FAQs: COVID-19 - Hospitals and Medical Staffs

Alerts / March 20, 2020
Q: May medical staff committees hold meetings via telephone instead of in person? Normally these in-person meetings occur monthly, but is there a confidentiality issue in conducting these meetings telephonically or via video conference?

A:These meetings can be conducted telephonically or via videoconference if the technology is secure. An instruction should be provided to all participants that they must be the only person on the call or video conference and in a private area to avoid breaches of confidentiality. Additionally, any circulated agenda should be sent securely, with directions not to print or disseminate in any way (i.e., marked CONFIDENTIAL PEER REVIEW DOCUMENTS: DO NOT COPY OR FORWARD). If the participants print out any of these documents, those items should be promptly shredded after the meeting or returned to the Medical Staff office. The usual admonition about all discussions at the meeting being CONFIDENTIAL should be given both at the beginning and at the end of the meeting.

Q: How should hospitals prepare to supplement professional staff in the case of a surge of patients?

A: State law should be consulted regarding requirements governing the practice of retired or inactive physicians, podiatrists, dentists, nurses, etc., in emergency situations. Such practitioners, if permitted to practice, could be granted emergency privileges by hospitals under disaster plans. For example, California has the Health Care Professional Disaster Response Act (Business and Professions Code Section 920-922), which allows healthcare practitioners with lapsed or inactive licenses to potentially serve in those areas where a shortage of qualified healthcare practitioners exists.

Q: Can hospitals consider granting temporary or disaster privileges to prepare in case of a surge of patients?

A: Hospitals should consult their Medical Staff bylaws regarding the granting of temporary and/or disaster privileges. The Joint Commission provides that temporary privileges may be granted to meet an important patient care need. The need must be documented in the credentials file at the time privileges are granted. It typically appears as a recommendation from the medical staff president or designee to the CEO, who grants the privileges. It could also appear in a statement by the CEO as to the reason for granting the temporary privilege(s).

The Joint Commission provides that important patient care needs may include, but are not limited to, “the patient care volume exceeds the level that can be handled by currently privileged practitioners and additional practitioners are needed to handle the volume.”

Q: Several members of our Medical Staff just returned from trips to high-exposure areas – overseas and domestic – like Vail or Italy. How do we treat them?

A: While each practitioner should be assessed on a case-by-case basis, if they are asymptomatic, they should be asked to be tested for the virus. If they test positive, they should be directed to self-quarantine.

Q: What if members of our Medical Staff refuse to be tested?

A: While you cannot compel members of a Medical Staff to be tested, if the Medical Staff member has recently been in a high-exposure area or is symptomatic for COVID-19, it is reasonable to presume that they are positive unless proven otherwise.

Asking Medical Staff members to be tested to prove their negative status is not only in their best interest, but also in the best interest of the patients and other healthcare workers they must interact with in the hospital.

In such extreme circumstances where a practitioner refuses to be tested, summary suspension under the bylaws should be considered after consultation with competent legal counsel.

Q: Since cancellation of elective surgeries is being encouraged by CMS, what is happening at hospitals?

A: Most hospitals and their surgical staffs are complying. However, we are seeing two scenarios develop.

First, surgeons are declaring (and justifying through documentation) that their planned surgeries are “essential” or “emergencies,” so they should go forward.

Second, several surgeons are taking cases to outpatient Ambulatory Surgical Centers that are privately owned and performing those surgeries there.

While CMS has not yet announced whether it will be limiting reimbursement for non-essential procedures performed after its issued guidance on Mar. 18, CMS may stop reimbursing for surgeries that are not truly emergencies, as an enforcement mechanism. If this is done, private insurers likely will follow the lead of CMS and also will not reimburse the surgeries. If this occurs, unless the surgery is clearly documented as a true emergency, both the surgeon and the facility run the risk of not being paid.

On Mar. 17, the American College of Surgeons published Guidance for Triage of Non-Emergent Surgical Procedures, which includes an “elective surgery acuity scale” to assist with classification of cases. On Mar. 18, CMS issued Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response.

Authorship Credit: Mark A. Kadzielski and Jenna N. Scott

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