Pediatric Practice Management Tips During the COVID-19 Pandemic

Pediatric primary care and subspecialty practices around the country are facing the challenge of providing care to their patients and families amidst the COVID-19 pandemic. Practice management resources for independent practices, and approaches used by other practicing pediatricians are provided below. Please note that the information provided below is not AAP policy or official guidance, but are suggestions for consideration.

Practice Management Resources

Small Business Assistance

Through the Families First Coronavirus Response Act (FFRCA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, new resources are available to small businesses, such as pediatric practices. See Federal Programs for Pediatric Practices and Small Businesses for an overview of loan/grant opportunities, paid family and sick leave, and unemployment insurance.

OSHA Guidance on COVID-19

It is an OSHA workplace safety violation to require a worker to put themselves at risk. The General Duty clause of the OSHA Act requires employers to furnish each worker “a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm.” PPE must be provided at the employer’s expense, along with a comprehensive respiratory protection program. Requiring an employee to perform patient care without providing the necessary PPE puts the employee’s health at risk and puts the employer at risk of an OSHA violation.

HHS Good Faith Provision of Telehealth

The HHS Office of Civil Rights recently announced that it will not impose penalties for noncompliance with HIPAA for good faith provision of telehealth service during the COVID-19 crisis. A covered health care provider that wants to use audio or video communication technology to provide telehealth to patients such as Apple FaceTime, Google Hangouts video, Facebook Messenger video chat, and others during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients.

The following list includes some vendors that provide HIPAA-compliant video communication products that would include a HIPAA BAA.

• Skype for Business
• Updox
• VSee
• Zoom for Healthcare
• SnapMD
• Doxy.me
• Google G Suite Hangouts Meet

Staffing Concerns

• CDC guidance on assessment of risk, monitoring, and work restriction decisions for health care professionals with potential exposure to COVID-19 can be found at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html.
• Several practices have started checking the temperatures of all staff each morning upon arrival.
• Health care workers who are parents of school-aged children (particularly where both parents work in health care) are concerned that school closures will require one parent to stay home with the children. Encouraging parents to seek alternative childcare arrangements for their children is helpful.
  • While having on-site/practice-based large group childcare for children is a helpful idea, there are a large number of restrictions states put on childcare for more than a small number of children who are unrelated.
  • High school and college students who are home from classes might be able to provide childcare or extend existing childcare providers.
  • There may be tax credits for small and medium size businesses who link up employees to healthcare and/or provide actual childcare reimbursement or services to their staff.
  • Families with similar aged children might be able to “go in on” an in-home sitter.

Office Workflow

Office Process Suggestions

• Extra adults and siblings are discouraged from attending visits.
• Having families complete “pre-work” items such as forms and surveys in advance via a patient portal in the car by hand.
• Payments are handled virtually when possible (payment through patient portal, even taking credit card number over the phone).
• Utilize telehealth to increase practice capacity
• Assign a staff member to review reports of patients who are overdue on immunizations or we-child care and contact these individuals to schedule appointments either in person or via telehealth.
• Specific rooms are dedicated for sick visits and well visits. A back/side entrance is used for ill patients.

Scheduling

• Refer to AAP Guidance on Providing Pediatric Well-Care During COVID-19 for current recommendations about scheduling visits.
• Consider scheduling well-visits in the morning and sick visits in the afternoon.
• For practices that have multiple sites, consider using one location for well-visits and a different location for sick visits.

Exam Room Cleaning

• When disinfecting exam rooms you should wipe down each room with the usual approved cleaning solutions, this will allow for immediate turnover. The only time rooms are required to be to shut down is when aerosolized procedures occur; which is for 2 hours.

Waiting Rooms

• All toys, books, tables etc. have been removed from the waiting room and extensively cleaned.
• Waiting room has been shut down altogether. Patients wait in their car; they text the office that they have arrived. When a room is open, the office texts the patient and instructs them to come straight in (picking up a mask for adult & child) and walk directly to a pre-assigned exam room number (sent to them by text).