Policymakers are urged to rely on best available evidence and resume activities in phased-in, prioritized way
May 15, 2020 (ACP) – The American College of Physicians has released a new policy statement that provides criteria for policymakers to consider as they prepare to resume social, medical and economic activities.
“ACP is committed to charting a way forward through this pandemic crisis. We are providing the clinical and public policy guidelines to allow certain economic and social activities to be resumed in a phased-in and prioritized way,” said Dr. Jacqueline W. Fincher, president of ACP. “Since the current Centers for Disease Control and Prevention guidelines have been restrained, it is more important than ever for the physician experts in adult medicine to help lead the way.”
In the recommendations released on May 7, ACP urges that policies on restarting certain economic and social activities rely on the best available evidence. Priorities must include the mitigation of risk related to COVID-19 and the rapid expansion of the health system's capacity to diagnose, test, treat, conduct contact tracing (with privacy protections) and conduct other essential public health functions.
“ACP is especially concerned that the discussion has been characterized as a binary choice of opening the economy or keeping everyone sheltered in place,” Fincher said. “This false choice is misleading and does not help physicians, public health officials, elected officials and businesses to get to the win-win we all want. Unfortunately, we cannot turn back the clock and pretend we can go back to business as usual pre-COVID-19 world.”
ACP is making the following recommendations:
- Communities need to have sufficient testing capacity. In the absence of an effective vaccine, ACP calls for testing to be prioritized, particularly for vulnerable populations, underserved communities and the populations at greatest risk: older adults and those with underlying medical conditions.
“We have to understand the prevalence of the disease in any given community before making the best recommendations for resuming economic activities,” Fincher said. “Without adequate testing of populations in a given location, how can you possibly make the best decisions and estimates of impact on the health care system and its ability to care for patients who become extremely sick?”
She added: “Testing would give you more accurate numbers in order to know if all health care sectors have all the equipment – especially personal protective equipment for the frontline health care responders and clinicians. In addition, public officials would have greater expertise in deploying and redeploying staff, ventilators and other critical equipment from one location to another.”
- Communities need to have appropriate health care system capacity.
- Communities need to have the capability for effective contact tracing with privacy protections.
- Communities need to work with public health authorities to develop risk-based plans for a phased resumption of economic and social activities when cases and transmission are declining sufficiently. “Public officials and businesses must communicate and work together with public health physicians and nurses and hospitals to understand the scientific data in order to create the logistical plans and new workflows required for both resumption of economic and social activities and the response to a new surge in cases,” Fincher said.
ACP is also offering specific criteria regarding the resumption of in-person medical care visits and other health care services:
- A community's ability to achieve the capacity needed for COVID-19 mitigation, as recommended by ACP in the rest of the guidance, should guide decisions on resuming in-person medical care visits and other health care services.
- Public and private payers should provide direct financial support to practices to offset lost revenue and increased costs through at least the 2020 calendar year, even as in-person visits resume.
“Until there is a COVID-19 vaccine and genuinely effective treatment, especially for mild-to-moderate disease to prevent it from ever deteriorating to severe disease requiring hospitalization, CMS and other private payers must continue to provide the additional financial resources to pay parity with the current evaluation and management codes for physicians to convert many stable patients with chronic diseases or easily diagnosable minor medical problems to telehealth or telephone visits rather than in-office evaluations,” Fincher said.
- Ambulatory internal medicine practices should start planning how they might safely and effectively begin to resume in-person visits that have been temporarily suspended or postponed.
“As ambulatory physician practices begin to see more patients in the office, they will also have to consider new changes in scheduling and workflow of patients through the office while keeping appropriate social distancing in waiting areas for patients and work areas for staff,” Fincher said. “Physicians will need to have an understanding of the current infection rates and impact of COVID-19 in their local communities to decide how best to handle patients with acute respiratory illness needing in-person evaluation.”
Also, she said, “With a mix of telehealth, telephone, and in-office patient visits and a resulting condensed volume of patients and some staff actually in the office, it would be logistically easier to keep patients and staff more socially distant from one another in the waiting and treatment areas.”
Moving forward, ACP will continue to speak out on the process of resuming social and economic activity. “We are the physicians who are directly advising public officials on prevention, diagnoses and treatment of COVID-19 at the local, state and national levels. COVID-19 is definitely our lane,” Fincher said. “In addition, we are known for relying on the best available scientific evidence to advise our members, the public and government officials through clinical guidelines and public policy since our inception in 1915.”
The policy statement “Partial Resumption of Economic, Health Care and Other Activities While Mitigating COVID-19 Risk and Expanding System Capacity is available on the ACP website.