Updated Oct. 14, 2020
As physicians reopen and strive to keep open their practices during the COVID-19 pandemic, measures to limit the spread of the SARS-CoV-2 virus to patients, caregivers, staff and themselves are just as, if not more, necessary as ever.
It will be those measures, clearly communicated, consistently implemented and updated as new evidence becomes available, that will engender in patients the confidence they need to seek care. Furthermore, as instances have been reported in which fear of exposure to the virus has resulted in adverse outcomes for patients who delayed or avoided seeking necessary care, the importance of ensuring access to care and addressing patients’ concerns about risk of seeking care has been reaffirmed.
The U.S. Centers for Disease Control and Prevention (CDC) has provided a framework within which non-COVID-19 care can be delivered. The Centers for Medicare & Medicaid Services (CMS) also has published and updated its guide (PDF) for reopening facilities to provide non-emergent, non-COVID-19 care.
Building upon this guidance, the American Medical Association suggests using the following checklist to ensure that your medical practice is ready for reopening and is well-situated to remain open going forward.
Download the complete physician practice guide for keeping your practice open (PDF) for best practices that should be in place at the federal, state and local levels before reopening. Previously known as the "Physician Practice Reopening Guide", the Keeping Your Practice Open guide includes a detailed pre-visit screening script and frequently asked questions around privacy and confidentiality concerns for practices.
󠇉Comply with governmental guidance
Guidance from cities, states and the federal government establishes guardrails that should be in place before, during and after opening your practice.
󠇉Make a plan
Planning will be vitally important to the success of your practice reopening and remaining open.
Anticipate and plan for COVID-19 exposures in the office
Decide in advance how you will handle contact tracing, staffing and cleaning if an employee, patient or visitor who has been in the clinic is later diagnosed with COVID-19.
What should be done if an employee contracts COVID-19 while at work?
Follow CDC and local public health protocols regarding notification and quarantine of potentially exposed staff and communication to patients.
Plan in increments
Adopt a step-wise approach so that the practice may quickly identify and address any practical challenges presented. Identify which visits can be conducted via telehealth or other modalities and continue to perform those visits remotely.
󠇉Institute safety measures for patients
To ensure that patients are not coming into close contact with one another, utilize a modified schedule to avoid high volume or density.
󠇉Ensure workplace safety for clinicians and staff
Communicate personal health requirements clearly to clinicians and staff. For example, the employee should know that they should not present to work if they have a fever, have lost their sense of taste or smell, have other symptoms of COVID-19 or have recently been in direct contact with a person who has tested positive for COVID-19.
󠇉Implement and make continued use of a tele-triage program
Depending on a patient’s medical needs and health status, a patient contacting the office to make an in-person appointment may need to be re-directed to the practice’s HIPAA-compliant telemedicine platform, a COVID-19 testing site or to a hospital.
Continue the practice of screening patients before scheduled in-person visits
Before a patient presents in the office, the practice should verify as best it can that the patient does not have symptoms of COVID-19. Visits which may be conducted via telemedicine should be. For visits which must take place in person, administrative staff should contact the patient via phone within twenty four hours prior to the office visit to 1) review the logistics of the reopening practice protocol and 2) screen the patient for COVID-19 symptoms.
Your administrative staff should have a script to follow when conducting these calls. The AMA has developed a sample script included in this guide.
󠇉Coordinate testing with local hospitals and clinics
There will be instances where your patients require COVID-19 testing. Contact your public health authority for information on available testing sites. Identify several testing sites in your catchment area. Contact them to ensure that tests are available and to understand the turnaround time on testing results.
󠇉Limit non-patient visitors
Clearly post your policy for individuals who are not patients or employees to enter the practice (including vendors, educators, service providers, etc.) outside the practice door and on your website.
Review coverage with your medical liability insurance carrier
To ensure that clinicians on the front line of treating COVID-19 patients are protected from medical liability litigation, Congress has shielded clinicians from liability in certain instances.
Institute or update confidentiality, privacy and data security protocols. Results of any screenings of employees should be kept in employment records only (but separate from the personnel file).
󠇉Consider legal implications
New legal issues and obligations may arise as the practice reopens. The AMA has additional resources for physician practices related to employees and COVID-19.
Disclaimer: The information and guidance provided in this document is believed to be current and accurate at the time of posting. This information is not intended to be and should not be construed to be or relied upon as, legal, financial, medical or consulting advice, and the AMA hereby disclaims all express and implied warranties of any kind. Consider consulting with an attorney and/or other advisor to obtain guidance relating to your specific situation. References and links to third parties do not constitute an endorsement, sponsorship or warranty by the AMA.