COVID-19 Information, Resources, and FAQs

December 17, 2020

As a mutual company, CMIC is here to support our members throughout this crisis however we can. These are challenging and unprecedented times, and as a company, our primary focus is helping our members through this so they can focus on their health, and the health of their patients. Please feel free to reach out to us at any time with questions about coverage, best practices, or anything else we may be able to assist with. We are here for you, and we will all get through this together.

Below please find COVID-19 information and resources, as well as a list of Frequently Asked Questions. Our intention is to update this regularly so please reach out to us if there is something you would like more information on, or anything you would like to see added.

Information and Resources

Documentation Update Focusing on Delayed Procedures

Due to the COVID-19 pandemic many elective surgeries and non-emergent medical procedures are being postponed and patients may be delaying various procedures and tests. In the event that a provider has had a patient who postponed a surgical or diagnostic procedure or clinical labs, documentation of the length and reason for the delayed event is important.

In regards to routine surveillance procedures such as yearly eye exams or a once-every-5 year colonoscopies, documentation is still recommended in terms of rescheduling. If the patient had the surgery postponed due to the pandemic, but was hospitalized and needed emergent surgery, accurate and precise documentation in this scenario would be favorable.

Equally as important, if delaying a procedure or test carries a risk that a patient’s known medical condition may worsen, the provider should document that the procedure or test was unavoidably delayed and that the patient was advised about maintaining vigilance for and reporting to the provider about any changes in condition that would indicate disease progression.

Accurate and timely documentation is beneficial, especially when attempting to recall specific conversations or incidents that took place days, months or years prior to possible litigation. It is acceptable to write an addendum, however, it is more favorable to document in real time.

Encouraging Your Patients to Seek Medical Care When Necessary

In the midst of the COVID pandemic, many individuals are hesitant to seek medical care when necessary. Emergency room visits have decreased by approximately 40% across Connecticut. This indicates that individuals may be reluctant to seek care when needed due to the fear of contracting coronavirus, out of respect to social distancing recommendations, or in an attempt to avoid overcrowded hospitals. However, you should encourage your patients to seek medical care in an emergency situation or when they feel it may be necessary or prudent. Below, please find a form that you can send to your patients encouraging them to seek medical care when necessary. You may alter the form to fit your needs.

Sample Email Script for Adult Patients: Seeking Care during Social Distancing

Reopening Your Medical Practice

Social Distancing While in the Workplace:

Stagger schedules (if possible) to limit the number of individuals in the office at one time.
Reconfigure workspaces to allow for a safe distance between employees; make sure enough room is available to allow for social distancing, focusing on common areas. Reorganize processes to allow for social distancing when possible.
Respect each person’s personal space and professional boundaries, especially when it comes to greeting one another at work and/or having conversations.

Update Policies and Procedures:

Post signage that addresses COVID-19 expectations and workflow processes.
Make sure your employee handbook is updated or modified to meet the new COVID requirements as well as workplace expectations.
Be aware of any legal requirements related to COVID-19 for your practice/office.

Sanitization and Safety Equipment:

Do not have magazines, pens, pencils, or clipboards out for multiple patient use. Keep your waiting rooms free of extra objects.
In the waiting room, space your chairs to follow social distancing guidelines. *If you are unable to remove extra chairs, flip over chairs in between the available chairs to demonstrate social distancing.
Have patients wait in their vehicles until they are called into the facility for their appointment.
Only patients should be allowed in the office. Visitors accompanying patients should wait outside, unless the companion is needed by
Remind patients to wear appropriate face covering as directed by the Centers for Disease Control.
Utilize other acceptable means of communication such as phone, video, etc. to limit exposure.
Have appropriate hand sanitizer, cleaning wipes, and hand soaps available for employees to utilize throughout the entire workspace. Have it available in your waiting rooms as well.
Do not allow employees to share office equipment, instruments or work utensils without sanitizing/sterilizing in between uses.
Remind employees to wash hands frequently, disinfect their workspace, and practice coughing and sneezing etiquette.
Post signage for appropriate hand washing techniques and coughing and sneezing etiquette.
Regular cleaning protocols are required and should follow CDC and OSHA guidelines.
Provide the appropriate PPE for your staff.

Communication is very important.

Keep the lines of communication open with employees and your patients.
Provide frequent updates and allow for questions and concerns to be heard and addressed in a timely manner.

*Please be sure to check with your particular state and local health departments for specific guidelines and requirements.

Best Practices for Reopening Dental Offices - CT
Criteria for Return to Work for Healthcare Personnel with Suspected or Confirmed COVID-19
Reopening Practice Guidelines from the AMA
Roadmap for Resuming Elective Surgery after COVID-19 Pandemic
Sample Informed Consent Policy - COVID-19

Telemedicine Information, Recommendations, and Consent Form

Note: Please see our FAQ page for coverage information

Best Practices for providing Telehealth services:

Select a product that is secure and HIPAA compliant
Confirm that you are appropriately credentialed and privileged to provide telehealth services and that your policy complies with documentation and record-retention requirements
Before providing services, do your best to identify the patient and their location
Inform your patient of your name and credentials
Document the visit as you would a telephone message or an office visit. Make sure you are documenting the physical location of the patient and platform of the visit. Keep your notes consistent across the practice and make sure they are easily accessible for future use
Be careful sharing personal cell phone information with patients and communicating over social media

AMA Resources by State
American Telehealth Association
CMS Telehealth
What to Say During Telehealth Visits with Older Adults

Information for providing Telehealth services:

The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) has announced it will temporarily allow consumer audio or video chat applications for telemedicine use.
The Centers for Medicare & Medicaid Services (CMS) has waived requirements relegating Medicare payments for telemedicine visits.
The purpose of these temporary actions is to accommodate telemedicine needs during the COVID-19 health emergency and encourage infection control and outbreak response measures to help control the spread of the infection.

In order to continue to communicate and care for your patients, the use of non-public facing audio or video chats during the COVID-19 public health emergency is permitted. The purpose of telehealth by means of these routes is not limited to COVID-19 specific diagnoses but any patient care issues that may arise.

For clarification purposes, examples of acceptable non-public facing audio or video chats include:

Apple FaceTime
Facebook Messenger video chat
Google Hangouts video
Skype

Examples of unacceptable examples of non-public facing audio or video chats include:

Facebook Live
Twitch
TikTok

We are currently in a crisis that has resulted in abnormal circumstances and has launched the use of consumer audio and video chat applications normally noncompliant with the HIPAA Security Rule. Any communication applications use for telemedicine would require a Business Associate Agreement with the vendor.

Recommendations for Clinicians:
Be prepared to use consumer audio and video chat applications to communicate with patients as needed during the COVID-19 health emergency.

For IT/Security Staff:

Draft Temporary appropriate technology usage policies needed to accommodate telemedicine use
Accommodate requests for access to non-public facing audio and video chat applications for telemedicine purposes as an appropriate businesses need
Consider role-based firewall web-filtering rules

For more information on this process, please click here.

Recommendations while utilizing Telemedicine:

Clinicians should make certain an informed consent discussion occurs when using technology or the phone to treat a patient.
Healthcare providers should document the results of the informed consent conversation with the patient in the medical record.
It is recommended that the provider verify the patient’s identity to the best of their ability.

Telemedicine Consent Form template download

Hand Sanitizer Shortages and Strategies

Based on the current need for hand sanitizers, the FDA has published a policy that you can find on their website here.

This policy provides information on guidance to temporary compounding of certain alcohol based products for use during these emergent times.

ISMP Medication Safety Alert

Patients infected with the coronavirus (COVID-19 virus) often require inhaled bronchodilator medications (e.g., albuterol). It has been determined that the use of nebulizer therapy with bronchodilators for suspected and/or confirmed COVID-19 patients may not be safe. This is attributed to the generation of aerosols, which increases the risk that respiratory droplets will remain in the air and spread the virus.

To reduce this risk, the current recommendation is to utilize metered dose inhalers (MDI’s) to deliver the medication. This could cause concern that the supply of MDI’s will decrease to dangerously low levels, posing problems for patients in need of this medication as we continue through the pandemic. MDI canisters usually contain enough medication to last 2-4 weeks, while patients are often hospitalized for shorter periods, frequently leading to drug waste. Currently, hospitals are considering the best way to conserve MDI supplies, which include:

Ask patients to bring in their own prescribed MDI from home for use while hospitalized.
When an inpatient is prescribed an MDI by the pharmacy, it is immediately being labeled for home use, therefore the patient can take it home with them upon discharge.
Consider putting in place protocols for MDI usage, however, during the pandemic, this may require intense examination and analysis of procedures.

To view the alert, please click here.

Documentation and Communication

Documentation and communication are critical during this time. Adhering to proper documentation procedures, regardless of the modality, is essential in maintaining consistency and accuracy. Clinicians need to utilize their best clinical decision making processes, especially, if the patient issue/complaint may require an in-patient visit, but during this time, may not be recommended. Documentation of these type of situations can be beneficial in the event that there is a less than optimal outcome.

Recommendations Include:

Document all conversations with your patients whether it be in the EMR or paper charting
Timely documentation is very important
Documentation should include rationales and basis for your decisions regarding care
Be sure to include any conversations with family related to care and decisions
Document any information related to COVID-19 and rationales for treatment as well as the options and/or lack of options at this time
Document the rescheduling of treatments/procedures and the ongoing plan of care during this time of COVID-19
Be sure to accurately document any limitations in examinations do to the risk of COVID-19 exposure
If you utilize any resources such as the DPH websites for information, guidance, etc. it may be helpful to document this information

Other Resources

COVID 19 FAQ

What is CMIC doing to help policyholders at this time?

In an effort to help support our policyholders through the challenges created by the COVID-19 outbreak, the CMIC Board of Directors has declared a special $5 million dividend for CMIC members and has deferred premium payments for all members. The new due date for premium payments is June 30, 2020.

Has CMIC changed any coverage options to account for the challenges brought by the pandemic?

We are currently evaluating various special underwriting considerations in response to coverage questions from our insureds during this outbreak. Please continue to reach out to us with specific questions so we can best serve you and your needs through the challenges ahead.

Are there any trainings I can do while my practice is scaling back operations due to COVID-19?

CMIC has a variety of trainings available 24/7 for providers and staff, such as HIPAA Compliance training modules, a sexual harassment training webinar, and state mandated CME courses that are available via enduring material downloads and online webinars. Please reach out to us for more details if you are interested in participating.

Am I covered if I transition my practice to telemedicine?

Currently, our policy form states that CMIC will respond to claims arising from services within the “customary scope of the insured’s practice specialty or classification as described in their declarations.” In other words, while there is no specific exclusion for the practice of telemedicine, the policy does restrict coverage to services provided that are within the scope of a physician’s specialty. Further, CMIC Group is currently monitoring the legislative changes regarding the delivery of Telehealth services in response to COVID-19. In the event that a claim is made against our policyholders serving in this capacity, CMIC will offer coverage that is commensurate with the legislation, effective the date the legislation is passed.

What are the coverage options if I am scaling back, or even closing my practice due to COVID-19?

CMIC is working to accommodate many changes to how practices are operating due to this evolving crisis. Our underwriters have the ability to provide coverage based on your decisions and needs as a provider. Many of our insureds have inquired about Scope of Practice, Leave Of Absence, Retirement, and Part-Time status, among other topics, and CMIC will continue to be able to provide you with coverage that meets your needs.

Please reach out to our Underwriting team so we can discuss your individual circumstances and craft a policy plan that works for you and your practice during these challenging times.

What is CMIC doing on the legislative-front regarding COVID-19?

CMIC Group greatly appreciates the efforts of medical providers working on the frontlines of the COVID-19 pandemic and recognizes the personal and professional risks they face in answering this call to duty. Accordingly, CMIC is supporting efforts around the country to promote civil liability immunity laws similar to executive order issued by New York’s Governor Cuomo on March 23, 2020 (see below).

We are working with legal professionals and industry leaders to ensure that our state and national leaders recognize the unprecedented demands placed on medical practitioners and respond by providing them with the protection they have earned with their selfless response.

EXCERPT from NY Executive Order 202.10
Subdivision (2) of section 6527, Section 6545, and Subdivision (1) of Section 6909 of the Education Law, to the extent necessary to provide that all physicians, physician assistants, specialist assistants, nurse practitioners, licensed registered professional nurses and licensed practical nurses shall be immune from civil liability for any injury or death alleged to have been sustained directly as a result of an act or omission by such medical professional in the course of providing medical services in support of the State’s response to the COVID-19 outbreak, unless it is established that such injury or death was caused by the gross negligence of such medical professional;

Any other questions, please feel free to contact Integris Group team members at any time.