PPE Shortages Put Medical Staff & Patients at Risk

Personal Protective Equipment (PPE) shortages are proving to be the biggest hurdle in providing COVID-19 care, with 85% of primary care practices unable to access protective equipment and testing for in-person patient visits. Telehealth appears to be the only viable alternative, with President Trump  endorsing it and expanding its benefits for Medicare Beneficiaries.

As reports of significant Personal Protective Equipment (PPE) shortages are  pouring in from different states hit by the coronavirus pandemic, primary care practices seem to be the hardest hit by disruptions in supplies.

A weekly survey recently conducted by the Primary Care Collaborative and the Larry A, Green Center determined that PPE shortages had considerably slowed down the COVID-19 testing at many health practice centers. 

Nearly three-quarters of respondents, according to the survey, worked in a practice having three clinicians, and came from five different states: Virginia, Colorado, California, Pennsylvania and New York, which is experiencing the highest number of COVID-19 cases. 

Physicians are desperately looking for supplies, as one respondent in the survey noted that they had a patient two days ago, who needed to have been tested, but since she hadn’t travelled internationally, or supposedly did not not have a known contact with COVID, she had tested flu negative. Despite the prevalence of COVID in the area of the practice, they are unable to monitor patients the way they should be doing it.  

Other than primary care practices waiting for PPE, a survey by Premier found that 86 percent of health systems were greatly affected by shortages of PPE, including gowns, gloves, face shields, and face masks.  

Likewise, senior living facilities too according to a survey cannot access PPE needed for COVID-19 containment plans, with two-thirds of the facilities unable to access  N95 face masks, being the most critical aspect of  PPE supplies. 

Nearly 80 percent of PPE supplies come from Asia according to Premier, the key countries include China, Taiwan, India, and South Korea, and with lockdowns announced in some of these countries grappling with COVED-19, supply lines have severely been affected.

Without proper protective gear medical staff not only put themselves at risk, but other patients as well. Medical protocols require a physician  treating a patient with COVID-19  to remove any gear exposed to the patient and the virus, the shortages are forcing them to disinfect the gear, and immediately reuse it, significantly increasing the risk of exposure.

With inadequate PPE or without any PPE, when healthcare workers enter patient rooms they are at risk of becoming disease carriers,  and when they enter the room of a subsequent patient or meet family members at home, the disease has the potential to spread unintentionally. 

With President Trump endorsing and expanding telehealth benefits for medicare beneficiaries  to combat COVID-19 outbreak, a wide range of healthcare services can be accessed by beneficiaries from their doctors, without having to travel to the healthcare facility. Center for Medicare & Medicaid Services (CMS) will be the administrative authority for temporarily paying clinicians providing telehealth services to beneficiaries across the country.

Assume that a Medicare patient walks into a rural health clinic with complaints of headache, nausea and vomiting. At the originating site, a clinical staff employee will escort the patient to a room, and using audiovisual equipment, the patient can interact with the provider. The necessary history will be performed by the provider, while the clinical information, such as the vital signs, requested by the provider will be obtained by the clinical staff employee

Any diagnostic tests ordered by the provider are performed onsite, depending on the availability of the appropriate equipment and personnel at the clinic. The patient assessment and plan to be discussed with the patient is rendered by the provider. 

Following an expanded problem-focused exam and moderate medical decision-making, the provider during this new patient encounter, documents a detailed history. Information included in the documentation states that the services provided to the patient were through telehealth, the information will also include  the location of the patient and the provider and the names of other staff rendering the service.  

Typically, for these distant site encounters, CPT code 99202 is billed with POS code 02 for the professional provider’s service. HCPCS code Q3014 can be reported by the originating site providing the service. Coding guidelines available right here.

The telehealth service documentation requirements are similar to face-to-face encounters. It includes information of the visit, the history, review of systems, and consultative notes. It may also include any information used to make a medical decision about the patient. The documentation protocols require that  the statement  must include that the service was provided through telehealth, including the location of the patient, and the names and designation of any other personnel involved in providing the telehealth service. 

Guidelines for final instructions on billing and documentation requirements for telehealth services can be accessed through local Medicare Administrative Contractor (MAC). The guidelines set forth by Medicare can also be followed by private payers, they can also follow  their own guidelines. 

As patient outcomes improve through an efficient telehealth network, more services may be approved for reimbursement. Payment policies and criteria may also change, with more payers covering telehealth services.

The COVED-19 has had a severe impact on staff turnover, especially the billing and coding staff. One of the most critical aspects during an outbreak is having the billing office running, so that hospitals and practices remain open for infected individuals requiring care. Understandably, COVID-19 demands are going to be a challenge for smaller organizations, with limited cash on hand, it is to be seen how they cope with these challenges. 

The COVED-19 has had a severe impact on staff turnover, especially the billing and coding staff. One of the most critical aspects during an outbreak is having the billing office running, so that hospitals and practices remain open for infected individuals requiring care. Understandably, COVID-19 demands are going to be a challenge for smaller organizations, with limited cash on hand, it is to be seen how they cope with these challenges. 

Health systems promoting telehealth will also have to overcome billing staff turnovers. Assigning telehealth billing responsibilities to remote billing teams or companies can be  explored through collaboration with billing companies that are able to designate telehealth billing staff at short notice, considering the emerging health emergency.

The software for telehealth billing can be accessed from the billing companies on the basis of SaaS, and telehealth operations can be established without any infrastructural cost to the health facility. Looking at the current scenario, telehealth appears to be the only solution to effectively combat COVED-19, and prevent the spread of the deadly virus that has accounted for 3000 deaths in the US today, and  affected over 160,000 people nationwide.