The gradual drop in COVID-19 cases, hospitalizations and deaths across many parts of the country have prompted federal, state and local officials to allow mask and personal protective equipment (PPE) requirements to end.
As many Americans seek a return to normalcy, there are many public health officials and healthcare leaders who remain adamant that COVID-19 is still a threat, especially for older patients and immunocompromised people, and that masks should still be worn in indoor settings.
A March 11, 2022, MGMA Stat poll found that only 34% of medical practices have relaxed their mask policies since the beginning of the year, while most (66%) report no such changes. The poll had 252 applicable responses.
However, almost half (49%) of practice leaders who have not relaxed their policies yet in 2022 noted that they anticipate updating mask policies in the next six months. The two most common responses from the other 51% who do not intend to change policies anytime soon were:
- Their specialties involve high-risk, immunocompromised patients, and masking remains an effective precaution against COVID-19 and other illnesses.
- Any changes to masking policies will be determined for the entire hospital/health system campus on which their practice is located.
Among practice leaders who have relaxed policies, the changes had several variations:
- Some practice leaders told MGMA that masks are still required for patient-facing providers and staff, whereas patients and non-patient-facing staff do not need to mask.
- Other practices only loosened mask policies in staff-only areas, requiring masks in patient areas.
- Many practice leaders chose to update their policies following new guidance from the Centers for Disease Control and Prevention (CDC) in late February, which created new community levels to drive indoor masking guidance.
- Multiple practices made it clear to staff that masking might become required again if COVID-19 case levels increase in the future.
New guidance, new questions
The CDC relaxed mask guidance Feb. 25, suggesting that indoor mask wearing should continue in locations where there’s significant spread of coronavirus that could overwhelm local health systems and hospitals.
The “COVID-19 Community Levels” metrics unveiled by the CDC — COVID-19 admissions, available staffed inpatient beds and total new cases for defined populations — are intended to guide communities and individuals on assessing pandemic risks via color-coded “low,” “medium” and “high” risk levels.
The initial community-level data showed that more than 90% of Americans live in low- or medium-level areas where indoor masking was no longer part of CDC recommendations.
CDC Director Rochelle Walensky, MD, MPH, told reporters recently that “the overall risk of severe disease is now generally lower,” and that the CDC’s prevention efforts would shift to focusing on “protecting people of high risk for severe illness and preventing hospitals and healthcare systems from being overwhelmed.”
Who enforces these guidelines?
For medical group leaders assessing these new guidelines, it’s important to remember that these latest recommendations are just that: Strong recommendations. With the exceptions of masking in airports and on domestic airlines, as well as vaccination requirements for foreign travelers entering the United States, the CDC guidelines are not statutory or regulatory requirements directly enforceable by the CDC or other federal agencies.
However, there are situations in which CDC guidelines become enforceable in other ways, such as when state governments and localities incorporate CDC guidance into their laws, regulations and/or ordinances. For example:
- Indoor mask requirements in healthcare settings were still in place until just before midnight March 11 for Oregon, California and Washington State as part of a coordinated lifting of the requirement.
- The National Park Service (NPS) is enforcing masks on all enclosed forms of public transportation and inside NPS buildings in high community level areas.
Similarly, payers or professional liability insurers might adopt them by reference in contract documents to which a medical practice might be a party. Furthermore, there are potential professional liability implications in which patients, employees or others are harmed by COVID-19 in settings where specific CDC guidance applies and the practice has opted not to follow CDC recommendations.
For practice leaders who are not certain about the enforceability of guidance in certain circumstances, seeking out legal counsel to advise is highly recommended.
How practices are approaching the changes
For practice leaders in areas of “low” or “medium” community levels, the decision to relax policies often is framed as letting staff, patients and visitors know that masks are optional for the time being, and that the practice reserves the right to require masks in the future if COVID-19 case levels worsen.
Other practice leaders shifting to “optional” mask policies will ask patients about their preference for mask use and whether they would be more comfortable being seen by a provider who is masked. Communications to patients often can still note that the practice encourages the use of protective masks to protect against airborne illnesses, even in the absence of an enforced mask policy.
However, some medical groups have chosen to stick with existing policies “to be on the safe side.” As one practice administrator noted in the MGMA Member Community, all patients and visitors are required to wear a mask and have their temperature checked upon entry, in addition to a limit of one visitor per patient in the building.
The reasoning? It’s a single-physician facility, “so we cannot afford for our physician or any employees to become sick,” the practice administrator noted. Another practice leader noted that before the pandemic, he would experience some form of respiratory distress each year but has not had a single viral infection in the past two years. “I may never give up masking in public,” he said.
For practices with specialties that have high percentages of high-risk patients (e.g., rheumatology, pulmonology, cardiology), maintaining a mask policy might make the most sense regardless of community level guidance.
Several medical group leaders whose providers work in hospital settings also stress that there are inpatient settings where mask use will continue to be enforced and to always be mindful of policies at other facilities.
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