On or off? Medical groups face renewed mask policy questions after judge nixes CDC transit mandate

Editor's note: This information is not up to date and remains unchanged from its April 2022 publication for historical reference.

The legal and political fights over the COVID-19 pandemic often spur confusion and anger across parts of society, leaving frontline staff and providers at medical groups left to answer patient questions and concerns.

The April 18 court ruling that overturned the Centers for Disease Control and Prevention (CDC) rule to require masks on public transportation — which was set to expire May 3, 2022 — is among the latest in a series of changes to mandates and emergency measures to limit the spread of coronavirus.

An April 26, 2022, MGMA Stat poll found that nearly one in three (30%) healthcare leaders reported that their providers and staff have spent more time on patient questions regarding masking in the past week, compared to 70% who did not. The poll had 394 applicable responses.

Practice leaders who experienced an increase in patient questions about masking told MGMA:

• “When patients present at the front desk they are more hostile about our mask requirement.”
• “Patients have mixed feelings — some upset and some not; mostly distrust in authorities to know what is best to do.”
• “We won’t be changing our mask policy anytime soon, but the ruling has made patients and visitors think all mask mandates everywhere are gone. It’s crazy.”

The attention given to last week’s ruling — and the federal government’s pending appeal of that ruling — could result in patients forgetting about still-existing indoor mask policies at medical facilities, most of which have not altered their rules: A March 11, 2022, MGMA Stat poll found that two-thirds of medical practices have not relaxed mask policies in 2022.

Confusion arising from the recent transit mask mandate ruling could cause renewed instances of disruptive, unruly and potentially violent behavior by some patients: Refusal to wear masks in practice facilities was the No. 1 reason given by healthcare leaders for increasing levels of disruptive patients in 2021, according to a Jan. 4, 2022, MGMA Stat poll.

Several medical practice leaders who did not notice an increase in patient questions noted that their continued communication of their mask policies to patients and visitors resulted in very little change since the ruling. However, there were many practice leaders whose organizations have shifted to “mask optional” policies to try and appease workers and patients who are unhappy about mask mandates. Other respondents told MGMA:

• “Mask mandates interfered with patients coming to the office and receiving care, especially preventative care.”
• “Our local mask mandate changed because with the new CDC data review methods, our risk level changed,” which caused “confusion and concern” in the community.

Mask rules remain in many settings

As reported by Modern Healthcare, several major hospitals and health systems — including Mayo Clinic in Rochester, Minn., Cleveland Clinic, Northwell Health in New York City, among others — continue to require masks and have made no changes to existing rules for indoor areas of their facilities. In some organizations that have relaxed masking requirements — specifically, three UnityPoint Health hospitals in Iowa — the decision was based on declining case counts in the area.

Mask policies remain in many healthcare settings for several reasons:

• Medical groups often will align policies with CDC guidance. For infection prevention and control, the CDC still encourages “source control” (use of respirators or well-fitting masks to cover a person’s mouth and nose) and physical distancing for everyone in a healthcare setting.
• Some local and state mandates remain in effect for healthcare facilities. For example: Oregon Health Authority’s mask requirement remains in effect in healthcare settings despite the rescinding of the rule for schools and general indoor areas. Similar mask requirements in healthcare settings remain in effect for all individuals in California, for example, and for unvaccinated and not fully vaccinated individuals in certain healthcare settings in Colorado.

While some travelers cheered the move to end the transit mask mandate, some critics of the ruling suggest that the judge used a restrictive interpretation of the word “sanitation” in her analysis to support the ruling that — as physician and economist Jeffrey E. Harris, MD, PhD, wrote in STAT News — is “simply too absurd to take seriously.” As Harris noted, “Selective, formulaic wordplay should not be used to decide if a federal agency, exercising its own expertise, has the authority to take scientifically supportable measures to block the transmission of a potentially lethal virus.”

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