Masks remain a top challenge in medical practices’ quest to secure PPE, supplies

MGMA Stat - May 27, 2020

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The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders: “Is your practice still struggling to obtain adequate personal protective equipment?” The majority (57%) answered “yes,” while 43% responded “no.”

Practice leaders who answered “yes” were asked, “Which PPE is most difficult to acquire for your practice?” Masks (76%) were the most-frequent response, followed by:
  • Gowns (27%)
  • Disinfectants (16%)
  • Gloves (7%)
  • Face shields (5%)
  • All (2%)
  • Other (1%).

The poll was conducted May 26, 2020, and had 1,060 applicable responses.

For practice leaders who responded “no,” three common threads emerged as to how they found supplies:
  1. They used a variety of vendors, either searching outside of traditional medical supply vendors (e.g., dental offices, auto parts stores), networking with peers and vendors to find supplies or accepting donations.
  2. They leaned on health system/hospital partners with existing resource allocation or the ability to request from a department/practice without a high PPE need, such as departments for which elective procedures were postponed.
  3. They purchased in bulk when supplies were available, despite being expensive compared to pre-pandemic prices. Practices that did not experience a surge in COVID-19 patients reported being able to use available bulk inventory as new safety protocols are put in place for practices that have reopened to in-person visits.

An MGMA Stat poll conducted two months earlier found 89% of practice leaders reported their practices faced a PPE shortage. That poll had 1,131 applicable responses. At the time of the March poll, respondents noted:
  • Many practices centralized and secured inventories of masks and other PPE.
  • COVID-19 testing was consolidated to specific locations. Since March, many MGMA members noted that open-air and drive-through testing sites have been started; however, warmer weather often poses difficulty for practice workers to be in hot temperatures in full mask, gown and other PPE.

Demand remains

A study recently published in The Lancet, analyzing requests to the PPE clearinghouse GetUsPPE.org, revealed these details about ongoing demand:
  • More than 87% of organizations requesting PPE were in metropolitan areas.
  • Almost two-thirds (65%) of PPE-requesting organizations were in counties in the highest quartile for median incomes.
  • Hospitals (27%) represented the majority of requests, followed by outpatient clinics (15%) and skilled nursing facilities (SNFs) at 9%.

Meyer Greenbaum, spokesman for medical supply distributor TwinMed LLC, noted in a recent interview with Skilled Nursing News that the demand for PPE remains high after an initial wave of many people purchasing PPE and “flipping product to the highest bidder” ebbed.

“Not just health care providers have to think about PPE; it’s every walk of life, every business has to now consider what they’re looking for,” Greenbaum said. “Therefore, masks, sanitizer, gloves, gowns, whatever it might be, you are competing, literally, for product against the entire world.”

Reusability concerns

Matt PaneGasser, national sales manager with Scrubin, noted that many of his organization’s customers are shifting focus from single-use PPE to reusable products, noting that single-use items are not necessary in all environments and that they can contribute to a good deal of waste compared to items that can be laundered safely for additional use.

PaneGasser noted that face masks and shields appear to be a priority for many practices as of late, adding that it’s important for practices to follow manufacturer recommendations for optimal methods of cleaning to prevent fading, removal of bacteria and other steps for ensuring the longevity of reusable products.

CDC guidance on extended use and limited reuse of N95 respirators
CDC guidance on decontamination and reuse of filtering facepiece respirators

Before many practices shifted to focus on reusable PPE, numerous providers nationwide noted that lack of supplies forced them to improvise. A survey of almost 23,000 nurses by National Nurses United recently found 87% reported having to reuse single-use masks while working with a COVID-19 patient. Practices lacking adequate PPE for providers can expose workers and patients to potential infection, with the potential of severely disrupting staffing and overall operations if numerous workers are forced to take leave for self-quarantine.

Focus on cost

The focus on reusing supplies when possible is a good way to try to save money, where possible, and not overspend, PaneGasser added. That’s especially important given the increased costs of securing PPE; an April analysis by the Society for Healthcare Organization Procurement Professionals (SHOPP) noted that guidelines for long-term care settings would lead to increased costs of thousands of dollars per day for a 100-bed SNF.

Handling the added costs for PPE also can present marketing issues, as evidenced by recent headlines in broadcast media after some dental offices began charging additional, PPE-specific fees to help offset added costs. Practice leaders, if they opt to try to charge for PPE, may need to have a plan for how to answer patient questions about such a fee and the potential for media scrutiny.

Finding trusted vendors, avoiding scams

The Better Business Bureau has cautioned businesses of all types to be wary of scams and price gouging related to PPE. A recent BBB report on COVID-19 business impacts listed online retailers as a top source for price-gouging allegations and slow/no delivery as a top online complaint.

As noted in recent months, some supplies in the global market have been faulty to the point of being labeled “useless,” and a provision of the Families First Coronavirus Response Act offers protection to manufacturers of N95 respirators against lawsuits if the products fail.

Some MGMA members have reported setting up clinic officers with Amazon Business accounts and bulk order some supplies when normal sources have been unavailable.

MGMA STAT

Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: mgma.com/stat.

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