By: Mark T. Abell and Alaina N. Crislip
Hospitals should anticipate coronavirus patients filling hospital beds from coast to coast based on projections for COVID-19 spread. Healthcare workers, and healthcare providers may become patients needing treatment for the virus resulting in possible shortages of staffing at hospitals, urgent care centers, and even nursing homes.
Hospitals should have policies in place related to the credentialing of medical staff for their facilities. For some facilities, the credentialing process can take weeks or months. But when there is a public health emergency (like Coronavirus) and more healthcare providers are needed, facilities should review their policies to see if there is an expedited path for credentialing of medical staff and advance practice nurses. If not, the hospitals should consider creating one. Such a policy may provide exceptions to some of the usual credentialing guidelines like having one committee, rather than multiple, consider an application for privileges. The policy could also limit the privileges given to someone who has been through expedited credentialing or may limit the time in which those limited privileges may be exercised. Some hospitals may have policies respecting expedited credentialing in their contingency plans or emergency plans.
A documented plan and guidelines can protect these medical facilities when expediting credentials. This policy should be reviewed to ensure that it protects not only patients by enabling appropriate medical and nursing staff will be on hand for treatment, but that the plan must also protect the facility when granting expedited privileges. Counsel can assist in advising on revising or updating policies/procedures for credentialing, either on its own or as part of a contingency or emergency plan.
During times of crisis, staff is the hospital resource most at risk for inadequate supply. If a facility brings in outside workers through a locum tenens arrangement to provide adequate staffing the hospital must consider issues including: credentialing, billing, and insurance coverage. Facilities may also need to devise a plan for implementing service restrictions to preserve staff resources for higher priority tasks. Decisions need to be made concerning what the triggers may be for when (or if) a facility must temporarily stop performing elective surgeries or procedures to better accommodate patients with emergent, possibly life-threatening conditions. Having a solid contingency plan for these matters is key if several years down the line there is litigation concerning how these procedures may have impacted patient care.
Hospitals should consider if the facility can appropriately increase services through alternate means, such as telemedicine. While payment for telemedicine care is an issue for many healthcare providers, in many states insurance commissioners and/or states are pushing for insurers to review and make sure that their telemedicine services are robust. If the facility already has some telemedicine capabilities implemented, there may be ways in which to increase the use of those services and limit the number of patients arriving at the hospital emergency department, particularly when they may be carrying a communicable virus. Facilities may also want to consider setting up separate on-site triage facilities as permitted by new CMS guidance provided under EMTALA . Due to the current Coronavirus pandemic, specific guidelines for utilizing these areas have been developed and can be used by healthcare facilities. See https://www.cms.gov/files/document/qso-20-15-hospitalcahemtala.pdf