Dr. Lorna Breen Heroes’ Foundation Hails Senate Passage of Legislation Protecting Healthcare Workers’ Mental Health

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The Dr. Lorna Breen Heroes’ Foundation today praised the U.S. Senate for passing the Dr. Lorna Breen Health Care Provider Protection Act. The legislation is named after Dr. Lorna Breen, a New York City emergency room physician who tragically died by suicide in Spring 2020 after treating confirmed COVID-19 patients, aims to reduce the stigma of seeking mental health assistance among health care professionals.

Jennifer Breen Feist and Corey Feist, co-founders of the Dr. Lorna Breen Heroes’ Foundation released a video praising the bill’s passage.

“We want to take a moment with you to pause and let all those health care professionals know that we heard you and we have been working diligently to support you,” said Jennifer Breen Feist, co-founder of the Dr. Lorna Breen Heroes’ Foundation. “We owe each of you our deepest gratitude for all you’ve done for us and for this country.”

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Looking for confidential support in Virginia? SafeHaven™ was founded in 2020 after recognizing a greater need to provide physicians and PAs the support they need to stay well and prevent burnout. Learn more here.

Health Commissioner Update: COVID-19 Update for Virginia | February 17, 2022

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Dear Colleague:

Thank you for your continued partnership in responding to the COVID-19 pandemic.  Please visit the Virginia Department of Health (VDH) website for current clinical and public health guidance, epidemiologic data, and other information.  Updates on the following topics are included in this correspondence:

  • CDC Updates Vaccine Recommendations for Immunocompromised Individuals and Those Who Received Passive Antibody Products
  • FDA Grants Emergency Use Authorization to Bebtelovimab
  • New Isolation and Quarantine Calculators
  • National Blood Shortage

Read the Full Update

Health Commissioner Update: COVID-19 Update for Virginia | February 10, 2022

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via VDH

Dear Colleague:

Thank you for your continued partnership in responding to the COVID-19 pandemic.  Please visit the Virginia Department of Health (VDH) website for current clinical and public health guidance, epidemiologic data, and other information.  Updates on the following topics are included in this correspondence:

  • State Health Commissioner Issues Interim Guidelines for the Prioritization of the Use of Rapid COVID-19 Tests
  • CDC Recommends FDA-Approved Moderna COVID-19 Vaccine
  • Therapeutics Updates
  • CDC and CMS Updates for Infection Prevention in Healthcare Settings
  • Keeping Up With COVID Video Series

State Health Commissioner Issues Interim Guidelines for the Prioritization of the Use of Rapid COVID-19 Tests

In response to Governor Youngkin’s COVID-19 Action Plan, VDH recently issued new Interim Guidelines for the Prioritization of the Use of Rapid COVID-19 Tests.  Due to nationwide challenges in the supply chain, combined with a surge in demand for testing due to the Omicron surge of cases, there is a strain on the COVID-19 testing system in the Commonwealth.  Testing remains an important tool to guide the care of individuals and to prevent transmission to others.  In general, testing should be prioritized for people who have symptoms and/or have had a known exposure.  Additionally, healthcare providers should review the guidelines and prioritize available rapid tests in accordance with the guidance to the extent possible.  As cases decline and demand for testing decreases, providers are advised to expand testing as appropriate.  As a reminder, a negative test is not required to be released from isolation and quarantine.

Additionally, the U.S. Food and Drug Administration (FDA) recently updated its Molecular Diagnostic Tests for SARS-CoV-2 page to specify which authorized tests are designed with single or multiple viral targets.  Tests with single targets are more susceptible to changes in performance due to viral mutations because they are more likely to fail to detect new variants.   In contrast, tests with multiple targets are more likely to continue to perform well with the emergence of new variants.

CDC Recommends FDA-Approved Moderna COVID-19 Vaccine

FDA granted full approval to the Moderna COVID-19 vaccine on January 31 and the Centers for Disease Control and Prevention (CDC) recommended the vaccine for people 18 years of age and older on February 4. The vaccine, which will be marketed as Spikevax, will be the country’s second fully approved vaccine to protect against COVID-19 and will be administered as a two-dose primary series.  FDA’s Emergency Use Authorization (EUA) for Moderna COVID-19 vaccine will continue to cover the two-dose primary series for individuals aged 18 years and older, the administration of a third dose to certain immunocompromised individuals aged 18 years and older, and a single booster dose for individuals aged 18 years and older at the recommended interval following the completion of a COVID-19 vaccine primary series.  The FDA-approved vaccine and the FDA-authorized vaccine have the same formulation, and the two can be stored, handled, and used interchangeably.  The FDA has updated its Spikevax and Moderna fact sheets for healthcare providers administering vaccines and for recipients and caregivers and should continue to be distributed at the time of vaccination. CDC will be updating their Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States to reflect these changes.

The FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC) will also be meeting on Tuesday, February 15 to discuss Pfizer-BioNTech’s data on its COVID-19 vaccine for children aged 6 months to 4 years.  The VRBPAC meeting will be able to be viewed via live stream, and additional meeting information will be available on their site.

Therapeutics Updates

On January 24, 2022, the FDA revised the EUA fact sheets for REGEN-COV and bamlanivimab/etesevimab (bam/ete) to limit their use to only when the patient is likely to be exposed or infected with a COVID-19 variant susceptible to these treatments.  REGEN-COV and bam/ete are highly unlikely to be effective against Omicron.  Due to the Omicron surge, HHS has paused allocations of REGEN-COV and bam/ete until further notice.

Demand for Sotrovimab is decreasing, following a decrease in case rates as well as increased availability of oral antivirals.  Molnupiravir is available for providers to order in Vaxmax.  Please note that providers should only order Molnupiravir through Vaxmax if the dispensing site is a pharmacy or if the facility has a “Physician Selling Controlled Substances Facility Permit,” issued by the Board of Pharmacy.  Paxlovid will become available for ordering through Vaxmax when supply is more readily available.

CDC and CMS Updates for Infection Prevention in Healthcare Settings

On February 2, 2022, CDC updated Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic and descriptions are provided regarding “up to date” COVID-19 vaccination status for healthcare personnel, patients, and visitors.  CDC continues to emphasize that anyone with even mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test as soon as possible.  Asymptomatic patients in any healthcare setting with close contact with someone with SARS-CoV-2 infection, regardless of vaccination status, should have a series of two viral tests immediately (but not earlier than 24 hours after the exposure) and, if negative, again 5–7 days after the exposure.

In areas with substantial to high community transmission, CDC recommends a NIOSH-approved N95 or equivalent or higher-level respirator when caring for patients not known or suspected to have SARS-CoV-2 infection in the following higher-risk situations: all aerosol-generating procedures; higher-risk surgical procedures; and in situations where additional risks for infection are present.  These situations include caring for a patient who is not up to date with their vaccines, the patient is not able to wear source control, or the area is poorly ventilated.

On February 2, 2022, CDC updated Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes and the Centers for Medicare and Medicaid Services updated their nursing home visitation FAQs.  In nursing homes, residents who are not up to date with all recommended COVID-19 vaccine doses and are new admissions or readmissions should be placed in quarantine, even if they have a negative test upon admission; COVID-19 vaccination should also be offered.  VDH Recommendations for Hospitalized Patients Being Discharged to a Long-Term Care Facility During the COVID-19 Pandemic were updated February 9, 2022.

VDH Presents Keeping Up With COVID Video Series

VDH’s Health Professionals page is excited to announce the Keeping Up With COVID video series.  Each Monday, the page will feature a new short video on a topic of interest to keep providers up to date on new COVID-19 information.

Thank you for your continued partnership as we respond to the COVID-19 pandemic.

Sincerely,

Colin M. Greene, MD, MPH
Acting State Health Commissioner

Biden-Harris Administration Will Cover Free Over-the-Counter COVID-19 Tests Through Medicare

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Via cms.gov Newsroom

As part of the Biden-Harris Administration’s ongoing efforts to expand Americans’ access to free testing, people in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring. Under the new initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA).

This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries. There are a number of issues that have made it difficult to cover and pay for over-the-counter COVID-19 tests. However, given the importance of expanding access to testing, CMS has identified a pathway that will expand access to free over-the-counter testing for Medicare beneficiaries. This new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. CMS anticipates that this option will be available to people with Medicare in the early spring.

Until then, people with Medicare can access free tests through a number of channels established by the Biden-Harris Administration. Medicare beneficiaries can:

  • Request four free over-the-counter tests for home delivery at covidtests.gov.
  • Access COVID-19 tests through healthcare providers at over 20,000 free testing sites nationwide. A list of community-based testing sites can be found here.
  • Access lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost. In addition to accessing a COVID-19 lab test ordered by a health care professional, people with Medicare can also already access one lab-performed test without an order, also without cost sharing, during the public health emergency.

In addition:

  • Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits, so Medicare beneficiaries covered by Medicare Advantage should check with their plan to see if it includes such a benefit.
  • All Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.

For more information, please see the FAQ Fact Sheet.

As Corporate Entities Enter Healthcare, Practices Can Respond via Patient-Centered Care

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Richard E. Anderson, MD, FACP, Chairman and Chief Executive Officer, The Doctors Company and TDC Group

Retail medicine and private equity are important drivers of primary care delivery in the U.S., and they are poised to become even more so. Corporate entities have always been involved in healthcare, but now mega corporations—from outside the medical space—are entering the field. The involvement of these large non-legacy corporate entities in healthcare is growing and is challenging—and while this trend brings some benefits, it will also impact how all clinicians provide healthcare.

In a single quarter of 2021, private equity firms acquired $126 billion in medical practices. And these private equity firms, formerly mostly interested in specialty practices, have now set their sights on primary care. Similarly, the expansion of retail medicine into traditional areas of physician practice has been massive. For context, here’s a quick snapshot of the retail medicine landscape:

Let’s focus on several of these.

Amazon Brings Credibility to Claims of Service

As Amazon continues their push into the healthcare space, they have several advantages. One is their remarkable reputation for customer service. As they move into healthcare, they will have significant credibility in claims they make about providing better service, better access, better prices, and better convenience. Traditional healthcare will struggle to match them.

We clinicians are aware of the distinction between medicine’s definition of “patient-centered care” and retail’s perspective on “customer service.” Yet despite the profession’s emphasis on patient-centered care for several decades, we haven’t fully achieved it. That’s one reason that these new healthcare entities will exert broad downward economic pressure on primary care practices.

But Amazon’s expanding influence goes beyond drawing patients away from individual small practices. Nobody has more data than Amazon—between Whole Foods, Alexa, and Prime members—and this data can be used to shape healthcare delivery. Moreover, Amazon is in the process of developing nationwide pharmacy availability, a hospital at home partnership with leading healthcare providers, and an accelerator for healthcare startups. Clearly, Amazon plans to develop into a major player in healthcare delivery.

Walmart Brings Experience as an Insurer—Plus Affordable Prescriptions

Walmart seems to be one company that is able to compete, at least along some metrics, head to head to head with Amazon. Though Walmart once had a terrible reputation for not providing healthcare insurance for their own employees, they now provide substantial coverage. And they already have more than a million people in their own insurance plan. It may not be long before Walmart starts providing a health insurance plan for non-employees.

In addition, Walmart has done some very commendable things in the realm of pharmaceutical pricing. Walmart provides most of the most common generic drugs for a flat $4 per prescription, which is a true blessing for many people. In addition, while the cost of some proprietary insulins runs to thousands of dollars a month, Walmart has its own private-label version of analogue insulin, which it makes available at very nominal cost. That’s not only an important service, but a visionary one.

We’ll see how the healthcare competition between Walmart and Amazon shapes up over time, but the outcome is likely to have a major impact on pricing and service in many areas of clinical practice.

Health Insurers Bring Their Ambition to Become Healthcare Providers—At Scale

Health insurers are not just financing care. They’re providing care. Optum, working under its parent company, UnitedHealth Group, purchased its first medical practice 15 years ago. Today, they own the practices of 56,000 physicians in 1,600 clinics, representing $40 billion a year of revenue. By 2028, their expressed goal is to reach $100 billion in revenue. Optum is far from the only player in this space, but it is the biggest.

This is a different model of healthcare delivery, with a real potential for conflicts of interest. As this trend accelerates, it is conceivable that health insurance will come to cover an increasingly limited range of clinical options.

Private Equity Brings Ongoing Disruption

The model of private equity—invest, disrupt, exit— wouldn’t seem to fit healthcare. Nonetheless, as the first wave of private equity investments matures, we’ll see what those exits look like. Who will buy these companies and practices? They will be sold, presumably, at much higher valuations than before. This means that revenue and operational efficiencies will become more important than ever, and the management agreements that may have been attractive in the initial partnership may or may not be continued into the new partnership. Regardless, when we see that private equity firms acquired $126 billion in medical practices in a single quarter of 2021, we must expect that pressure will increase on physician-owned practices to compete with the challenges presented by private equity investment.

Can Medicine Compete Through Patient-Centered Care?

If we want to continue to be the driving force in our healthcare system, when medical professionals say “patient-centered care,” we’re really going to have to mean it. We’re going to have to mean it in the customer-service-forward way practiced by corporations like Amazon or Nordstrom or FedEx. After a decade of talking about “patient-centered care,” although we know what it should mean, it isn’t what we typically offer. We need to stop requiring outpatients to see multiple doctors, labs, and imaging centers in different locations at different times, and then to hope that someone thoughtfully acts on the results. That isn’t how we access services anywhere else in the economy. Retail medicine is making significant inroads into primary care by providing rapid access at convenient locations at lower cost.

We should recognize that some of the disruption in healthcare today is actually healthy, because it is based on the pressing need for improved healthcare access, healthcare equity, and healthcare literacy. That said, as these new forces in healthcare compete to recruit new medical school graduates, they will also disrupt the day-to-day operations of many existing physician practices. Instead of reacting in surprise when these forces reach the door of our practice or our healthcare system—if they haven’t already—we would be wise to think now about how we should respond.

We would like to know what steps your practice or medical system has already taken in response to large non-legacy corporate entities delivering healthcare. Please answer this poll, and we will provide an update with your responses.

To discover more about upcoming changes, read our whitepaper, What U.S. Healthcare Will Look Like in 2032.

Begin the Poll

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Poll: Majority of Virginians only want eye surgeon to perform eye surgery

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FOR IMMEDIATE RELEASE
Contact: Jeff Kelley for VSEPS
(804) 397-9700
[email protected]

80% of respondents would not trust primary vision care doctors with eye surgery

RICHMOND, VA (JANUARY 20, 2022) — A new poll released today by the Virginia Society of Eye Physicians & Surgeons found an overwhelming majority of Virginians — 80 percent — would only trust a trained eye surgeon to perform eye surgery. Just 10 percent said they would allow an optometrist, whose role is to provide primary vision care, to perform surgery on their eyes.

The poll is released as Virginia legislators review two bills in the General Assembly that would allow optometrists to perform laser-eye surgery if certified by the Virginia Board of Optometry. The bills are Senate Bill 375 (J. Chapman Petersen, D-Fairfax City) and House Bill 213 (Roxann L. Robinson, R-Chesterfield).

Laser-eye surgery procedures are common to treat cataracts, glaucoma, and related conditions. They are advanced eye surgeries requiring careful placement of laser energy into the eye. The procedures are never without risk, which is heavily minimized when performed by a medically trained surgeon: an ophthalmologist.

“Eye surgery should be performed by eye surgeons, who have experience and proficiency that only comes with years of education and training supervised by other surgeons, and participating in hundreds of surgeries on real live people,” said Michael Keverline, M.D., President of the Virginia Society of Eye Physicians & Surgeons. “Optometrists play a key role in eye and vision care, but it is important to understand where their scope of practice should end, and that is with surgery. Ophthalmologists are the only physicians qualified to perform eye surgery and prepared to manage surgical complications that can and do occur.”

  • Ophthalmologists (eye physicians and surgeons) are medical doctors (who can treat the entire body and specialize in eyes) and complete between 12-13 years of total higher education — which include 4-5 years of intensive surgery training. They typically have 17,000+ hours of surgical training before certification.
  • Optometrists (vision care experts) can practice after 7-8 years of higher education and diagnose eye conditions and treat vision problems. Optometric surgical training is generally didactic or simulated and does not include surgical experience involving patients under the supervision of a trained eye surgeon. They do not attend medical school.

The vast majority of states — 43 — prohibit laser surgery by optometrists, as does the U.S. Department of Veterans Affairs. Even in those states where laser surgery is allowed for optometrists, few optometrists provide the services and typically not in any rural or underserved areas. Eye surgeons are widely available statewide, even in rural areas. There is no evidence that allowing optometrists to perform laser eye surgery would increase access to care or reduce costs — reimbursement is the same regardless of specialty. Expanding scope of practice for optometrists may lead to over-utilization of these procedures and drive up costs and health insurance premiums and the need for corrective medical care.

“No need has been demonstrated to change Virginia’s standard for eye surgery. Not on access to care, cost, or other patient need,” Keverline said. “The only thing we know is that if this legislation passes, inadequately trained practitioners will be performing surgery on people’s eyes.”

About the Virginia Society of Eye Physicians & Surgeons

As the “Eye MDs” of Virginia, The Virginia Society of Eye Physicians & Surgeons is a statewide, non-profit organization comprised of medical doctors and doctors of osteopathy. The VSEPS mission is to advocate for the best quality eye care through education, legislative efforts and community service. Members are committed to heightening public awareness that eye disease and blindness can be reduced through prevention, and early detection and treatment. Member physicians are dedicated to the public’s direct access to ophthalmic care. The organization was chartered in 1920.

About the Poll

The poll was commissioned by the Virginia Society of Eye Physicians and Surgeons and conducted by Mason-Dixon Polling & Strategy from January 13 to 17, 2022 with 625 registered voters statewide. The margin for error is no more than +/- 4 percentage points. For questions on the poll, contact Brad Coker with Mason-Dixon at [email protected] or call (904) 261-2444.

Bills being considered by the General Assembly may remove safeguards to protect the health of Virginians

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Wider health care access
Letter from Dr. Mohit Nanda, President of the Medical Society of Virginia, to the Richmond Times-Dispatch Editor

Editor, Times-Dispatch:

Enhancing access to medical care in underserved and rural communities is an important priority for Virginia’s health care system, and there are many possible solutions. Currently, three bills being considered by the General Assembly are not likely to help and may remove important safeguards to protect the health of Virginians…

Read the Full Letter Here

Federal Public Health Emergency Extended Until April 16, 2022; New State Public Health Emergency

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TO: All Providers Participating in the Virginia Medicaid and FAMIS Programs

The federal public health emergency (PHE) was extended on January 14, 2022, and will now last until April 16, 2022. In addition, Executive Order 84 allowed for certain additional state flexibilities under a new, temporary state PHE…

Read the Full Bulletin

Birth Defects Have a Lifelong Impact for Physicians, PAs, and their Patients

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Every 4-1/2 minutes in the U.S., a baby is born with a birth defect.

Birth defects affect 1 in 33 babies in the U.S. each year. That means about 120,000 babies born every year have a defect that affects how their body looks or works, or both. Those defects can range from mild to severe and can be fatal. Birth defects cause 20 percent of all infant deaths.

While some birth defects can be corrected in utero or in infancy, many birth defects have a lifelong impact for patients and physicians — who will treat patients with birth defects not only during pregnancy and childhood but throughout adolescence and into adulthood.

This month, during National Birth Defects Awareness Month, we will provide you with information about birth defect prevention and considerations for lifelong care.

Birth Defect Prevention

Unfortunately, not all birth defects can be prevented, but risks can be mitigated. Evidence points to many factors that cause them, from genetics and the environment to behaviors, medications, medical conditions, and maternal age.

Having one or more of these risk factors may result in a birth defect, or it may not. There’s no exact formula — or fail-safe. That’s why it’s important for physicians and PAs to work closely with patients who are or may become pregnant to help them understand how to lower their risks. Though most birth defects occur in the first 3 months of a baby’s development, they can occur later, so prevention efforts are important throughout pregnancy.

Three prevention strategies to advise patients include:

1. Be cognizant about what you’re putting in your body. Pregnant women should avoid smoking, drinking alcohol, and using marijuana and illegal drugs, as well as taking certain prescription and OTC medications and some dietary and herbal supplements.

2. Communicate with your physician to monitor and manage your overall health, not just your pregnancy. Close management of medical conditions like diabetes, infections like the Zika virus, and medical situations like a high fever are critical, as all can contribute to increased risk for birth defects.

3. Learn as much as you can about your medical history. For patients with personal or family histories of birth defects, which includes the baby’s father, genetic counseling is also an option to understand and evaluate risks.

For more prevention strategies, visit The American College of Obstetricians and Gynecologists’ FAQ page on “Reducing Risks of Birth Defects” or the Centers for Disease Control and Prevention’s web page titled “Commit to Healthy Choices to Help Prevent Birth Defects.”

Lifelong Care of Patients with Birth Defects

Infants and children with birth defects often require specialized treatment and care, especially those with physical and intellectual disabilities. Early recognition and early intervention and supports are integral to their health, well-being, and quality of life as they grow up.

But what happens next?

To help physicians and PAs understand how best to help your patients with birth defects throughout their lives, here’s a list of challenges they may experience as adults and as they transition from adolescence to adulthood:

  • Navigating changes in insurance providers and coverage
  • Switching from familiar, trusted pediatric specialists to new specialists who treat adults
  • Adapting to new lifestyle situations related to increased independence, like becoming responsible for managing their own care and skill development required to effectively address their daily needs
  • Mental health issues resulting from managing their condition, treatments, transitions, and other circumstances
  • Requirement of additional surgeries, medications, or other procedures to maintain or improve health
  • Increased health risk factors related to their birth defect, like an increased risk of cancer later in life
  • New or ongoing health complications related to their birth defect, like heart defect patients who may develop trouble breathing
  • Loss of family relationships and support on which they depend, such as the death of a parent
  • Developing new social relationships, including dating and marriage
  • Entering the workplace, which may require new skill development and managing needs for adaptation
  • Exposure to discrimination
  • Planning for parenthood, including understanding risks to their own health as well as to their baby
  • Planning for long-term care as their healthcare needs may evolve and change over time

Birth defects have a lifelong impact on patients. With increased awareness and focus, physicians and PAs can help empower their patients with birth defects to live healthier, longer, happier lives.

Sharon Sheffield, MD, FACOG
Obstetrician-Gynecologist

Telephone Communication for Healthcare Providers: Strategies to Mitigate Malpractice Claims

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Nicole Franklin, MS, CPHRM, Patient Safety Risk Manager II, The Doctors Company

The way we communicate has changed dramatically over the years. Even with the introduction of technology-based communications, such as social networking sites, telemedicine, and texting, the telephone call is still the most widely used communication tool between healthcare providers and patients. Telephone conversations can, however, present difficulties and may be inherently deceptive if both parties lack the ability to observe nonverbal communication (for example, facial expressions, eye contact, and gestures) that clarify and qualify what the voice is expressing.

When casually or carelessly conducted, telephone communications can lead to diagnostic errors and misunderstandings that may culminate in professional malpractice claims.

Mitigate Risk in Telephone Communication with Patients

Creating comprehensive, clear guidelines for telephone encounters with patients is critical in mitigating risk. Establish practice guidelines and ensure that all office and clinical staff are trained on their roles in communicating with patients by telephone. Protect yourself from potential liability by following these general practices:

  • Smile when greeting patients. Research has shown that people are able to tell if you are smiling by the tone of your voice. Warmly express to patients that you are happy to speak with them today. This interaction may be the first impression that a patient has of the practice or the staff, and it is a factor in patient satisfaction.
  • Triage and refer all critical calls to emergency services. Examples of critical calls include abdominal or chest pain, fever of unknown origin, high fever lasting more than 48 hours, convulsion, vaginal bleeding, head injury, dyspnea, casts that are too tight, visual alterations, and the onset of labor. For more information on this topic, read our article, Telephone Triage and Medical Advice Protocols.
  • Obtain as much information as possible about the patient’s presenting complaint, medical and surgical history, current medications, and allergies to help you arrive at an accurate appraisal of the patient’s condition. Listen carefully and allow the caller both the time and opportunity to ask questions.
  • Speak to patients clearly and slowly, and enunciate carefully. Use easy-to-understand language that avoids medical terminology.
  • Obtain the services of an interpreter if you encounter a language difficulty. Follow the Americans with Disabilities Act (ADA) requirements for patients using telephone auxiliary aids or services, including interpreters. For more information, see ADA Requirements: Effective Communication.
  • Avoid distractions, such as checking email or attending to other duties, when speaking with patients. Drowsiness, fatigue, or distraction on the part of either party can affect the ability to communicate effectively.
  • Adhere to HIPAA rules and regulations to maintain patient privacy when communicating over the telephone, both inside and outside the office. Use a low voice when discussing protected health information, and implement reasonable safeguards to avoid disclosing information to others not involved in the patient’s care.
  • Develop written protocols for front office/unlicensed personnel to help them respond to patient questions and concerns. An unlicensed individual cannot provide medical or dental advice. Clinical/licensed individuals answering patient calls cannot exceed their scope of practice.
  • Prescribe or advise by telephone only when you have reviewed the patient’s allergies, medications, and medical and surgical history. If providing new instructions to the patient, such as changing a medication dosage, ensure understanding by asking the patient to repeat back the instructions to you. Document the patient’s understanding in the medical or dental record. For more information on this topic, read our article Rx for Patient Safety: Use Ask Me 3 to Improve Patient Engagement and Communication.
  • Accept a third party’s description of a medical or dental condition only when you have confidence in that person’s competence to describe what he or she sees. If descriptions are unclear, the patient may require an office visit.
  • Make prompt referrals if the patient’s call concerns a medical or dental problem that is outside your expertise. Proactively track the consultation and expected report, and follow up with the referred provider and patient.
  • Confirm that pharmacists understand all dosages and instructions for drug prescriptions given by telephone. Spell out any similar drug names and use individual numbers for dosages, such as “five zero” for 50. Include the reason for the use of the drug. Insist that pharmacists repeat information back to you. Do the same with facility personnel who take your telephone orders. A safer approach is to use electronic prescribing or fax the medication order.
  • Verify and document the patient’s adherence with telephone advice through a follow-up contact to ensure continuity of care.

Mitigate Risk During Provider Cross-Coverage

When you will be away from your own practice or covering for another provider, these additional strategies can help you avoid problems:

  • Implement a communication process between cross-coverage providers. In several instances, a covering provider has been held completely responsible for damages resulting from a telephone misdiagnosis while the original provider was exonerated.
  • Give a brief status report on your acute patients with notice of any anticipated patient calls when handing off care.
  • Document all calls in the patient record. Brief the primary provider on all calls during your coverage period.
  • Prescribe only the amount of medication the patient requires during the period you are covering for another provider. Pain medications and narcotics should be refilled or ordered only in small amounts and per state regulations.

Document Thoroughly to Mitigate Risk

Disagreements about what was said during telephone conversations can be a major problem in professional malpractice cases. Follow these documentation processes to mitigate this risk:

  • Document all patient telephone conversations in the medical or dental record—including those received and returned after hours. Include the date and time of each contact and when follow-up is completed.
  • Record all details immediately about the information you received, what you advised, and the orders you gave. This action is especially important when a telephone call occurs after office hours or on a weekend.
  • Implement an office process for calls received during office hours. Office staff should tell the caller when the provider is most likely to return the call. Include tracking and follow-up to ensure that the caller’s questions and problems are resolved and documented.
  • Document a patient’s hospital medical record with telephone conversations about the hospitalized patient—including any conversations with nurses or other providers.

Effective telephone communication and its documentation are vitally important in preventing and defending litigation.

For further assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.