09/01/2020
Lessons Learned from the COVID-19 Pandemic
Each year, OSMA’s malpractice insurance partner, The Doctors Company, assembles healthcare leaders to discuss the most pressing issues affecting physicians, practices, and systems across the spectrum of care. The 2020 virtual discussion focused on pandemic experiences and what can help healthcare organizations navigate through COVID-19 and beyond.
by David L. Feldman, MD, MBA, FACS
Chief Medical Officer, The Doctors Company Group
and Laura Kline, CPCU, MBA
Senior Vice President, Business Development, The Doctors Company
Here are some key takeaways from the 2020 Executive Advisory Board meeting of top healthcare executives:
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Change your own mindset to succeed.
Andrew Racine, MD, PhD, system senior VP and chief medical officer at Montefiore Medical Center in the Bronx, New York, reflects on his experience with COVID-19 at the heart of the crisis in NYC: “Everything about what you are used to doing and how you are used to doing it had to be discarded, had to be put aside . . . Where were you going to do things? What kind of equipment were you going to use? Who was going to do things?” He advises, “You have to be flexible. You have to adapt to the circumstances.” And, “You have to be proactive.”
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Plan for what’s coming next.
Dr. Racine says that Montefiore has systematized lessons learned: “We have a very detailed plan about what will happen if we get 10 percent more patients than we currently have, if we get 20 percent more patients than we currently have, if we get 100 percent more patients than we currently have.”
And Martin Fee, MD, senior VP and chief clinical officer at Hoag Memorial Hospital Presbyterian in Newport Beach, California, and an infectious disease specialist, describes contingency plans that incorporate not only medical realities, but political ones—factoring for predicted executive actions from California’s governor.
- Communicate with honesty, empathy, authenticity, and consistency.
Dr. Racine describes the need for empathy in effective communication: “People were frightened. They were anxious. They were angry, they were grieving. And the communication had to acknowledge that.” In addition, Dr. Racine stresses authenticity: “People were not going to accept communication coming from just anybody”—which was why Montefiore’s communications came from their CEO.
Dr. Fee notes a communication lesson learned: “Initially, I was trying to be very reassuring with the physicians and saying, ‘We're going to get through this and everything's going to be OK and this will be over soon.’ In retrospect, that's not true . . . What I would have done differently is say, ‘We'll have to just see,’ but maybe not be too reassuring.”
- Recognize the pandemic’s silver lining: Innovation.
Dr. Fee says Hoag had been planning on a nine-month telehealth implementation in 2021, “but all the regulatory and financial barriers came down and we were able to launch that very quickly.”
Overall, the rerouting of usual workflows “forced us to be innovative quickly,” says Dr. Fee, “which I think was a silver lining.”
Chad Anguilm, MBA, VP of in-practice technology services at Medical Advantage Group, a subsidiary of The Doctors Company, says that sustained shifts across technology and workflows are already progressing: “Like we saw with telehealth—the big boom in the spring—we're seeing something similar with wearables now where we're getting many requests to start integrating wearables into the EHR systems. To have that constant flow of data from those with chronic conditions” could positively impact physicians’ ability to treat patients in real time.
- Expect malpractice claims to increase—know what to document and transfer risk
John E. Hall, Jr., Esq., of Hall Booth Smith, P.C., predicts filing of COVID-19-related cases will peak in 18 months to two years. Mr. Hall encourages physicians and practices to document daily life now, because juries will forget. He recommends documentation of daily infection control measures, as well as noting who is working hard to procure personal protective equipment (PPE), coordinate with labs, and so on. This will make it easier later to contact staff members who can attest as witnesses that providers made their best effort to reduce risks.
Awareness of risk transfer opportunities may also be protective. Jacob Zissu, Esq., of Clausen Miller, P.C., points out: “It may be that the injury alleged is attributable to the acts or omissions of your vendor or an independent contractor.” He advises, “Think about risk transfer as if it’s a Swiss Army knife with multiple tools . . . The best position to be in is to have multiple risk transfer options available.”
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
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