Clinically Integrated Network Briefing

12.29.21: Jan. 6, 2022 COVID-19 Update Webinar l Prevention l Treatment l Testing l New CDC Guidelines: Isolation and Quarantine l Office Practice Tips
A Message for the Wellforce Clinically Integrated Network, including primary and specialty care physicians, practice administrators, Network leaders (Presidents, Administrators, and Medical Directors) and Network staff
Save the Date: COVID-19 Update Webinar
Thursday, January 6, 2022
5:30 p.m. - 6:30 p.m.
Dear Colleagues:

We are all coping with a rapidly rising volume of COVID-19 cases, triggered by the new Omicron strain in addition to the existing Delta strain. New information and protocols are rapidly emerging, reminiscent of the rapid pace of change at the beginning of the pandemic in Spring 2020. We will endeavor to keep you up to date with key changes. Below are some important reminders when managing your practice during the current surge.
Prevention, Treatment and Testing
Prevention
  • Continue to encourage unvaccinated patients to have the primary series.
  • Encourage ALL patients over 16 who qualify, to get their booster shots with either the Moderna or Pfizer vaccine.
Treatment
  • Two of the monoclonal antibody products are not effective against Omicron, and their use at Tufts Medical Center has been suspendedThere is one monoclonal antibody product active against omicron, and Tufts Medical Center hopes to have that product in use shortly.
  • Intravenous remdesivir can be given as an outpatient to high-risk patients within the first few days of a COVID-19 infection to reduce the risk of hospitalization and severe COVID-19 (similar to the monoclonal antibodies) but requires once daily IV infusions for 3 days in a row. 
  • Oral antivirals, despite emergency use authorization by the FDA, will not be widely available for months.
Testing
  • Patients can use rapid in-home antigen testing, which is effective at detecting omicron as well as prior viral strains; however, false negatives can occur, especially in asymptomatic patients and early in the course with symptomatic patients. Patients testing early after symptom onset who get a negative antigen test result should retest 24-48 hours later for improved sensitivity.
  • Consider using rapid tests for flu and COVID-19 in your office.
New CDC Recommendations for Isolation and Quarantine
Guidance for the General Public
CDC has substantially changed the recommendations for Isolation (symptomatic illness or positive test) and Quarantine (COVID-19 exposure) for the general public. The new recommendations are summarized in this table.

Guidance for Healthcare Personnel (HCP)
CDC has released new guidelines concerning healthcare workers’ return to work following a COVID-19 diagnosis. These guidelines differ depending on the degree of staffing constraints being experienced by an organization.

  • Click here for a CDC chart outlining Work Restrictions for HCP With COVID-19 Infection and Exposures.
  • Wellforce is in contingency status in terms of staffing and is moving to a protocol of releasing employees from isolation after 5 days, rather than the standard 10 days.
  • Wellforce employees must follow the self-clearance protocol below and speak with their manager before returning. Employees who have been in an ICU during their current illness or are severely immunocompromised, as defined by CDC, cannot follow this policy and must be cleared by employee health to return.

Self-Clearance Protocol Check List
_____ I have not had a fever (100.4 F or greater) in the last 24 hours.
_____ I have not taken fever-lowering medication (such as acetaminophen or ibuprofen) in the last 24 hours.
_____ If I have a cough or shortness of breath, it has been improving for at least the last 24 hours and I am comfortably able to wear a mask for the duration of my shift.
_____ I have not had vomiting or diarrhea in the last 24 hours.
_____ I am not moderately or severely immunocompromised, as defined by the CDC. (See definition below)
_____ I have not been in the ICU as a result of my current illness.
_____ I feel well enough to work and fulfill my job duties.
Office Practice Tips
We are all seeing the enormous harmful effects of delayed care; let’s make sure that it is safe and that patients know it is safe to come into your office.
  • Review your triage protocols.
  • Make sure you are allocating your staff resources wisely
  • Arrange your schedule with blocks of telehealth and face-to-face time to reduce “switching cost”; have a chunk of telehealth time as part of every session.
Telehealth Visits
  • Tune up your telehealth processes.
  • Consider starting every visit as Telehealth.
  • Many issues do not require physical presence and there is still payment parity for primary care (and chronic disease management even done outside of primary care) through fall of 2022. (Behavioral health has permanent rate parity.)
In-Person Visits
  • In-person visits can be done safely with appropriate precautions
  • Patients should not be tested for COVID-19 only in order to come into the office for an unrelated reason.
  • Anything that does require physical presence (physical exam, test, procedure/treatment) can be booked as a short add-on visit after an initial evaluation by telehealth.
  • Recommended PPE includes a surgical mask OR surgical and cloth mask for better fit OR N95 mask with good fit/tight seal; gloves; gown and eye protection, as needed.
  • Try to avoid patients meeting face to face; distance or close off waiting room, have patients wait in their cars and call the office to find out when to come in; stagger appointment times, if needed.
  • Go back to doing as much as possible in exam room or remotely before/after visit.
  • Reassure patients by letting them know what you are doing to keep them safe (Safe With Us Wellforce communications campaign, website/Facebook or other social media, outgoing phone message, portal or email addendum, broadcast message explaining what you’re doing to keep patients safe).

Please feel free to reach out to any member of the Wellforce Clinically Integrated Network Clinical Leadership Team with questions.

Ben Kruskal, MD                             
Senior Medical Director
Wellforce Clinically Integrated Network

WCIN Clinical Leadership Team:
The Wellforce Clinically Integrated Network is a distinctively different population health enterprise and value-based care contracting entity. It comprises 2,300 primary care and specialist physicians and advanced practice clinicians, in private and employed practices, working in community and hospital settings. The Network’s purpose is to build healthier communities and to create healthy, rewarding experiences for our participating physicians and care teams. The Network was launched in July 2021 by building upon the legacies of two long-standing, high-performing organizations – Lowell General Physician Hospital Organization and New England Quality Care Alliance (NEQCA).