The right tools for the job: Securing personal protective equipment and supplies to treat COVID-19 MGMA Stat - March 20, 2020 Operations Management Sign in to save MGMA Staff Members Manufacturing of PPE, such as N95 respirators and surgical and procedure masks; isolation, surgical and coverall gowns; gloves and more were affected in part due to the reliance on a large number of manufacturers in Hubei Province, China, where the novel 2019 coronavirus first was identified. The World Health Organization issued a warning of a PPE shortage in early February, citing potential for inflated prices as a result. Despite production ramping up prior to the Chinese Lunar New Year, the spread of COVID-19 halted work and resulted in factories running at diminished capacity during recovery, as well as caused delays in global transportation and an increased domestic demand for masks in China, according to Bob O’Brien with MGMA BestPrice. A March 19, 2020, MGMA Stat poll asked medical practice leaders, “Is your practice facing a shortage of personal protective equipment (PPE)?” The majority (89%) responded “yes” while 11% indicated “no.” The poll had 1,131 applicable responses. The effects on medical group practices Members of MGMA’s Government Affairs Council recently listed lack of supplies as one of the top concerns for medical practice leaders. Higher utilization of hand sanitizer and respiratory medical products (ventilators and supplies such as tubing, cannulas, circuits, etc.) further strains the normal supply chain. Multiple MGMA members shared stories in the MGMA Member Community regarding limited quantities of PPE and other routine items from some distributors; as one member noted, “The supply chain seems to be constricted.” Kelly Ladd, CMPE, chief executive officer and practice administrator, Piedmont Internal Medicine, said on a recent MGMA Insights podcast that when she learned PPE would be on back order from her usual vendor, she started reaching out on local email lists to confirm that other practice leaders were experiencing similar issues. As noted by Christi Siedlecki, MSN, RN, FACMPE, chief executive officer, Grants Pass Clinic, Grants Pass, Ore., her office has placed regular orders for up to the allocation limit with the supplier, as well as finding alternate suppliers for certain products, such as sanitizing wipes. Siedlecki also noted that the practice has added a degree of security to ensure some supplies don’t run out. “Some supplies that are usually readily available on our central supply shelves are now locked up — this includes N95 masks,” she said. One MGMA member even reached out to nearby construction companies and industrial supply groups to inquire about available N95 masks. For such a critical piece of safety for patients, providers and staff, practice leaders have taken extraordinary steps to solve a fundamental problem in the global response to the COVID-19 pandemic. Summary of findings from MGMA Stat respondents: Inventories of masks and other PPE have been centralized and secured in many practices. Practice leaders have consolidated COVID-19 testing to specific clinic locations, and moving supplies from locations that have less immediate needs. Social distancing and virtual visits have been promoted to patients, with telehealth options implemented to keep patients at home when possible. Advocacy efforts and federal action The MGMA Government Affairs team recently urged Congress to identify ways to secure and distribute PPE to frontline physicians and staff, having heard directly from group practice leaders nationwide that they faced difficulties obtaining PPE. Ensuring PPE is available for the nation’s healthcare workers is a key means to stop the transmission of COVID-19 and minimizing risk to patients, clinicians and staff. MGMA Government Affairs also recommended that Congress increase the $500 million in funding for PPE provided in the Public Health and Social Services Emergency Fund by the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (H.R. 6074). The Administration announced March 18 that domestic production of medical supplies such as N95 masks and other PPE would be increased by invoking the Defense Production Act. For more regulatory and legislative updates, visit the MGMA COVID-19 Action Center. For operational resources, visit the MGMA COVID-19 Resource Center. What’s next? As efforts develop at the federal level to secure PPE for healthcare providers, O’Brien recommends working closely with distributors and key suppliers to make sure you are getting your allocated product and to keep backorders open. Additionally, practice leaders should be vigilant to avoid fraudulent suppliers taking advantage of the situation by selling non-regulated products. The Centers for Medicare & Medicaid Services (CMS) also has recommended that healthcare providers limit all non-essential planned surgeries and procedures to conserve PPE. “These considerations will assist in the management of vital healthcare resources during this public health emergency,” according to a March 18 CMS adult elective surgery and procedures recommendations statement (PDF). Tiers Definition Locations Examples Action Tier 1a Low acuity surgery (healthy patient): Outpatient surgery, not life-threatening illness HOPD*, ASC**, Hospital with low/no COVID-19 census • Carpal tunnel release • Colonoscopy • Cataracts • EGD Postpone Tier 1b Low-acuity surgery (unhealthy patient) HOPD, ASC, low/no COVID-19 hospital • Endoscopies Postpone Tier 2a Intermediate acuity surgery (healthy patient): Not life-threatening but potential for future morbidity and mortality. Requires in-hospital stay. HOPD, ASC, low/no COVID-19 hospital • Low-risk cancer • Non-urgent spine and ortho (hip, knee replacement, elective spine) • Stable ureteral colic • Elective angioplasty Consider postponing Tier 2b Intermediate acuity surgery (unhealthy patient) HOPD, ASC, low/no COVID-19 hospital Postpone if possible Tier 3a High acuity surgery (healthy patient) Hospital • Most cancers • Neurosurgery • Highly symptomatic patients Do not postpone Tier 3b High acuity surgery (unhealthy patient) Hospital • Transplants • Trauma • Cardiac with symptoms • Limb-threatening vascular surgery Do not postpone *Hospital outpatient department / ** Ambulatory surgery center 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.