The world has been drastically impacted by the emergence of the novel coronavirus known as COVID-19. Coronavirus disease 2019 has now made its way around the globe to the United States and to New York. Whatever the nature of your medical practice, no one is untouched by the COVID-19 outbreak. The challenges associated with providing the best care and treatment to your patients—as a result of COVID-19 or otherwise—are enormous.
PRI recognizes the gravity of the changing clinical world caused by the rapidly evolving COVID-19 pandemic. Medical professionals possess the ability to think critically with expert clinical judgment and decision-making skills, and it is this skillset that is essential during this pandemic. Thank you for your continued and heightened service and commitment to your patients and communities in this time of crisis.
We Are Here for You
While our medical professionals and facilities are facing intense disruptions in supplies, services, and staff, we would like to assure you that PRI is fully operational and available to you as a resource. At the outset of the COVID-19 outbreak, PRI developed contingency plans to ensure that our operations remain intact and uninterrupted should New York become affected. From our underwriters to our claims representatives, and everyone in between, PRI is at your service. For our policyholders facing disruptions to their practice and potential financial hardship, PRI is here to assist you. Please contact PRI’s Underwriting Department (800) 632-6040 ext. 4334 or underwritingcontact@medmal.com so we may identify solutions that work best for you.
For information regarding the 60-day grace period for cancellation, conditional renewal or non-renewal of your policy and deferment of late premium as a result of COVID-19 hardship, Click Here.
COVID-19 Physician Peer Support
PRI’s Physician Peer Support program is always available for you. Your colleagues have been finding it immensely valuable during this COVID-19 crisis to know that they are not alone in dealing with the stresses of the profession which can often leave you feeling exhausted, isolated and frightened. Fearfulness knows no bounds for your patients’ safety, your safety, and the safety of your loved ones when you return home after a seemingly unending day. By calling (516) 277-4329, you can be connected to a physician peer to share a private and confidential conversation, just the two of you.
If you prefer to be in a larger setting, PRI has multiple weekly complimentary Virtual Support Groups on Coping with COVID-19 which your fellow physicians have been utilizing and finding great comfort and support from.
Every Tuesday and Thursday from 5:30 – 6:30PM EDT, Joseph Weiner MD, PhD facilitates complimentary Virtual Peer Support Groups to all members of the healthcare team in New York and beyond during the COVID-19 Pandemic. We are not limiting this group to physicians and nurses – all healthcare workers are welcome. Dr. Weiner is an Associate Professor of Clinical Psychiatry, Medicine and Science Education in the Zucker School of Medicine at Hofstra/Northwell. He is an expert in crisis management with healthcare professionals. For more information on the Tuesday and Thursday group, visit: COVID-19 Virtual Group Support for Medical Professionals and Healthcare Workers.
Additional Support Resources
New York State is partnering with Headspace, a global leader in mindfulness and meditation, to offer free meditation and mindfulness content. This may serve as a useful resource for your patients: www.headspace.com/ny
The New York State Office of Mental Health has also established a COVID-19 Emotional Support Hotline @ 1-844-863-9314. According to the Office of Mental Health, the Emotional Support Line provides free and confidential support, helping callers experiencing increased anxiety due to the coronavirus emergency. The Help Line is staffed by volunteers, including mental health professionals, who have received training in crisis counseling.
Key Links to COVID-19 Resources
AMA COVID-19 (2019 novel coronavirus) Resource Center for Physicians
The Lancet COVID-19 Resource Center
CDC Coronavirus Disease 2019 (COVID-19) Information for Healthcare Professionals
CDC Coronavirus Disease 2019 (COVID-19) Information for Healthcare Facilities
FDA Coronavirus Disease 2019 (COVID-19)
NIH Coronavirus Disease 2019 (COVID-19)
NYC.gov Coronavirus Disease 2019 (COVID-19) — Information for Providers
Information on how to identify and contact your local New York Department of Health office
Health.NY.gov Novel Coronavirus (COVID-19)
USA.gov Government Response to Coronavirus, COVID-19
UpToDate Open Access COVID-19 Content
COVID-19 Special Topics
Telemedicine and PRI Policy in the COVID-19 Pandemic
Malpractice claims arising from medical services related to the use of telemedicine are covered under policyholders’ policies subject to the terms, conditions, and exclusions identified in the policy.
Telemedicine and COVID-19 – Risks, Guidance, and Strategies
New York physicians are facing systemic challenges in responding effectively to the needs of their patients, communities and practices amidst this disruptive public health crisis. Many are turning to telemedicine as a means of forward triage, maintaining continuity of care, reducing exposure potential, and “flattening the curve”.
Some practices may be accustomed to using telehealth while a sizable number may be new to telemedicine. While the latter population may have more risks to consider, those who already use telemedicine may be under pressure to apply telemedicine to novel patient situations.
As healthcare providers seek to employ telemedicine technologies, it is important to consider the potential risks of telemedicine as well as strategies to reduce risk.
Risks of telemedicine include:
- The same standards of care which apply to in-person patient encounters are applied to physicians practicing telemedicine.
- Delays in medical evaluation and treatment due to failures of technology, such as a disconnected phone call.
- Lost information due to technical failures.
- Vulnerabilities of patients’ personal health information (PHI)
- A lack of access to complete medical information leading to adverse drug interactions, allergic reactions, or other judgment errors.
- An inability to have direct, physical contact with patients, reducing the thoroughness of patient assessment.
Guidance and strategies for reducing telemedicine risk include:
- Be aware that when using telemedicine to treat patients in New York, most requirements of an office visit apply.
- Practice within the scope of your specialty.
- Educate patients on the limitations imposed by telemedicine as part of the telemedicine informed consent discussion with the patient.
- Follow-up care may need to be equitable or more frequent for telemedicine encounters when compared to in-person patient care.
- Be cognizant that providing professional advice or treatment via telemedicine, even if gratuitous, will be considered the establishment of a physician-patient relationship, and physicians will be beholden to all the obligations associated with a physician-patient relationship.
- Have a plan in place to advise patients on appropriate courses of action should it be determined that the telemedicine encounter is inadequate for the patient’s medical needs.
- Ensure staff is adequately trained to support the practice’s use of telemedicine.
- Establish patient’s location at time of virtual visit to ensure that the patient is in a jurisdiction where the physician/provider is licensed. Additionally, stay abreast of changes to state licensure requirements as they are changed throughout the COVID-19 Pandemic and thereafter.
- Carefully advise patients as to the care plan and ensure that the plan is understood by the patient.
- Ensure that the environment for both patient and provider is professional and does not compromise patient confidentiality.
- Thoroughly document each encounter and ensure that documentation is integrated into the patient’s formal record.
- When using telehealth for screening potential COVID-19 cases, document denial of key symptoms, exposure to others with symptoms or confirmed diagnosis. Document advice given to the patient if symptoms fail to improve or if new or escalating symptoms appear.
- Establish a contingency plan with the patient should the telemedicine encounter get disconnected.
- Ensure that services provided by means of telehealth are in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and all other relevant laws and regulations governing confidentiality, privacy, and consent (including, but not limited to 45 CFR Parts 160 and 164 [HIPAA Security Rules]; 42 CFR, Part 2; PHL Article 27-F; and MHL Section 33.13).
- Ensure that your telemedicine service is in compliance with federal and state laws governing healthcare translation services.
New York State Department of Financial Services (DFS) Telehealth Information
The DFS has issued guidance on telehealth during the COVID-19 pandemic. For answers to important questions such as: “Are insurers required to cover telehealth visits?”, “Does a telephone call qualify as telehealth service during the state of emergency?”, “What settings/locations are acceptable for providing and receiving telehealth services?”, visit: Department of Financial Services – Information for Insurers and Providers on Coverage for Telehealth Services.
To review the Insurance Circular Letter No. 6 (2020) issued by the DFS to all Insurers Authorized to Write Accident and Health Insurance in New York State, Article 43 Corporations, Health Maintenance Organizations, Student Health Plans Certified Pursuant to Insurance Law § 1124, Municipal Cooperative Health Benefit Plans, and Prepaid Health Services Plans, visit: Department of Financial Services – Insurance Circular Letter No. 6 (2020).
What are the Seven Metrics for Opening New York?
MONITORING NEW INFECTIONS
Metric #1: Decline in Total Hospitalizations
The Centers for Disease Control and Prevention (CDC) recommends that reopening be dependent on a downward trajectory of hospitalizations and infections over a 14-day period. Before a phased re-opening begins, a region must experience a sustained decline in total net hospitalizations – the total number of people in the hospital each day, calculated on a three-day rolling average – over the course of a 14-day period.
Metric #2: Decline in Deaths
Before reopening, a region must experience a sustained decline in the three-day rolling average of daily hospital deaths over the course of a 14-day period.
Alternatively, regions that have seen few COVID cases overall will satisfy this metric if the three-day rolling average of daily new hospital deaths has never exceeded 5.
Metric #3: New Hospitalizations
In addition to monitoring the decline in disease trajectory, it’s important to monitor the absolute level of infection in each region. This is because it’s possible for a region that has seen a high level of infections – for example, New York City – to see a sustained decline in hospitalizations and deaths over a 14-day period, while still having an underlying infection rate that is too high to allow for a safe phased re-opening.
HEALTH CARE CAPACITY
Upon the recommendations of public health experts, every region must have the healthcare capacity to handle a potential second surge in cases – regions must have at least 30 percent of their total hospital and ICU beds available at all times.
Metric #4: Hospital Bed Capacity
In addition to ensuring that disease progression is contained, guidance from both the CDC and World Health Organization (WHO) require that regional health system capacity remain sufficient to absorb a potential resurgence of new cases. Phased re-openings will therefore be conditioned on the hospital bed capacity in each region. Regions must have at least 30 percent of their total hospital beds available before a phased re-open can begin.
Metric #5: ICU Bed Capacity
Nearly 30% of hospitalizations for COVID-19 ultimately require critical care. Regional health care systems must not only maintain sufficient bed capacity for a potential resurgence in cases, but also achieve sufficient capacity for ICU beds specifically. Regions must have at least 30 percent of their ICU beds available before a phased re-opening can begin.
To ensure needed personal protective equipment (PPE), every hospital must have at least 90 days of PPE stockpiled. The State is working with the hospitals, nursing homes, and other facilities to develop a timeline to build a robust stockpile.
DIAGNOSTIC TESTING AND CONTACT TRACING CAPACITY
The key to controlling the virus is aggressive testing and tracing, so that hotspots can quickly and effectively be isolated.
New York has scaled up testing at rates higher than any state or country in the world. Testing identifies the full rate of spread. Regions can watch that rate move, and adjust their reopening strategies as needed.
Widespread testing is also key to effective contact tracing. This allows health officials to identify asymptomatic carriers, who are spreading the virus undetected, and isolate them before they infect others.
Metric #6: Diagnostic Testing Capacity
Widespread diagnostic testing is a key lynchpin to which containing the spread of the virus depends. Testing is critical to identifying new infections, isolating them, and tracing their contacts. Phased re-openings will depend on the ability of each region to achieve 30 tests per 1,000 people per month, consistent with the recommendation of the White House Coronavirus Task Force.
Metric #7: Contact Tracing Capacity
The CDC and WHO also recommend that robust contact tracing programs be in place before local governments consider easing restrictions. Contact tracing helps prevent the spread of COVID-19 by rapidly interviewing positive patients; identifying their close contacts; interviewing and alerting those contacts to the risk of infection; and instructing those contacts to quarantine or isolate for 14 days. The New York State Department of Health (DOH) has partnered with former New York City Mayor Michael Bloomberg, the Johns Hopkins University School of Public Health, and Vital Strategies to recruit and train an army of contact tracers to meet the needs of each region statewide, including from State, City and County Health Departments. In collaboration with these partners, DOH has established region-specific thresholds for the number of contact tracers required, based on the characteristics within each region.
How does contact tracing help prevent the spread of COVID-19?
Through four key steps:
- First, labs report positive cases of COVID-19 to contact tracers on a daily basis via a state reporting system.
- Contact tracers then interview positive patients to identify people they may have been in contact with over the past 14 days. Based on the results of the interview, tracers will advise the positive individual to get tested, and either isolate or quarantine themselves for the following 14 days to prevent further spread of the virus.
- The contact tracer then notifies and interviews each contact of the original positive individual to alert them to their risk of infection, and instructs those contacts to quarantine or isolate for 14 days to prevent further spread.
- Finally, the contact tracer monitors those contacts by text throughout the duration of their quarantine or isolation to see if the contacts are showing any symptoms.
resource: https://forward.ny.gov/metrics-guide-reopening-new-york
Guidance for Reopening Your Practice
PRI COVID-19 Update: Preparations for Opening Up Your Practice.
THIS MATERIAL IS PROVIDED FOR INFORMATIONAL PURPOSES AND IS NOT TO BE CONSTRUED AS DICTATING THE PRACTICE OF MEDICINE.
As always, we are here to support you and to answer any questions you have during this rapidly changing healthcare event. For questions please contact the Underwriting Department at (800) 632-6040 ext. 4334 or email us at underwritingcontact@medmal.com.
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