access to cash)
- Real-time, remote work-queue assignments, management/reporting of backlogs, and resource supervision of HIM/claims edits and follow-ups.
- Redefined workflow and scanning/imaging tools for lockbox/check payments.
Supply Chain and Staffing
- Flexibility of labor resources and access to on-demand resources to support necessary functions during surge.
- Freeing up clinical resources from nonessential tasks to provide direct patient care.
- Review and reset of trigger points for automated supply reordering – including increases in on-hand inventories.
- Setup of temporary, secondary inventory locations.
- Reconfiguration of distribution channels to accommodate for changes at GPO/distributor, secondary inventory locations, and intra-system movement of supplies.
- A supply chain risk assessment for imported supply production and potential impacts of excess demand.
- Remote access to time-and-attendance system for workforce scheduling and timesheet submission.
Appointment Access, Management
- Updated website, portal and phone triage messaging regarding when not to come into the hospital or clinic.
- Phone system configured for capacity to forward to more than one number for remote coverage.
- Updated scripts for Access/Call Center, reception desks, and access/appointment personnel regarding appointment cancellations, clinical screening, and hospital/clinic visits.
- Automated outreach to scheduled patients to postpone nonurgent appointments, virtual/online alternatives for care (if available) and provide instructions for arrival in the hospital/clinic.
- Chatbots for automated patient assistance with questions and appointments.
- Remote third-party resource support to triage online appointment requests.
- Real-time, remote work-queue assignments, management/reporting of backlogs and resource supervision of online access queues.
- Identification of linked services (e.g., lab, imaging) related to in-person visits converted to remote/telemedicine.