Governor Polis’ April 20 announcement of the ‘Safer at Home’ phase of the COVID-19 response that will begin lifting some of the stringent, necessary social distancing requirements offers Coloradans the opportunity to move forward thoughtfully to help slow the spread of the virus and begin shaping the “new normal” of life in the Centennial State.
As physicians our first priority is the health of our patients and all Coloradans. We recognize that the response to date has tested patients, physicians and other health care providers, policymakers and communities in physical, mental, emotional and economic ways that seem unimaginable just months ago. We are committed to working with the Polis Administration and others to execute this phased approach that relies on six factors including work to suppress the virus, increasing the ability to conduct testing and containment, ongoing monitoring and evaluation of policies and their impact, deploying additional protections for those who are most at risk for COVID-19, ensuring the ability of the health care system to handle the increased demand, and using sustainable social distancing policies.
It is critical that testing — including efficient and available access to this testing by physicians, contact tracing and other surveillance activities — is expanded or all of this work is threatened. As further guidance is offered in the COVID-19 response, it is also essential that physicians are empowered to work with their patients and use clinical judgment to decide which procedures are appropriate; physicians should not be forced to perform procedures that, based on medical decision-making and available resources, they do not feel are in the best interest of the patient or the health care system at this time.
As the next steps in the response are taken, specifically including the resumption of non-emergent and elective procedures, the Colorado Medical Society recommends that the following issues and related recommendations should be prioritized.
Extend liability protections for physicians: Appropriate steps have not been taken to protect physicians who, based on their commitment to the health of all Coloradans and the need for care of their patients, have in good faith been practicing medicine during this public health emergency. Physicians working outside their typical scope of practice, caring for patients with altered assessment via telemedicine, making decisions relative to the crisis for patients who are not COVID-19 positive, triaging care based on public health needs as opposed to the specific needs of a patient, and using their professional judgment when attempting to adhere to the Executive Orders are exposed in the case of adverse outcomes.
Failing to address the liability issue will likely result in a number of lawsuits brought against physicians who have stepped up to work outside of their typical scope of practice, in dangerous conditions, and made decisions in the best interest of their patients that just happened to have a negative outcome. Beyond the clinical, economic and psychological impacts, leaving physicians exposed to liability during this unprecedented time sends the message that the heroes who stepped up to support the crisis response were not themselves a priority to protect and could compromise having the necessary workforce in the coming phase of the COVID-19 response.
Additionally, more lawsuits mean more liability insurance payouts, which increase premiums and increase the cost of health care for all Coloradans.
Recommendation: Extend immunity from liability to physicians practicing medicine during the public health emergency.
Ensure adequate PPE supplies: The Safer at Home order allows for non-emergent and elective procedures provided there is adequate PPE. Many independent physician practices do not have access to necessary PPE given massively disrupted commercial supply chains, lack of the purchasing power of larger health care institutions and hospitals, and scarce resources from public health departments. Inadequate PPE prohibits physician practices from reopening, which decreases the ability to relieve volume on critical health care resources (i.e. hospitals and emergency departments) and care for patients to avoid more serious illness or decompensation. It also prevents providers and their employees from making a living. The longer they go without the ability to safely perform procedures, the greater the financial burden.
If smaller and independent practices are unable to meet their financial responsibilities, they are likely to close, be acquired by a hospital system, private equity firm or others, which would reduce much-needed competition, decrease choice in the marketplace and potentially increase the cost of care in the long term. While during the response thus far PPE resources have been appropriately triaged to critical care sites like hospitals, different strategies must now be used in order to continue to take the pressure off of those parts of the system and provide now-long-delayed, health maintenance care, non-emergent and elective procedures.
Recommendation: Increase the prioritization level of PPE distribution to independent physician practices and procedure/care centers as non-emergent and elective procedures are restarted.
Leverage telehealth gains: The increase in effective utilization of telemedicine/telehealth has been critical to maintaining access to care without endangering patients. There is an opportunity to keep some of these processes in place once the current public health emergency ends. Failure to act on telemedicine/telehealth means that we will go back to the way things were before COVID-19.
The lessons learned in this crisis show that safe, efficient, and cost-effective health care can be provided via telemedicine in many cases. This increased access to convenient, quality care for individuals throughout the state, and especially those in rural communities, those who are less mobile, and those who have other limitations (transportation, childcare, inflexible work, financial, etc.) will benefit Colorado and reduce the overall cost of care in the future.
Recommendation: Extend all existing exemptions, expansions and exclusions allowing for and facilitating the widespread use of telemedicine/telehealth with reimbursement parity to office visits to continue through the public health crisis. Encourage all ERISA plans to do the same. In addition, expand the use of paid e-consults between primary and specialty care physicians to increase access within Medicaid and commercial health plans.
Joint statement by:
Colorado Medical Society
Arapahoe-Douglas-Elbert Medical Society
Aurora-Adams County Medical Society
Colorado Psychiatric Society
Colorado Society of Eye Physicians & Surgeons
Colorado Orthopaedic Society
Denver Medical Society
Foothills Medical Society