COVID-19

Road Map to Measured Resumption of Healthcare Operations During the Ongoing COVID-19 Pandemic in Maine

April 29, 2020
The senior physician executives from the largest four health systems in Maine - Northern Light Health, MaineGeneral Health, Central Maine Healthcare, and MaineHealth, and the Maine Hospital Association, have evaluated the many specialty guidelines and national directives for how hospitals and health systems can safely resume services after the peak of the COVID-19 pandemic. All hospitals have continued to provide care for urgent and emergent conditions and adopted novel ways for routine care to be delivered.  However, the care of a significant subset of patients who have complex chronic conditions, serious illness, or require in-person visits for other reasons necessitates re-opening of services in our outpatient clinics, and operating rooms in a new model, while also caring for those patients who have COVID-19.
We have developed guidance which takes into account the following key considerations:

  • Priority for patients with medically necessary, time-sensitive conditions
  • Safety of our patients, staff, and communities
  • Sufficient supply of key resources such as personal protective equipment (PPE) and testing supplies
  • Scaling the re-opening of services based on the level of community COVID-19 activity and maintaining capacity in our hospitals for potential outbreaks
 
Situational update of the current situation of the COVID-19 pandemic in Maine:
  • The COVID-19 pandemic necessitated stopping elective cases and postponing procedures and office visits while preparing for COVID-19 patients and continuing to care for patients with urgent and emergent conditions
  • Telehealth services were rapidly expanded as safer alternatives to office visits to maintain access to care across Maine
  • New alternatives care sites, such as outdoor testing tents and respiratory disease assessment facilities were stood up in the time of need
  • Cohorting of COVID-19 positive patients, in both inpatient and outpatient care areas, was swiftly instituted across all healthcare institutions across Maine
  • These urgent measures, together with maintained social distancing and universal masking and screening policies, have effectively flattened the curve and slowed the spread of the COVID-19 pandemic in Maine

 
Measured resumption of healthcare services in Maine:
Reopening of healthcare services in Maine will be gradual and require constant monitoring of epidemiologic data and reassessment of all available tools for the safe delivery of healthcare.
Criteria for moving forward are:
  • Downward trajectory of new COVID-19 cases over a 14 day period which will likely be met within the next week
  • Surge capacity for new COVID-19 cases and outbreaks sufficient to more than meet a demand equal to the Maine April peak in hospitalizations
  • Adequate levels of testing materials and PPE to offer increased patient services
  • Prioritization of medically necessary, time-sensitive procedures and visits, those that were postponed at the onset of the pandemic, but if further postponed could pose a risk to patient well-being
    • This will necessarily be clinician-driven, with specialists in all areas determining those procedures and visits that need to be accommodated in the earliest stages of reopening
    • Medical professionals will determine that the benefit of a visit or procedure exceeds that of alternatives and exceeds the potential risk of delay
Necessary components to keep our citizens, patients and healthcare workers safe are:
  • Continue identifying and cohorting COVID-19 patients in both inpatient and outpatient areas
  • Continue social distancing measures and universal masking policies of all healthcare workers and patients in all care settings
  • Constant monitoring of supply chain and inventories of PPE, medications, testing kits and equipment
  • Ongoing monitoring of local COVID-19 disease burden with contingency plans to rapidly adjust volumes in event of an outbreak or secondary surge
  • Continued utilization and expansion of telehealth
 
Full resumption of health care services:
Health care services will likely not be able to fully resume normal operations, including pre-COVID-19 volume of elective procedures and full hospital occupancy, until the threat of surges have diminished and the following criteria are met:
  • Expansion of testing capabilities that include surveillance testing and contact tracing, including capability to test all appropriate patients and healthcare workers
  • Reliable and readily-available technology that is focused on antigen or antibody testing
  • Commercially available vaccinations to create herd immunity
  • Safe and effective therapies to address complications associated with COVID-19 infections

Health systems and hospitals are also working closely with DHHS, nursing homes, home health and hospice providers to ensure continuity of care and safe care for all affected patients.
 

Legislation


 

Reports

Resources

CMS Master Summary of Waivers with Maine DHHS reponse

Health & Environmental Testing Laboratory (HETL) FAQ for Electronic Testing Order and Reporting (eTOR) and Submitting COVID19 Specimens

Flexibilities with Additional Regulatory Waivers and Rule Changes to Support U.S. Healthcare System during COVID-19   April 30, 2020

CMS Guidance includes guidance on clinical and technical operations, billing and coding, survey, coverage, provider enrollment, Medicaid and CHIP, market planning, and open payments

Transferring Patients from Hospital to Skilled Nursing Facility

CMS Coronavirus (COVID-19) Partner Toolkit

State issues blanket waiver

Swing bed waiver

MLN Matters Article on Swing Bed Waiver (May 21, 2020)

CMS grants state 1135 waivers

State expands testing, eliminates waivers (May 18, 2020)

Maine Hospital Solutions Trusted Resources: Maine Hospital Solutions has compiled a list of trusted companies for hospitals to help navigate the COVID-19 crisis. These companies provide vetted solutions to hospitals’ operational and financial challenges resulting from this unprecedented event.

Certificate of Need
Finance and Payment Concerns
Personal Protective Equipment Ventilators
Listing of Documents:
EMTALA Resources
Telehealth
MaineCare Guidance Relating to Telehealth and COVID-19
Centers for Medicare & Medicaid Services Waivers Relating to Telehealth
Centers for Medicare & Medicaid Services FAQ Regarding Telehealth
Governor Mills' order suspending certain healthcare licensing statutes

Links from the Northeast Telehealth Resource Center
  • NETRC Telehealth Implementation Toolkit – Maine Edition: this online toolkit includes key aspects to implementing telehealth programs, and includes many embedded resources, including sample forms, workflows, etc. This version includes Maine specific policy information and resources, and a special section on COVID-19.
  • NETRC COVID-19 Telehealth Resources webpage, which compiles many key resources in one place.
  • NETRC Spring Newsletter, which includes a wide variety of information, including telehealth funding opportunities through the FCC and the USDA, upcoming virtual conferences/events, and a collection of the latest telehealth news and resources.
  • Updated Provider Guide to Telehealth Reimbursement in Maine During COVID-19, which has a couple of updates, including a link to Governor Mills’ Executive Order #35, which explicitly states: All Maine-licensed psychologists, psychological examiners, clinical social workers, clinical professional counselors, pastoral counselors, marriage and family therapists, alcohol and drug counselors, physical therapists, physical therapy assistants, chiropractic doctors, pharmacists, pharmacy interns, pharmacy technicians, podiatrists, occupational therapists, occupational therapy assistants, speech-language pathologists, hearing aid dealers and fitters, audiologists, certified interpreters, certified deaf interpreters, limited interpreters, and limited deaf interpreters, athletic trainers, naturopathic doctors, acupuncturists, dietitians, radiologic technologists, respiratory care practitioners, and certified professional midwives may provide necessary health care services permitted by their licenses through the use of all modes of telehealth, including video and audio, audio-only, or other electronic media.
  • The AMA also released an updated version of their Coding Guidance Document, which now has many more scenarios with associated coding.
  • Videos focused on increasing both provider and patient knowledge with respect to telehealth, what to expect, etc.
Medicaid Anti-trust concerns
Joint Federal Trade Commission/Department of Justice anti-trust statement: The agencies will aim to respond expeditiously to all COVID-19-related requests, and to resolve those addressing public health and safety within seven calendar days of receiving all necessary information. "The Agencies will also account for exigent circumstances in evaluating efforts to address the spread of COVID-19 and its aftermath. For example, health care facilities may need to work together in providing resources and services to communities without immediate access to personal protective equipment, medical supplies, or health care."

Hospital Incident Command For System COVID-19 templates prepared by the California Hospital Association Quality Measurement
  • The Centers for Medicare & Medicaid Services (CMS) recently announced extreme and uncontrollable circumstances policy exceptions and extensions for upcoming quality measure reporting and data submission deadlines for CMS quality reporting programs in response to the 2019 Novel Coronavirus (COVID-19). The following resources provide additional details about these changes:
  • Guidance Memo -Quality Reporting and Value-based Purchasing Programs: Describes the specific changes to CMS provider, hospital, and post-acute care quality reporting programs.
  • Quality Payment Program COVID-19 Factsheet: Outlines the Merit-based Incentive Payment System (MIPS) extreme and uncontrollable circumstances policy and procedures for MIPS eligible clinicians affected by COVID-19.
Surge Capacity
The Centers for Disease Control and Prevention (CDC) has released a  tool for estimating surges in demand for hospital-based services related to COVID-19. CDC said the spreadsheet-based tool can help hospital administrators and public health officials "produce estimates of the number of COVID-19 patients that need to be hospitalized, the number requiring ICU care, and the number requiring ventilator support."

340B Solutions
Performance Healthcare Solutions (PHS) is a Maine Hospital Solutions-endorsed partner that specializes in increasing 340B revenues without having to change administrators or cause the covered entity to expend many hours of time and resources in order to realize these added benefits. Please take a look at this case study, this is just a one month snap shot of the dramatic benefit PHS’s 340B Enhanced program can provide for 340B covered entities. This program is easy to implement and can have a significant impact on 340B revenues.

Payment Solutions

CommerceHealthcare Payment Hub is a technology platform that streamlines vendor payment processing across all enterprise applications, payment types and banks. It enables hospitals and practices to gain significant efficiencies in invoice payment management, generate revenue and
enhance supply chain processes.

Staffing Resources
COVID-19 Workforce Virtual Toolkit: Resources for Healthcare Decision-Makers Responding to COVID-19 Workforce Concerns is a collection that provides a curated set of resources and tools for decision-makers managing healthcare workforce challenges in response to the COVID-19 emergency. The toolkit was recently updated to include new content on healthcare workforce training resources, workforce surge staffing strategies, considerations for pre-hospital/EMS settings, and more.

FocusOne Solutions Healthcare Workforce Logististics
  • Healthcare Workforce Logistics is looking to offer a rapid response program to hospitals with increased staffing needs specifically around COVID-19.  There will be a special agreement for hospitals that is in and around this situation with no obligations.  For more information, check out this blog
Jackson Physician Search 

Jackson Physician Search is a leader in the permanent recruitment of physicians and advanced practice providers to hospitals and health systems across the United States. The company is recognized for its track record of results built on their clients’ trust in the skills of their team and the transparency of their process.  They continue to work with hospitals to place physicians during this busy time.

Jackson Physician Search can:

  • Attract qualified candidates locally, regionally, and nationally through a vast digital network of recruiting channels;

  • Leverage a proprietary database containing the widest selection of physician specialties;

  • Provide consistent communication and individualized attention and support; and

  • Accurately budget and control expense based on their transparent, affordable fee structure.

To learn more about how Jackson Physician Search can help hospitals find the right physician,
contact Kyle Knox, Business Development Manager, at (404) 943-1777 or
kknox@jacksonphysiciansearch.com.
 

VISTA Staffing Solutions
VISTA Staffing Solutions is committed to remaining a vital healthcare staffing resource to Maine hospitals.  The company seeks to balance the safety of their clinicians with the vital care they provide.  The staff at VISTA is working hard to mitigate disruption of their services, so that they can continue to meet the needs of their partners during this uncertain time. 


Nursing Homes
The Federal Healthcare Resilience Task Force released Nursing Home Concepts of Operations for Infection Prevention and Control, this Concept of Operations document provides an overview of recommendations and resources for nursing homes that can help reduce the impact of COVID-19 on residents and staff.

Assisted Living
Guidance from the State

Emergency Management System Behavioral Health
Other resources

Events

Telehealth Strategies and Coding Concerns: Coronavirus (COVID-19), a webinar presented by Stroudwater Revenue Cycle Solutions. With billing guidelines and payor expectations for telehealth services being updated regularly, revenue cycle staff must understand the correct use and implementation of these services to ensure clean claim submission and timely reimbursement.

State Telehealth Webinar: If you were unable to attend the state's telehealth webinar, hosted by Lisa Letourneau, MD, MPH, senior advisor, delivery system change, with the Maine Department of Health & Human Services, and Danielle Louder, director of Northeast Telehealth Resource Center and co-director of MCD-Public Health, here are links to the recording, slides and other related resources.

  • Link to the ;
  • , which includes hyperlinks to key info, training, and policy resources discussed;
  • document; and
  • , which includes hyperlinks to various policy documents pertaining to current federal and state telehealth policy expansion.
  • Northeast Telehealth Resource Center next week will start offering Telehealth Virtual Office Hours for as long as needed. Just click on one of the links below to join the session you are interested in. No need to RSVP – members of the NETRC team will be online and available to answer your questions and share resources:

    at 8 a.m.

    Call in: +1 646 558 8656 US

    Meeting ID: 869 834 403

     

    at noon

    Call in: +1 646 558 8656 US

    Meeting ID: 477 247 220
     

COVID-19: Disaster, Emergency, and Temporary Provider Privileges, a webinar hosted by the Louisiana Hospital Association. Password: bMQXGhM5
Coronavirus: Strategies and Tools to Prepare Your Organization for Emerging Infections, webinar recording from the Hospital Association of New York State

Federal Funding Considerations and Data Capture –Loss of Revenue, Increased Costs, and Other Matters, webinar hosted by the Georgia Hospital Association.  View the recording.

Publication

Links