As federal and state directives and guidance impacting the operation of medical facilities, reopening of sectors of the economy, and the public’s mobility status are expected to relax over the next several weeks, physician practices and other health care facilities will need to determine their readiness to resume routine health care. The Michigan State Medical Society (MSMS) convened a workgroup, chaired by MSMS Immediate Past-President, Mohammed A. Arsiwala, MD, to explore what steps are minimally necessary for physicians and other health care providers to safely “ramp up” for full delivery of health care services. The result is a compilation of recommendations for the Safe Return to Clinical Practice.
MSMS greatly appreciates the time, effort, and insights provided by the workgroup comprised of the following members: Mohammed A. Arsiwala, MD, Chair; M. Ashraf Mansour, MD; Michael Berneking, MD, FACOEM; Amit Ghose, MD; Iltefat Hamzavi,MD, FAAD; Fauzia Hassan, MD; Annette Mercatante, MD, MPH; Rose Ramirez, MD; Virginia Skiba, MD; Robert Standring, MD; Alice Watson, MD; David Whalen, MD, MPH, and MSMS staff members – Amber Dunlop, Virginia K. Gibson, Stacey P. Hettiger, Julie L. Novak, and Joshua C. Richmond.
Medical practices and clinics determining when to resume postponed services need to consider legal and practical factors. From a legal perspective, current Executive Orders 2020-17, 2020-37, and 2020-59 include various conditions related to services, visitor restrictions and screening, and staffing parameters. From a practical perspective, physicians and other health care providers are encouraged to use their best clinical judgment to determine which procedures can be safely resumed and when in order to ensure the overall health and safety of their patients and staff. To assist in this determination, MSMS recommends physicians check with their national specialty societies for guidance on which medical services are most appropriate to resume.
MSMS Legal Counsel has prepared responses to the following two frequently asked questions:
When will my medical practice be allowed to lawfully resume non-essential encounters and procedures?
In order for Michigan medical practices to lawfully resume all non-essential procedures and encounters, Executive Orders 2020-59 and 2020-17 must expire or be rescinded.
Presently, Executive Order 2020-59 prohibits in-person work that is not necessary to sustain or protect life or to conduct basic operations through May 15, 2020. The Executive Order designates “health care workers” as “critical infrastructure workers,” or those necessary to sustain and protect life. Thus, medical practices have been permitted to remain open, provided that they comply with all requirements imposed by Executive Orders that apply to medical practices, including limiting in-person staff to only those necessary to sustain and protect life (e.g., healthcare workers) or to conduct basic operations (e.g., employee benefits, billing, etc.), postponing non-essential medical procedures, conducting screenings of all staff members and patients, implementing social distancing measures to the extent feasible, etc.
Executive Order 2020-17 imposes temporary restrictions on non-essential medical and dental procedures that are not necessary to address a medical emergency or to preserve the health and safety of a patient. This Executive Order is effective through the end of the state of emergency declared by Governor Whitmer. Thus, unless this Executive Order is rescinded, it is unclear how long “non-essential” procedures will be required to be postponed.
Importantly, Executive Order 2020-17 does not explicitly state that it applies to physician practices and clinics and does not explicitly require the postponement of all non-essential medical procedures. However, it should be treated as applicable, given its broad scope and the State’s position that Executive Order 2020-7 (predecessor to Executive Order 2020-37) applies to medical practices. Given that the purpose of the Executive Order is to minimize patient and healthcare worker exposure to COVID-19 and to reduce the overall demand on personal protective equipment (PPE) supplies, even in the absence of Executive Order 2020-17, medical practices should continue to adhere to guidance issued by the CDC and other medical associations and organizations for which medical procedures may resume and when they may resume. This may include resuming certain office visits and medical procedures in phases (as opposed to immediate business-as-usual) based on factors such as community progress towards reducing the incident of COVID-19, availability of staff and PPE supplies, protocols established by inpatient or outpatient facilities, and the overall necessity of the medical visit and procedure. In addition, medical practices should continue to consider using telemedicine as an option for patient visits that do not have to be conducted in-person. Medical practices should refer to guidance and notices that may have been issued by Medicare, Medicaid and other third-party payors concerning any modifications to reimbursement guidelines for telemedicine services.
The CDC recently issued guidance for re-opening facilities to provide non-essential, non-COVID-19 healthcare under Phase One of President Trump’s Guidelines for Opening Up America Again. The CDC’s guidelines are available here. The Guidelines for Opening Up America Again may be found here.
Does my medical practice have to screen patients for COVID-19 risks?
Executive Order 2020-37’s screening requirement applies to all individuals that “are not under the care of the facility” each time the individual seeks to enter the facility. Patients presenting to a medical practice for treatment may be considered “under the care of the facility” and therefore not subject to the screening requirements under this Executive Order. However, the CDC has issued guidance called “Get Your Clinic Ready for Coronavirus Disease 2019” which provides helpful tips on protecting patients and healthcare workers, including screening patients during reminder calls before they arrive to the practice and handling patients who present with symptoms and still need to be treated in-person. Both the CDC’s guidance for clinic preparedness and the CDC’s guidance for re-opening facilities recommend that patients be screened prior to entering the clinic or facility.