Although physician offices were always classified as essential businesses under the Pennsylvania Emergency Closure Rules, and could always have remained open, many physician practices nevertheless opted to close the practices, reduce hours, or remain only open for emergency patients. Now that Pennsylvania is reopening to all businesses in stages, we thought it would be valuable to have a source of curated information specifically applicable to the reopening of physicians’ offices, similar to the COVID-19 Private Practice Checklist published by ACMS on March 19, 2020.

We believe the risk issues can be separated into four basic categories:

  1. Patient management
  2. Facility management
  3. Staff protection
  4. Patient consent forms and waivers

Patient management

The scheduling, management and testing of patients returning to the practice, and prioritizing their treatment based upon the severity of their medical conditions, will be one of the most challenging aspects of reopening the practice, if only because of your lack of actual control over patients’ conduct.

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I started this narrative 17 days into my “house arrest” resultant from the COVID-19 pandemic. Unfortunately, despite having more free time than I cared to admit, I was too worried and preoccupied to continue my chronicle. I had been confined to “house arrest” several times previously. Twice while recovering from extensive orthopedic surgery and again as a precaution secondary to life-threatening neutropenia. But this time is very different. “House arrest” is the norm, especially for those in my demographic group. I don’t have a friend or family member to help navigate the outside world for me. I can’t invite the outside world in.

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Welcome to the second quarter of 2020! The coronavirus pandemic has changed the way physicians interact with their families, practice medicine and spend money. Perhaps you’ve been on the front lines in the critical care units. Perhaps you’ve been seeing patients by telemedicine or fielding lots of phone calls and trying to figure out how to get paid for what you do. Perhaps you’ve been isolating at home with not a lot to do, spending more time with family and doing some online CME. The question on your mind might be: When this pandemic ends, what position will I be in?

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Within a few weeks, COVID-19 has transformed our lives, medical practices and global networks in frightening and devastating ways. Yet at the same time, it has been remarkable to observe how the scientific community is working together at almost lightning speed to acquire and disseminate knowledge on the virus. Our understanding of the virus is expanding daily thanks to this collective effort.

Dermatologists across the world have been actively documenting cutaneous manifestations in patients with COVID-19. One of the first studies emerged from Italy in March. They followed 88 hospitalized patients with COVID-19 and found that 20% developed skin findings.

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At the time I write this, we are all warily preparing to reopen the economy, and most of us are fearing the rebound surge that may occur in the four to six weeks after the population emerges and encounters interstate travelers and potential homegrown super-spreaders.

We’ve had weeks to prepare, assemble equipment and debate strategy. I think the best strategy we can adopt no matter what other measures are taken is the one that’s being employed in Asian countries that have lived through the SARS epidemic: universal masking. Between this policy (already in effect by state order for businesses), six-foot social distancing and the reduced population density of Pittsburgh, we might have a decent chance of remaining relatively unscathed compared to New York, Chicago and New Orleans until a successful vaccine is widely available.

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As I write this, the COVID-19 crisis is in full swing in New York City. Boris Johnson was in the ICU in the UK. Pittsburgh is still bracing for the surge here, and every day brings a few more deaths. I have no idea where we will be at time of publication, so I won’t talk about theories, or treatments, or vaccines, or politics.

Instead, I want to thank each and every one of you for what you are doing and for what you are about to do, regardless of the course of this pandemic in our area. We may be hit hard; we may be relatively spared in the first wave only to be hit hard in the second as restrictions loosen.

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Like most attorneys in the spring of 2020, I am working from home and composing this article on my laptop. Most of what I do can be done from anywhere that has an internet connection. Many forms of medical evaluation and treatment also can be performed remotely via commonly available technology. In some cases, telemedicine was already permitted, if not commonly used, before the advent of the novel coronavirus, COVID-19, and in other situations a number of regulatory and reimbursement barriers have been modified to respond to the crisis.

First, we should define what we mean by “telemedicine.”

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Laws regulating advance care planning (ACP) have been in place in all 50 states since 1992 to help assure that patients receive care at the end of life that is consistent with their values and treatment preferences. However, according to the American Association of Retired Persons (AARP)1, at this time, fewer than 40 percent of U.S. adults have created a living will.

Goal of advance care planning

The goal of advance care planning (ACP) is to allow patients to retain control over the life-prolonging treatment they receive. It is a process that at its best includes communication between patients, their family, and their healthcare providers and is done with consideration of the patient’s relationships and culture.

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*See bottom of article for information on a virtual Physician Wellness Program hosted by Dr. John.

Our work as physicians is extremely rewarding. But the demands of today’s healthcare system also can create stresses that lead to burnout. It’s important that we find a balance.

Physicians are constantly asked to perform many demanding tasks without the needed support to accomplish them. Studies have identified a multitude of different factors that contribute to physician burnout. You can certainly relate to some of these factors, such as:

  • Spending time on the phone with prior authorization peer-to-peer appeals instead of spending time in an exam room with patients
  • Losing sleep over paperwork, patient satisfaction ratings, RVU requirements, quality measures, MIPS and MACRA 
  • Pajama Time at night completing patient notes with your computer instead of quality time with your family
  • A sense of loss of control with the demands of an overwhelming workload

How can we achieve wellness and resiliency?

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Opinion

Editorial
Thank you
Deval (Reshma) Paranjpe, MD, MBA, FACS

Editorial
Finding my niche: The role of mentors
Andrea G. Witlin, DO, PhD

Perspective
Artificial intelligence in medicine: Is the genie out of the bottle?
Bruce L. Wilder, MD, MPH, JD

Perspective
How to take action against physician burnout
Lawrence R. John, MD

Departments

Society News
Pennsylvania Geriatrics Society – Western Division
Membership Benefits
In Memoriam 
Paul S. Caplan, MD
Classifieds 

Articles

Materia Medica 
Ferric maltol (Accrufer®): A novel option for oral iron replacement
Karen M. Fancher, PharmD, BCOP

Legal Report 
Telemedicine in the time of pandemic
William H. Maruca, Esq.

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