Vaccine requirements for healthcare workers gain traction to defeat COVID-19’s Delta surge

Curbing the recent surge of COVID-19 via the highly transmissible Delta variant will take renewed effort to protect medical practice workers, patients and their communities. That’s why MGMA is voicing strong support for healthcare organizations to get their workers vaccinated.

"MGMA strongly supports the efforts of our nation’s medical groups to vaccinate their employees against COVID-19. All scientific evidence has shown that vaccines are the safest and most effective way to control this deadly pandemic. As we work together to protect our patients and communities, MGMA supports medical groups that choose to implement policies requiring COVID-19 vaccinations for their employees,” said Halee Fischer-Wright, MD, MMM, FAAFP, FACMPE, president and chief executive officer, MGMA, in an Aug. 4 statement. “In doing so, we urge medical groups to follow the Centers for Disease Control and Prevention (CDC) & the U.S. Food and Drug Administration (FDA) guidelines, state and local laws, and provide all appropriate medical and legal exemptions. With hospitalization and death rates among unvaccinated individuals on the rise, medical groups must take the lead in reducing the spread of COVID-19."

An Aug. 3, 2021, MGMA Stat poll found that 18% of medical practices have a policy making COVID-19 vaccinations mandatory for workers, while 69% go as far as recommending immunization, and 13% have no policy. Several practice leaders who reported only recommending vaccinations said they planned on updating policies to require workers to be vaccinated once a vaccine has been fully approved by the FDA. [Update: The FDA approved the Pfizer-BioNTech COVID-19 vaccine on Aug. 23.]

The poll had 1,066 applicable responses.

The move to get healthcare workers immunized has grown since the early weeks of COVID-19 vaccine rollout. A Dec. 15, 2020, MGMA Stat poll found that only 21% of practice leaders had a policy regarding staff COVID-19 vaccinations, and another 32% had policies in progress.

Know the law

State and local governments step up requirements

Federal authority to mandate vaccines remains an open question, but state governments’ ability to mandate vaccines was established in the 1905 Jacobson v. Massachusetts U.S. Supreme Court ruling. (Read more in Kaiser Family Foundation’s overview of vaccine mandates.) The State of California recently began requiring state employees and healthcare workers to either provide proof of full vaccination or undergo weekly COVID-19 tests, with state healthcare facilities having until Aug. 23 to come into full compliance.

Practice leaders need to pay close attention to actions taken at the local level to know if their practices fall under vaccine requirements and if there are penalties for noncompliance. Several municipalities have added requirements for private-sector workers in high-risk settings (such as healthcare facilities) to get vaccinated. For example: Denver recently set a Sept. 30 deadline for city employees and “congregate care setting” workers to be vaccinated.

What private employers can do

The Equal Employment Opportunity Commission (EEOC) issued technical guidance in late May for scenarios in which employers can mandate a vaccine. In short:

• Federal EEO laws do not prevent employers from requiring employees who enter the workplace to be vaccinated, so long as the employer is compliant with the reasonable accommodation provisions of the Americans with Disabilities Act (ADA), Title VII of the Civil Rights Act of 1964 and other applicable EEO policies.
• There are no federal EEO limits on offering incentives to your employees to voluntarily supply proof of vaccination; however, employers must keep vaccination information confidential pursuant to the ADA.
• Incentives can be offered to employees by employers that administer vaccines if they are not coercive.

For a full guide to EEOC information on disability-related inquiries, medical information confidentiality, reasonable accommodation and other considerations for employers regarding COVID-19 vaccine policy, consult the latest EEOC technical assistance Q&A.

• For details on vaccine rollout recommendations, ethical principles, and Advisory Committee on Immunization Practices (ACIP) notes, visit the CDC’s page on how it makes COVID-19 vaccine recommendations.

Communication is key

Prior to the recent surge in Delta variant COVID-19 cases, dozens of medical practice leaders shared a common sentiment in the MGMA Member Community: They strongly encouraged all physicians and workers to get vaccinated, which was generally successful save for a small percentage of hesitant holdouts.

One OB/GYN practice leader in Texas said her group had resounding success in getting workers vaccinated by communicating about the at-risk nature of some employees and their family members, which fostered a sense that everyone should be “willing to do their part” to limit the spread by getting vaccinated.

In addition to making COVID-19 vaccinations a requirement for new hires, the group made arrangements and appointments for all physicians and staff to get vaccines as soon as they were available, and followed up by conducting anonymous surveys to get “honest responses” from staff about the process.

“The key to our success,” the practice leader said, was the communication and effort to “educate and remain vigilant and cautious.”

What works: Motivating your workers

For medical practices looking to get as many workers protected as possible, a recent study published in JAMA Network Open suggests that targeted emails, text messages and other communications that are designed based on behavioral science can be effective means to win over workers who have been hesitant to be vaccinated, mandate or not.

Officials at Geisinger Health System found that emails that emphasize coronavirus risk and social norms were twice as effective in getting workers to sign up for COVID-19 shots than workers in a control group. Making appointments for the shots easily accessible also contributed to converting vaccine holdouts.

Addressing hesitant workers: Why Delta is so worrisome

Growing concern about the highly transmissible variant (already, ICUs in Florida, Mississippi, Arkansas and Austin, Texas, have been pushed to capacity) has ramped up pressure on employers and public officials to take further steps to curb the spread of coronavirus — placing medical practice leaders in an inconvenient situation eight months after the first COVID-19 vaccine was given emergency authorization by the FDA.

While immunizations have been successful in curbing the spread of the coronavirus, healthcare employers who required workers to get a COVID-19 vaccine have faced public relations headaches when employees objected, and employee hesitance often is cited as a reason to not require vaccinations.

Alan Levine, chief executive officer, Ballad Health, recently noted that potentially suspending or terminating employees who do not comply with a vaccine requirement would put strain on clinical operations amid an ongoing nursing shortage — but he noted that a surge in COVID-19 cases could similarly cause disruption.

“If the Delta variant hits staff and we lose staff because they’re sick, or in the hospital with COVID, or they have to go home and quarantine, that’s also going to affect our ability to staff,” Levine told WJHL-TV in Tennessee.

Where public health and public relations collide

Houston Methodist was among one of the first hospital systems in the nation to require COVID-19 shots of workers, and 178 workers who did not get fully vaccinated or were not granted an exemption or deferral were suspended — out of nearly 25,000 at Houston Methodist — in June for two weeks after failing to be immunized.

The move to suspend those workers — which prompted a subsequent lawsuit that was dismissed but is now pending appeal — caused a flurry of headlines for an organization that otherwise had a 99.28% worker vaccination success rate.

As U.S. District Judge Lynn Hughes wrote in the order dismissing the case, “This is not coercion. Methodist is trying to do their business of saving lives. … It’s a choice made to keep staff, patients and their families safer.”

Additional resources

• MGMA COVID-19 Recovery Center — Find resources and tools by subject, ranging from telehealth and safety to coding/billing and reimbursement.
• MGMA COVID-19 Federal Assistance and Advocacy Center — Stay up to date on the latest waivers, regulatory updates, and relief available to medical practices throughout the pandemic.
• For articles on the ethical and population health considerations around vaccine access and equity, read more in the July issue of MGMA Connection magazine.
• “A holistic approach to improving care for underserved communities and vulnerable patient populations” — This episode of the MGMA Insights podcast features Nwando “Dr. O” Olayiwola, MD, MPH, FAAFP, chief health equity officer and senior vice president, Humana.

Do you have any best practices or success stories to share on this topic? Please let us know by emailing us at connection@mgma.com.

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