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Guidelines for Reopening the Health Care System

Executive Summary

reopenpracticeAs COVID-19 spreads throughout the world, Pennsylvania and the United States took steps to limit the transmission and impact of the virus by implementing stay-at-home orders and postponing non-emergent surgeries and procedures. While this has so far prevented any surges overwhelming our hospitals, it has also meant that many other parts of the health care system have been idled to preserve resources and capacity in the system and limit opportunity for transmission or exposure of the virus.

Physician practices and health care facilities have seen massive drops in patient visits, caused by a combination of stay-at-home orders and patient fear. This may lead to much more complex problems in the future, as patients miss routine screenings and preventive care.

As we begin to reopen our offices and facilities, many agencies, including the Pennsylvania Department of Health (DOH) and the Centers for Medicare & Medicaid Services (CMS) identified several steps that will be instrumental to ensuring the ongoing safety of patients and the health care workforce.

Pennsylvania Department of Health Guidance

Health Care Providers

In this Guidance on COVID-19 for Health Care Providers in Pennsylvania released May 9, DOH revised previous instruction as stay-at-home orders are lifted. Providers may resume non-urgent and elective care when appropriate personal protective equipment (PPE) is available and telemedicine is not sufficient. DOH recommends screening patients for symptoms.

Hospitals and Facilities

After directing physicians to postpone or cancel non-emergent surgeries and procedures, DOH announced that non-emergent surgeries and procedures may resume in hospitals and ambulatory surgical facilities provided that it can do so without jeopardizing safety of patients and staff or the ability to respond to the COVID-19 emergency.

Hospitals and ambulatory surgical facilities must ensure they have enough PPE available to handle a surge in COVID-19 cases without having to prioritize care. Additionally, hospitals and facilities must have adequate staff to handle a potential surge in patients. Hospitals and facilities will need to update their emergency preparedness plans to reflect their preparedness for possible resurgence.

Hospitals and facilities will need to review the Joint Statement issued by the American College of Surgeons, American Society of Anesthesiologists, Association of Perioperative Registered Nurses, and American Hospital Association. Any hospitals and facilities that also provide pediatric treatment and care should additionally review this guidance from the Children’s Hospital Association of the United States when determining whether to proceed with pediatric elective surgeries and procedures.

To review DOH’s guidance for hospitals, click here. To review DOH’s guidance for ASFs, click here.

Centers for Medicare & Medicaid Services Guidance

On April 19, 2020, CMS released Recommendations for Re-opening Facilities to Provide Non-emergent Healthcare: Phase I to support facilities and clinicians as they begin re-opening facets of health care services that had been paused during the public health emergency. Decisions for reopening must include careful planning and considerations for:

  • Adequate facilities, workforce, testing, and supplies
  • Adequate workforce across phases of care (i.e. availability of clinicians, nurses, anesthesia, pharmacy, imaging, pathology support, and post-acute care)

In conjunction with guidance from DOH, facilities should continually monitor their region for risk of incidence and should be prepared to cease non-essential procedures in event of resurgence. The full list of recommendations is available here.


As physicians begin to approach safely and cautiously reopening their medical practices for office visits, PAMED offers the following guidance on best practices.

Best Practices for Reopening a Medical Practice

  • Steps to Take Prior to Reopening a Practice

  • Financial Considerations

  • Staffing Considerations

  • Universal Safety Precautions for Practices

  • Licensure Waivers, Suspensions, and Allowances

References

California Medical Association. “Best Practices for Reopening a Medical Practice.” Adapted for Pennsylvania.





 

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