1. What are the goals in optimizing practice operations?
• Reduce the risk of infection and spread of COVID-19
• Patient safety
• Care team safety
• Conserve and protect our critical workforce
• Keep patients at home
• Preserve access to care
• Rapidly adapt to changing facts and events
• Communicate regularly to all affected stakeholders
• Use current experience to drive future care transformation

2. How should office structure and function be addressed?
• Move to a single point of entry
• Screen all patients, visitors, and staff (including physicians)
• Consider temperature screening before clinic/facility entry
• Limit potential exposure
• Reduce the number of individuals in waiting rooms
• Stagger appointments and restrict visitors
• Consider moving necessary in-office visits to off-campus (non-hospital) sites
• Limit patient exposure for high-risk individuals
• Try and maintain a distance >6 feet where possible
• Reorganize staff
• Reduce, redeploy and repurpose
• Have all administrative staff work remotely if possible
• Take an inventory of what other roles staff can play (even outside the service line)
• Rethink access
• Move as many encounters to be virtual
• Consider temporarily closing and consolidating offices in close proximity
• Consolidate days of service at outreach offices/clinics
• Identify tests and procedures that can be deferred
• Consider policies for issuing "excuse from work" letters for high-risk patients
• Perform daily huddles and operational reviews
• Provide targeted communication
• Have a "chain of command"
• Don't overwhelm with too many attachments/details

3. How should patient scheduling be changed to meet goals and clinical demands?
• Attempt to see all new patients with rare exception (e.g., elective pre-operative evaluation)
• Maximize use of virtual care where possible
• Understand the different types of virtual visits (e.g., video, telephone, e-consults)
• Review current schedules days in advance with a goal of identifying established patients that:
• Can be safely rescheduled >3 months
• Can be seen virtually for active issues
• Must be seen face-to-face (traditional visit)
• Stagger or space out appointments to reduce the number of patients in the office and waiting areas
• Limit office testing for those required for active clinical decision-making (no surveillance testing)
• Document triage decisions, disposition, and type/timing of follow-up for liability purposes
• Use shared decision-making whenever possible
Plan for future scheduling adjustments needed to accommodate deferred visits

4. How should physician and APP deployment be optimized?
• Reduce the number of physicians, APPs, and clinical staff in the office
• Consolidate schedules – Practice zone defense
• Create teams (physicians/APPs/clinical staff) that are restricted to remote duties 1 week at a time so as to avoid group exposure
• Particularly important for "mission-critical" physicians (e.g., interventional cardiologists, cardiovascular surgeons and intensivists)
• Rotate these "home teams" with "on site teams" on a weekly basis
• Attempt to keep those at increased risk (e.g., immunocompromised individuals) on a "home team" until risk is mitigated
• Leverage "home teams" to do:
• Virtual office visits
• Reading of remote diagnostic studies (e.g., echocardiograms)
• Phone/triage support
• Minimize duplication of visits by subspecialty cardiologists where possible (e.g., general cardiology, EP, heart failure)
• Take PTO as scheduled unless dictated otherwise by workforce shortage or surge demand
• Recognize and mitigate "burn-out"

5. How should hospital needs be met?
• Attempt to consolidate coverage (use shifts)
• Accommodation will be needed for higher risk physicians, APPs and clinical staff (e.g., immunocompromised, chronic illness)
• Identify tests and procedures that can be deferred
• Make every attempt to reduce the hospital census – free-up beds
• Attempt to prevent "unnecessary" admissions
• Re-evaluate transfer criteria
• Adjust procedural schedule to 7 days per week to facilitate discharges
• Emphasize same-day discharge post procedure
• Expedite discharges with early virtual follow up

6. What are the compensation issues that need to be addressed?
• Staff
• Ensure support
• Address work hours (guaranteed vs. reduced)
• How to redeploy and repurpose
• PTO, sick leave, etc.
• Keep staff engaged to be able to ramp-up as the crisis dissipates
• Physicians and APPs
• Anticipate/estimate reduced production and compensation
• Attempt to protect base compensation with adjusted wRVU targets
• Independent clinicians – Consider shared group revenue model
• Employed clinicians – Consider shared distribution model

Clinical Topics: COVID-19 Hub

Keywords: Cardiology Magazine, ACC Publications, COVID-19, Coronavirus, Coronavirus Infections, Patient Discharge, Patient Safety

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