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COVID-19 Update March 24
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Coronavirus Resources for Practices and Providers
TN Dept of Health: Coronavirus HQ - Guidance for Healthcare Providers and Public - New Data Updated Daily 2 PM
CPF WEBINAR
EMPLOYMENT LAW IN THE CORONAVIRUS LANDSCAPE 
THURSDAY AT NOON
CPF is hosting a webinar on THURSDAY (3/26) at NOON that will be led by Nashville Attorney Kim Vance on “Employment Law in the Coronavirus Landscape.”
 

Description
Nashville Attorney Kim Vance will be discussing Employment and HR law and what practices can do to be flexible and protect the business and staff while the Coronavirus outbreak impacts patient visits and employee hours.
 
Who is Kim Vance?
Kim Vance is a shareholder in the labor and employment practice group of Baker Donelson. She has over 30 years of experience representing employers in every aspect of labor and employment law. Ms. Vance has been listed since 2008 in Chambers USA: America’s Leading Business Lawyers as an Employment attorney and Mid-South Super Lawyers. Ms. Vance is listed in Best Lawyers in America for employment law for 2016-2020.
Register for 3/26 Employment Law Webinar
THE BUSINESS IMPACT OF COVID-19 ON PEDIATRIC PRACTICES 
WEBINAR PART 2 - THURSDAY AT 6 PM
The Pediatric Management Institute (PMI) is holding a webinar on THURSDAY (3/26) at 6 PM Central Time to discuss financial and operational issues pediatric practices are facing as COVID-19 continues to evolve. 

This week's webinar will have a couple guests join to focus on Human Resource issues related to staff and providers as well as follow up on key items discussed in the last webinar.
Register for 3/26 PMI Business Impact Webinar
Did you miss last week's PMI webinar on the Business Impact of COVID-19 on Pediatric Practices? View the video and slides at the links below:
3/19 PMI Presentation SLIDES: BUSINESS IMPACT OF COVID-19
3/19 PMI Presentation VIDEO: BUSINESS IMPACT OF COVID-19
EXECUTIVE ORDERS
In addition to local ordinances, TN Gov. Bill Lee has decreed multiple executive orders regarding emergency proceedings for every branch of the government and the delivery of health care. 

This week, Gov. Lee established the Unified Command Group to streamline the efforts of TDH, the TN Emergency Management Agency (TEMA), and the Department of the Military. Another newly signed Executive Order - EO 18 - prohibits hospitals and ambulatory centers from performing elective procedures. It also prohibits elective dental procedures and visits and asks for the donation of PPE when possible from those sites to local armories

Guidance for other providers, including ambulatory medical providers, has not changed. TDH continues to encourage patients to seek care first from their usual site of care. Telehealth and telemedicine should be maximized for acute and chronic visits. Elective visits should be postponed. 
View All TN Executive Orders Related to Coronavirus
TESTING UPDATE 3/23
TDH continues to ask that testing is prioritized for individuals who are the sickest, health care workers, and those who need the testing for clinical-decision making. If the test will not influence clinical decision-making, a test is unlikely to be needed. Many people will have symptoms and even exposures who do not need a test. 

Due to heightened need to care for the most medically at-risk patients, the state lab is currently unable to process COVID-19 testing for uninsured patients unless they are hospitalized. However, TDH has contracted with commercial labs to provide payment (no more than $70 each) for uninsured outpatients.

If the logistics have not been worked out with your contracted lab, please contact TDH and the state will reach out to the lab.
SITE OF CARE (ASSESSMENT AND TESTING)
TDH continues to encourage patients to seek care first from their usual site of care and to enable providers to accommodate that need. Shortages of PPE, of testing supplies, and of testing site availability are increasingly common.

TDH is looking for every opportuinty to fix those issues but permanent solutions are not immediately available and TDH needs your help in addressing shortages by implementing strategies to conserve PPE and by putting procedures into place to minimize unnecessary tests

Providers do NOT need to consult with public health before sending a test to a commercial lab. Providers are advised to prioritize testing highly symptomatic and not asymptomatic individuals.


TDH is continuing to test in the state lab, although capacity is limited, through the clinical consult line 615-741-7247. High-risk groups are being prioritized.

All COVID-19 cases should be reported immediately to TDH by calling 615-741-7247.
TDH: Guidance on Testing Decision-Making
VUMC: Weekly COVID-19 Clinical Guidance Summary
Barton Schmitt: COVID-19 Exposure Telephone Triage Protocols
PPE OPTIMIZATION STRATEGIES
The TN Dept of Health, VUMC, and the CDC have provided guidance on PPE conservation:
VUMC INFECTION PREVENTION: PPE Guidance
TDH: PPE Conversation Guidance
CDC: Optimizing Isolation Gowns
CDC: Optimizing Eye Protection
CDC: Optimizing Facemasks
CDC: Optimizing N95s
VUMC: How to Donate and Make Hand-Sewn Masks
Metro Nashville Announces Emergency Supply Drive - Learn How People Can Donate Here
TELEHEALTH
There has been a rapid expansion in reimbursement opportunities for telehealth, now including home-based telehealth coverage by nearly every plan in the state during this time of public health response. 

Guidance from TDH: Please utilize teleheath and telephone triage as much as possible for both sick and well patients. This is critical to minimize public exposure to illness and to optimize capacity for routine and emergent care. Utilization of telehealth and telephonic management should be optimized in all settings.
TMA: Telehealth Guidelines
TNAAP: COVID-19 Telehealth Coding Guidance
TNAAP: COVID-19 Telehealth Guidelines By Payer
TennCare Guidance on COVID-19
ISOLATION CHANGES FOR CASES
The CDC has adjusted recommendations for isolation of cases at home to be for at least 7 days (not 14), including afebrile and feeling well for at least 72 hoursThe TN Dept of Health has adapted this recommendation as well.

Note: Contacts should still remain quarantined for 14 days following last exposure.
CDC: Guidance for Persons with COVID-19 Under Home Isolation
TDH: Guidance for Releasing Cases and Contacts from Isolation and Quarantine
PUBLIC HEALTH MONITORING CHANGES
Public health staff are changing their monitoring protocol to include:
  • Making initial contact with lab confirmed cases
  • Conducting a thorough interview to identify close contacts
  • Ensuring that the cases understand the requirement to remain isolated
  • Contacting close contacts to explain their exposure, and the recommendation to remain home for 14 days following their exposure
Following the initial interview, public health will no longer actively check in with the patient (or contacts) each day, but rather ask the case to get in touch with their provider if they need medical care and public health if they have exposure, isolation, or quarantine questions.
NEWBORN NURSERY GUIDANCE
The TN Dept of Health does NOT recommend early (<24 hours after birth) discharges for newborns. Further guidance can be found at the link:
TDH: COVID-19 Update for Pediatric Providers Caring for Infants in the Newborn Nursery






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Cumberland Pediatric Foundation · 5141 Virginia Way, Suite 230 · Brentwood, Tennessee 37027 · USA