Telehealth visits

  • CMS implemented new telehealth guidance on March 17, 2020
  • Clinicians may now care for new or existing patients remotely in any healthcare facility and in their home
  • Allows for billing of E/M service, voice-only services and electronic/telephone/internet communications with patient or inter-professional assessment and management
  • Services are billed as if the service had been furnished in-person
  • State and commercial payer guidance varies
  • Rules are changing frequently
  • Healow is enabled for telehealth visits via the portal
  • Vivify Health is being rolled out to monitor employees who have COVID symptoms

See real time updates to the telehealth policies on the Atlas Telehealth Hub

Telehealth Visit

  • Interactive audio & video
  • Verbal consent
  • Real-time
  • All settings
  • Document provider time
  • Bill normal E/M CPT codes
  • All patients not just COVID-19

Virtual Check-In

  • Phone conversation (G2012)
  • Recorded video and/or images submitted & phone conversation (G2010)
  • Verbal Consent
  • Initiated by established patient
  • 5-10 minutes

E-Visits

  • Portals, secure email, other digital applications
  • Verbal Consent
  • Initiated by established patient
  • 7 day period

PPE Guidelines for physician practices

As the COVID-19 public health crisis continues to escalate rapidly and the public spread of disease becomes widespread, HCA Healthcare is adapting masking guidelines to continue to care for patients and the community while ensuring the continued protection of all patients and employees. 

As of Monday, March, 30, 2020, HCA PSG implemented universal masking for all staff and providers in patient care areas. Masks will be available, but optional, for any staff in other areas that can consistently maintain social distancing of at least 6 feet.

Our ability to socially distance when providing patient care and within the workspace is limited, so we are implementing these guidelines to protect both our patients and our staff.

We are optimistic that having a universal-masking policy, and practicing effective social distancing will mean we can protect our workforce from viral spread so that they, in turn, can continue to perform critical services for patients in need and serve the community.

Mask etiquette

  • Wear mask throughout your shift
  • Keep your mask on when using the restroom
  • Review donning and doffing to avoid contamination
  • Place your mask in container or bag for storage between uses (i.e. for meal breaks)
  • Change your mask if it becomes wet/damp/soiled
  • Keep your mask over both mouth and nose
  • Perform hand hygiene after any contact with the front of the mask
  • Perform hand hygiene before any contact with a patient
  • Perform hand hygiene after any contact with the environment
  • Perform hand hygiene when moving between dirty and clean tasks

Hospital provider PPE guidelines

Make certain that you are wiping your disposable stethoscopes down with 70% Isopropyl alcohol ONLY.

Clean protective eye wear in between patients per HCA Healthcare guidelines.

Masks

All colleagues, regardless of whether they work in patient or non-patient care areas, are required to wear a mask. Your health and well-being is of the utmost importance and by applying this masking requirement, that exceeds the CDC guidelines, we are continuing to implement precautions to keep our workforce as safe and healthy as possible.

Process:

Upon arriving in your department and receiving patient assignments (for patient-care areas) for the day, the CNC/charge nurse or supervisor will pick up the necessary PPE for each staff member in the designated location. At the end of the shift, the CNC/charge nurse or supervisor will bag and return the N95 masks, face shields and goggles to the same location for reprocessing and disinfection. Level 1 and Level 3 masks should be discarded at the end of each shift.

Mask levels by work area:

All colleagues (except RT, intubation, ER and staff caring for COVID patients)

From PPE Czar:

  • Level 1 Mask

On Unit:

  • Gloves per usual care
Respiratory therapy and intubation team

From PPE Czar:

  • N95 Mask with googles or any face shield
  • Hospital Scrubs for RT
  • Isolation gowns

On Unit:

  • Gloves
COVID or suspect COVID, ED staff

From PPE Czar:

  • N95 or Level 3 Mask with googles or any face shield
  • Hospital Scrubs
  • Isolation gowns

On Unit:

  • Gloves

Masking guidance

Masks should be replaced when wet, damp, torn, visibly soiled or hard to breathe through. When masks are removed for one of these reasons, discard in usual containers. Masks should remain on when using the restroom. However, for meal and water breaks utilize a disposable container to store the mask, with the outside surface of the mask facing down on the container. If at any time you touch the mask, immediately follow with hand hygiene. Do not discard masks between patients.

Gown guidance

Caregivers of isolation patients, including COVID or suspect COVID, will receive up to 15 isolation gowns per patient per shift. For additional gowns, please see your supervisor.

Patient PPE guidelines

PSG PERSONAL PROTECTIVE EQUIPMENT (PPE) FOR PERSONS HIGHLY SUSPECTED OF COVID-19

RowSituationFor highly suspected or confirmed COVID-19Colleague PPE1
1 All patient facing colleagues working in the practice/clinic, per division/market guidance (new 3/30/20) Give Level 1 face mask for active symptoms+ Face mask
2 Patient checking in at the front desk Give Level 1 face mask for active symptoms+ Face mask, gloves
3 Dedicated first point of contact patient screening area (standing within 6 ft. of patient) Give Level 1 face mask for active symptoms+ Face mask, gloves
4 Taking patient history in the exam room Level 1 face mask Face mask
5 Providing direct patient care, including taking vital signs Level 1 face mask Face mask, faceshield or goggles*, gloves
6 Swabbing for COVID-19, influenza, and/or strep test (nasopharyngeal/oropharyngeal tests) Mask removed for specimen collection. Give patient tissues to cover cough/sneeze N95 respirator (if available) or face mask, faceshield or goggles, gown^, gloves
7 Performing peak flow and/or nebulizer treatment Mask removed for treatment N95 respirator (if available) or face mask, faceshield or goggles, gown^, gloves

1Staff may be instructed to wear a face mask during their shift for other reasons (e.g., declined flu shot, known COVID-19 exposure)

+Fever, cough, difficulty breathing/shortness of breath, sneezing/runny nose, body aches (other than from injury), new rash with fever, travel to a geographic area with widespread ongoing transmission

*Faceshield (preferred) or goggles, if available. If faceshield and goggles are unavailable, colleague should continue to wear a face mask

^If gowns are no longer available, procedure may continue and is still considered low risk of exposure to colleague

Visitation policy for patients

To help reduce the spread of respiratory illnesses, we have restricted all non-essential visitors. We will allow exceptions for:

  • One dedicated parent or caregiver for minor patients who cannot be left alone.
  • One dedicated partner for those with disabilities or impairments warranting assistance from a companion.

Please note that any individual granted an exception who screens POSITIVE for respiratory illness will not be allowed in our facilities.

Labor/delivery patients

  • One support person for labor and delivery patients throughout their hospital stay.
  • One parent or guardian at a time for neonatal intensive care unit (NICU) babies.

Elective surgeries

As of Monday, March 23, HCA Midwest Health began postponing elective surgeries and procedures. This will assist in reserving supplies, resources, and blood products for future patient needs. This decision is consistent with recommendations from the American College of Surgeons, the Surgeon General of the Unites States, the White House Coronavirus Task Force, and CMS.

  • Tier 2: All cases should be postponed unless deemed clinically necessary
  • Tier 3: Continue cases as previously instructed. 

Provider screening at entrances

As the COVID-19 outbreak continues to rapidly evolve, HCA Midwest Health has instituted further heightened precautions to safeguard our patients, colleagues and physicians.

All providers, including physicians and staff, will now be screened using screening questions and a temperature check each time they enter our facilities. Physicians and staff will also be asked to complete hand hygiene with alcohol-based sanitizer before entering.

Thank you for your support and cooperation as we work together to slow the spread of COVID-19.

Testing

To assist you in responding to patient questions about testing in your practices and clinics, we have developed a new sign and “no testing” script for staff. These have been posted on the IP, under Operations, to communicate why testing is not being offered at most of our practice and clinic locations at this time.  

It is important to note that testing does not change the course of treatment in the ambulatory setting, and over-testing is leading to long turn-around times for acutely ill patients in the hospital who need a confirmed diagnosis for treatment. 

See real time COVID-19 updates on PSG COVID-19 IP site