Handling staff shortages in your medical practice amid COVID-19

Responding to COVID-19 is one of the most significant concerns for the nation’s healthcare providers in years, and it hinges on a key factor: Having the right staff and providers available and keeping their risk of exposure limited.

A March 17, 2020, MGMA Stat poll asked medical practice leaders if they have experienced staff shortages amid the spread of coronavirus/COVID-19. The majority (60%) responded “no” while 40% indicated “yes.” The poll had 1,220 applicable responses.

In a related poll with 310 applicable responses, 42% of practice leaders reported utilizing a floating staff pool or temporary workers to fill in, versus 58% who do not.

Summary of findings:

• Numerous respondents noted that many of the staff shortages or call-ins their practices faced were not directly related to potential or confirmed COVID-19 exposure, but rather for school closures and the need for employees to care for children.
• Multiple respondents noted that float pools in recent weeks have been short-staffed, as well. As one respondent noted, the pool of pro re nata (PRN) physicians “is never enough.”
• One respondent’s practice has moved to a systemwide staffing pool, and another redeployed staff whose departments had canceled patients, such as elective surgery.

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FAMILIES FIRST CORONAVIRUS RESPONSE ACT

The Families First Coronavirus Response Act was signed into law, which requires employers to provide employees with paid FMLA and sick time under certain circumstances. 

Both new sick and FMLA rules:

• Are effective within 15 days. 
• Apply to employers with fewer than 500 employees.
• Include exceptions to their respective requirements for: 
  • An employer of an employee who is a healthcare provider or an emergency responder may elect to exclude those employees, and
  • Two additional exceptions designated in forthcoming regulations under the Department of Labor.

Paid FMLA Leave for “Public Health Emergency”

• Creates a new category of FMLA-covered leave for up to 12 weeks of job-protected leave for employees unable to work (or telework) due to the need to care for his or her child (under 18 years) if their school or daycare has been closed due to a public health emergency. Leave under this category makes employees eligible.
• Payment during new category of leave:
  • The first 10 days of leave is not paid and the employee is allowed to substitute any accrued vacation, personal or medical/sick leave for unpaid leave.
    After the first ten days, the employer must provide the employee no less than two-thirds of the employee’s usual pay, capped at $200/day ($10,000 aggregate).

Tax credit for employers: Provides a refundable tax credit equal to 100% of qualified family leave wages paid by an employer for each calendar quarter, capped at $200/day and $10,000 for all calendar quarters.

Emergency paid sick leave

• Covered employers must make up to 80 hours of paid sick leave available for certain Coronavirus-related absences, in addition to any current paid time off provided by the employer.
• Reasons for sick leave:
  1. Employee is subject to federal, state or local quarantine or isolation order
  2. Employee has be advised by healthcare provider to self-quarantine 
  3. Employee is experiencing COVID-19 symptoms and seeking medical diagnosis
  4. Employee is caring for individual who is subject to order described in #1 above
  5. Employee is caring for his or her child if school or place of care is closed due to COVID-19 precautions
  6. Employee is experiencing nay other substantially similar condition specified by Secretary of Labor
• Payment during sick leave:
  • For sick leave under reasons 1-3 (e.g., employee is sick), leave is paid at the employee’s regular rate of pay, capped at $511 per day ($5,110 aggregate). 
    For sick leave under reasons 4-6 (e.g., employee is caring for someone else), leave is capped at $200/day ($2,00 aggregate).

Tax credit for employers: Provides a refundable tax credit equal to 100% of qualified paid sick leave wages paid by an employer for each calendar quarter. 

Find more updates on policy issues in the MGMA COVID-19 Federal Assistance and Advocacy Center. For more operational insights, visit the MGMA COVID-19 Recovery Center.

Starting with safety

Taking the proper precautions while in close contact with and caring for patients, such as wearing all recommended personal protective equipment (PPE), lowers risks for healthcare personnel. While there is no solid figure for how many healthcare workers have self-quarantined or taken time off since the spread of COVID-19 in the United States, reports suggest the number is still likely to rise “at an exponential pace.”

The Centers for Disease Control and Prevention (CDC) has interim guidance for risk assessment and public health management of healthcare workers with potential exposure to patients with COVID-19. Additionally, the Office of the Assistant Secretary for Preparedness and Response in the Department of Health & Human Services has technical assistance and tools for health and emergency management professionals, including a COVID-19 healthcare planning checklist. MGMA recommends checking these resources regularly for any changes.

The Occupational Safety and Health Administration (OSHA) has existing resources for employers to prepare the workplace for COVID-19, including existing standards and directives regarding potential worker exposure. Practice staff should understand OSHA’s PPE standards (29 CFR 1910 Subpart I), pertaining to use of gloves, respiratory protection and face/eye protection. The CDC recommends educating and encouraging employees regarding respiratory etiquette and hand hygiene. Ensure proper cleaning of commonly touched surfaces, and review with any employees or third-party vendors who perform regular cleaning of the facility.

Handling time off/sick leave

The CDC recommends that employers “actively encourage sick employees to stay home” and away from the workplace.

Phil Boucher, MD, FAAP, pediatrician at Lincoln Pediatric Group, Lincoln, Neb., recently noted on an MGMA Insights podcast that dealing with the potential for staff being out amid the COVID-19 response “requires a lot more innovation” than other challenges the organization faces. He noted that “there’s nothing off the table” when it comes to thinking about how to address the needs of staff who have school-age children who will be on extended break.

Peter Valenzuela, MD, MBA, chief medical officer, Sutter Medical Group of the Redwoods, noted in a recent MGMA Insights podcast that the leadership team at his organization is monitoring school closures to help prioritize which care centers stay open and shift staff to the more immediate-need care centers — a tactic honed in recent years in which the Sutter team has had to mobilize to respond to wildfires in Northern California. “This ain’t our first rodeo,” Valenzuela noted.

Valenzuela said that not knowing how long COVID-19 would affect the community is a bit unnerving, so the Sutter team has spent a lot of time educating staff and using their texting software to communicate to staff to provide updates from their internal infectious disease specialist. “I think that he’s done such a great job of allaying that fear for our leaders and our staff,” Valenzuela added, “that it’s really helped them to understand that we can take care of our patients in the proper way without fear of something more serious happening to ourselves or our families.”

Keep an eye on government changes

Practice leaders should pay close attention to pending legislation and temporary regulatory changes at the federal level. Bills are moving through Congress and being marked up at a rapid pace and may have implications for changes to FMLA, including for workers requiring childcare and workers who take paid leave for illness or caring for a sick loved one. Regular policy updates will be available through the MGMA COVID-19 Federal Assistance and Advocacy Center.

Practice leaders should also keep an eye on state emergency declarations and/or executive orders that might pre-empt existing state laws or organizational policies regarding sick leave. It is best to stay apprised of your state or locality’s specific changes to see how such changes, if any, apply to your organization.

Make sure you are aware of your practice’s short-term disability policy that might be available once a worker has exhausted available PTO.

Workers’ compensation

Numerous states have issued mandates to ensure that healthcare workers and first responders can still receive pay while away from work. The National Council on Compensation Insurance (NCCI) notes that states such as Washington have updated policies regarding workers’ compensation coverage for workers exposed to coronavirus on the job. Be sure to document a worker’s on-the-job exposure to support a potential claim.

After a staffer takes leave due to COVID-19

If a healthcare provider takes leave due to a confirmed or suspected COVID-19 case, the CDC recommends two approaches for when that worker may return to work:

1. A negative COVID-19 test result, in addition to recovery (defined as resolution of fever without the use of fever-reducing medications and improvement of any respiratory symptoms, e.g. cough or shortness of breath).
2. Passage of three days (72 hours) since recovery (as defined above) and having at least seven days passed since symptoms first appeared.

Planning steps for practice leaders

• Cross-train personnel on essential business functions wherever possible to account for absenteeism.
• For practice staff who can telework, ensure that they are prepared to do so. Clearly communicate expectations for productivity and hours for staff who will not be at their normal work site.
• Manage patient volume amid staffing challenges by proactively messaging patients via social media or patient portals to educate them about COVID-19 and encourage them to contact your practice before coming into a clinic if they suspect they might have been exposed.
• Stay in contact with local temp agencies if certain positions of need can be addressed with a temporary worker. If you have access to a float pool for nurses, medical assistants (MAs), billers, coders or other office staff, regularly reach out to see what resources might be available.

H1B visas

Numerous healthcare organizations have employees working in facilities while on H1B visas, a non-immigrant visa for graduate-level workers in specialty occupations. As noted by Diane Hernandez, employment and immigration law attorney with Hall Estill, premium processing for expedited servicing has been suspended by U.S. Citizenship and Immigration Services, but “the rest of the lottery petition process and H1B petition adjudication process should continue as planned” pending any notice of anticipated delays or suspensions of the H1B lottery process.

However, as a result of the COVID-19 emergency and associated travel restrictions, “some employers will not be able to bring on new talent from abroad, even those with approved visas and impending start dates,” Hernandez said. In that is the case, employers may want to consider establishing a remote work situation for these employees, if possible, Hernandez says.

Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: mgma.com/stat.

Additional resources

• Check the MGMA COVID-19 Federal Assistance and Advocacy Center for the most-recent updates on the response to coronavirus and its associated illness.
• Status of Medicare Telehealth Waivers 
• MGMA has multiple podcast episodes from practice leaders and emergency preparedness and response experts as healthcare responds to COVID-19:
  • “An action plan for medical practices and healthcare professionals”
  • “Protecting healthcare workers amid COVID-19 — ‘There is no room for error’”
  • ”‘COVID-19 has pretty much taken over my life’: A practice administrator’s perspective”
  • “COVID-19: How one of Northern California’s largest health systems is responding to the crisis”
• SHRM has dedicated coronavirus and COVID-19 resources for human resource leaders, including toolkits for managing through flu and other epidemics and various sample forms and policies.