Ongoing coronavirus (COVID-19) updates and resources for integrative healthcare professionals

Practice Management Considerations

As healthcare facilities begin to relax restrictions on services provided to patients in accordance with guidance from local and state officials, there are precautions that should remain in place as a part of the ongoing response to the COVID-19 pandemic. Integrative practitioners should develop a thorough clinic protocol considering official guidelines and recommendations.

The CDC recommends additional infection prevention and control practices in addition to standard practices that are already a part of routine healthcare. These include:

• Continued use of telehealth strategies
• Instruct patients to reschedule appointments if they have symptoms
• Advise patients to put on a face covering before entering the facility
• Develop a triage protocol for patients with possible COVID-19 requesting evaluation and manage such patients from home when possible
• Screen and triage everyone entering the facility for COVID-19 signs and symptoms
• Take steps to ensure that everyone adheres to source control measures and hand hygiene practices while in the facility
• Limit and monitor points of entry to the facility
• Consider establishing screening stations outside the facility
• Properly manage anyone with symptoms of COVID-19 or who has been advised to self-quarantine
• Implement universal source control measures
• Encourage physical distancing
• Implement universal use of personal protective equipment
• Develop targeted testing protocols
• Consider if elective procedures or non-urgent visits could be postponed
• Implement physical barriers and dedicated patient flow pathways
• Explore options to improve indoor air quality in shared spaces
• Create process to respond to COVID-19 exposures
• Establish reporting within and between healthcare facilities and public health organizations 

Telemedicine

The use of telehealth technologies is widely recommended to protect both practitioners and patients. General telemedicine resources include:

• HIPAA Guidance on Telemedicine
• Medicare Telemedicine Health Care Provider Fact Sheet
• Medicare Telehealth Frequently Asked Questions (FAQs)

The Centers for Medicare & Medicaid Services (CMS) issued multiple waivers, providing flexibility during the pandemic, and granting payment parity between telehealth and in-person clinical care for Medicare. Check with your state health department to confirm whether your services are covered under the state Medicaid program.

Additionally, the COVID-19 Telehealth Program provides $200 million in funding, appropriated by Congress as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to help healthcare practitioners provide connected care services to patients at their homes or mobile locations in response to the COVID-19 pandemic. The program provides immediate support to eligible healthcare providers responding to the COVID-19 pandemic by fully funding their telecommunications services, information services, and devices necessary to provide critical connected care services. Click here for more information.

Many electronic medical records (EMRs) offer integration with HIPAA-compliant telehealth platforms. For practices with an established EMR, this may be a viable option. However, there are several compliant platforms, including:

• Doxy.me
• AMC Health
• swyMed
• Teladoc
• Mend

Note, a HIPAA-compliant platform may be required for insurance reimbursement.

Triage

When scheduling appointments for routine medical care, instruct patients to call ahead and discuss the need to reschedule their appointment if they have symptoms of COVID-19 on the day they are scheduled to be seen. If they don’t have symptoms of COVID-19, advise them that they should still put on their own cloth face covering before entering the facility.

When scheduling appointments for patients requesting evaluation for possible COVID-19, use nurse-directed triage protocols to determine if an appointment is necessary or if the patient can be managed from home.

If the patient must come in for an appointment, instruct them to call beforehand to inform triage personnel that they have symptoms of COVID-19 and to take appropriate preventive actions.

Although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals with COVID-19, symptom screening remains an important strategy to identify those who could have COVID-19 so appropriate precautions can be implemented.

Source Control Measures

Take steps to ensure that everyone adheres to source control measures and hand hygiene practices while in a healthcare facility. Post visual alerts, such as signs or posters, at the entrance and in strategic places like waiting areas and elevators to provide instructions in appropriate languages about wearing a cloth face covering or facemask for source control and how and when to perform hand hygiene.

Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand sanitizer with 60-95 percent alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins.

Healthcare professionals should always wear a facemask while they are in the healthcare facility, including in breakrooms or other spaces where they might encounter co-workers. They should also wear eye protection in addition to their facemask to ensure the eyes, nose, and mouth are all protected from exposure to respiratory secretions during patient care encounters, and wear an N95 or equivalent or higher-level respirator, instead of a facemask, for aerosol-generating procedures and surgical procedures.

Healthcare delivery requires close physical contact between patients and the healthcare professional. However, when possible, physical distancing of at least six feet between people) is an important strategy to prevent COVID-19 transmission. Practitioners should consider:

• Limiting visitors to the facility to those essential to the patient’s care
• Scheduling appointments strategically to limit the number of patients in waiting rooms
• Modifying in-person group healthcare activities to virtual methods or scheduling smaller sessions while having patients sit at least six feet apart

Office Considerations

To reduce or eliminate disease exposure, practice managers should consider implementing physical barriers and dedicated pathways to guide symptomatic patients through triage areas, remote triage facilities for patient intake areas, and outdoor assessment and triage stations for patients with respiratory symptoms, if possible.

Additionally, explore options to improve indoor air quality in all shared spaces, such as optimizing air-handling systems, ensuring appropriate directionality, filtration, exchange rate, proper installation, and up-to-date maintenance. Portable solutions, like HEPA filtration units, are reasonable alternatives to augment air quality in areas when permanent air-handling systems are not a feasible option.

Proper cleaning and disinfecting protocols should be followed.

Practitioner Exposure Risk

The potential for exposure to COVID-19 is not limited to direct patient care interactions. Transmission can also occur through unprotected exposures to asymptomatic or pre-symptomatic co-workers in breakrooms or co-workers or visitors in other common areas. Therefore, practitioners should:

• Emphasize the importance of source control and physical distancing in non-patient care areas.
• Provide family meeting areas where all individuals can remain at least six feet apart from each other.
• Designate areas for healthcare professionals to take breaks, eat, and drink that allow them to remain at least six feet apart from each other, especially when they must be unmasked.

Staffing Considerations

For integrative healthcare professionals who manage clinics and other providers, there are steps practice managers should take, including updating leave policies to support employees who need to stay home if they or a household member are sick. Practice managers should instruct providers who become sick with a fever or other symptoms to stay home and return only after they are free of symptoms for at least 24 hours.

Practice managers should also consider creating or updating policies for employees who must stay home to care for sick family members or children who cannot go to school.

Additionally, practice managers should plan for employee absences due to illness by identifying essential functions, creating plans for community operations, and cross-training employees to perform essential functions.

Click here for more information on supporting your clinic staff. 

Communicating with Patients

Integrative healthcare professionals should communicate facts, not fear, and encourage following public health guidelines. The American Association of Naturopathic Physicians suggests the following:

• Communicate only evidence-based, accurate information.
• Reassure patients and the public regarding fears and discourage biases.
• Reinforce the importance of social distancing.
• Reinforce their role in supporting the global and local community efforts of containment.
• Use social media to inform the public of what steps your clinic is taking to reduce the spread and accommodate patients.
• Whenever possible, include citations for public education materials.
• Refrain from posting medically inaccurate or unsubstantiated claims regarding any potential therapies with relation to COVID-19.
• If you see misinformation from other providers, assume best of intentions and reach out to the individual privately.

Practitioner Self-Care 

Vaccination and treatment tracking continued on next page