COVID-19 Update – April 14, 2020
AMA Guiding Principles for Residents & CMS Blanket Waivers

As of April 13, there are 886 confirmed cases of COVID-19 in Alameda County and 23 deaths (including City of Berkeley information). As of April 13, there are 552 confirmed cases of COVID-19 in Contra Costa County and 11 deaths. Please check  www.accma.org/COVID-19   for the latest updates.   
AMA Guiding Principles to Protect Residents & Fellow Providers Responding to COVID-19

There are over 135,000 residents and fellows (“residents”) working in graduate medical education (GME) programs in the United States. They are participating in supervised clinical experiences that will qualify them for certification and independent practice in a wide array of medical specialties. While acquiring this experience, residents are the frontline physician workforce in the health systems that employ them.

In managing the engagement of residents during the response to COVID-19, the AMA Council on Medical Education strongly supports observance of the following principles by programs, sponsoring institutions, and national organizations:

  • Residents must be actively engaged in COVID-19 response planning regarding deployment of health care workers, including field promotion of fellows to attending roles, in order for the specific interests of trainees to be considered.

  • Residents must be free to raise concerns about their personal safety and the safety of those around them without recrimination or consequence to their employment and training.

  • Residents must have access to, and instruction in, the use of adequate personal protective equipment (PPE), as should all health care workers.

  • Residents deployed to clinical areas with which they are unfamiliar must receive appropriate training and supervision for the tasks they will be asked to perform.

  • Residents who become ill as a result of their participation in the COVID-19 response must not be required to use vacation and/or personal time off while ill and/or quarantined. Residents who require leave under these circumstances must continue to receive their salary and benefits.

  • Sponsoring institutions and residency programs must continue to comply with the Accreditation Council for Graduate Medical Education (ACGME) requirement to provide access to confidential, affordable mental health assessment, counseling and treatment, including access to urgent and emergency care 24 hours a day, seven days a week.

  • The clinical work that residents perform during the pandemic response must be considered in assessments of a trainee’s qualifications for program completion. Where possible, credit should be given for the work residents are doing during this time.

  • The ACGME review committees (RCs), the American Board of Medical Specialties (ABMS) specialty boards and the American Osteopathic Association (AOA) specialty boards should consider their program and certification requirements, in light of the pandemic, to allow flexibility in assessments of the competence of trainees. Where possible, these assessments should not delay program completion nor eligibility for certification.

  • Residents must be permitted to remain in their programs to complete necessary requirements that qualify them for board certification. They must continue to receive salary and benefits and have access to necessary clinical experiences.

  • Residents should be candidates for hazard pay in a way that is equitable to other health care workers.

  • Residents should be granted forgiveness and/or forbearance for all or portions of their student loan debt to ease the financial stress they may experience in caring for themselves and their families. This is particularly important during this time of compromised access to opportunities to supplement their income, such as moonlighting.

  • Fellows who assume attending physician roles in core disciplines in which they are licensed and certified should receive pay and benefits commensurate with these roles. The impact of this activity on progress toward completion of the training program must be openly discussed with fellows prior to them assuming these responsibilities.

  • The Centers for Medicare & Medicaid Services (CMS) should ensure flexibility in GME reimbursements to hospitals to accommodate variations in training due to the COVID-19 response. This flexibility should lengthen the initial residency period (IRP) for residents to allow them to extend their training, if necessary, to meet program and board certification requirements. In addition, CMS should expand the residency funding cap at institutions where residents must extend their training, in order to support an increased number of residents, as new trainees begin, while existing trainees remain to complete their programs.

  • As hospitals and health systems confront the economic impact of the pandemic response, we urge early consideration of effects on the training environment and the sustainability of GME programs. Health systems should also proactively manage opportunities for residents to continue their professional development.

  • In the event of program contraction or closure that may result from the pandemic response, disruptions to resident education may be mitigated through active planning for resident relocation. In the event of closures, the AMA stands with other organizations ready to assist should the need arise.

Read more about these new AMA proposed guidelines here.
COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers  

CMS has taken proactive steps through 1135 waivers to rapidly expand the Administration’s efforts against COVID-19. As a result, new blanket waivers have gone into effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration
Alameda & Contra Costa County Recruiting Physicians for COVID-19

East Bay physicians can support COVID-19 response efforts through paid and/or voluntary service opportunities through the Alameda County, Contra Costa County, or the State of California. Please visit accma.org/COVID-19 and scrolling to "COVID-19 Volunteer Opportunities" for application instructions.
PPE and Supplies - County Request Forms

The following is information about placing orders for PPE and other medical support through County resource allocation processes:


  • Contra Costa County: All Resource Requests should be submitted using the attachedCCCHS Request Form. If requesting PPE, must also complete attached “Medical/Health Items Provider Questionnaire" (found on the first page of the CCCHS Request Form). These forms should be submitted directly to the CCHS DOC Logistics Section at doc.logistics@cchealth.org. Per CCHS, you should first work within your vendors and systems first before sending requests to the DOC.
CMA Releases Financial Impact Survey

CMA has released a survey requesting input on the financial impact COVID-19 has had on physician practices. If you have not already completed the survey, please take a minute to submit your response no later than April 15, 2020 .
Complimentary Peer Discussion Groups
 
RechargedMD  is offering ACCMA members  complimentary online peer discussion and coaching specifically for physicians. With the guidance of a certified physician coach, physicians can receive and offer support, as well as learn from one another. Small groups will meet beginning on April 25 for 45 minutes per week for three facilitated sessions. Go to  rechargedmd.com/covid19support
ACCMA Resources Toolkit
 
The ACCMA has put together a free toolkit of resources that address the day-to-day needs of East Bay physicians of all career stages and in all modes of practice, from food and grocery delivery services to exercises that can be done at home. Click here to access and download the toolkit.  
Upcoming Webinars
Presented by the American Medical Association
Wednesday, April 15, 2020 | 12:00 PM - 1:00 PM | FREE

The COVID-19 outbreak has had many rapidly evolving impacts on medical education. With concerns for student safety, the Association of American Medical Colleges appropriately recommended (as of March 17) that student engagement in the direct care of patients be suspended. Some medical schools are graduating students early so they can assist in treating COVID-19 patients. This webinar will discuss the complex perspectives and issues related to early transition into provider roles.
Wednesday, April 15, 2020 | 12:30 PM - 1:30 PM | FREE

Anjali and Mary Jean will present on the changing landscape of telemedicine reimbursement what it was in the past, where it is now during the National Emergency, and probable future outcomes based on her experience and insight. Additionally, she will provide practical guidance on coding to avoid fraud and abuse issues to avoid post-pandemic audits and investigations. To register , please click here and complete the form at the bottom of the page. Please note that completion of the form will register you for the whole Telemedicine series, so if you are interested in attending more than one webinar, please only submit the form once.

Presenters:  
Anjali Dooley, Managing Partner of Law Office of Anjali B. Dooley, LLC  
Mary Jean Sage, The Sage Associates 
Presented by the Centers for Disease Control and Prevention
Thursday, April 16, 2020 | 11:00 AM - 12:00 PM | FREE

During this COCA Call, presenters will provide an overview of the importance of mortality data, discuss the NCHS publication and the guidance it provides to clinicians who may need to certify a death involving COVID-19, and present a summary of COVID-19 surveillance through the NVSS.
Friday, April 17, 2020 | 12:30 PM - 1:30 PM | FREE

Telemedicine is the new normal for patient care through the COVID-19 Emergency. This webinar will focus on using telemedicine to enhance patient-centered care, including exploring new and upcoming technology solutions that will help support physicians in providing optimal person-centered care to patients. To register , please click here and complete the form at the bottom of the page. Please note that completion of the form will register you for the whole Telemedicine series, so if you are interested in attending more than one webinar, please only submit the form once.

Presenters:  
Michael Harbour, MD
Monday, April 20, 2020 | 12:30 PM - 1:30 PM | FREE

With the COVID-19 Emergency requiring physicians to adopt telehealth and position more of their staff to work from home, important patient privacy and security risks emerge. This webinar will address those along with practical tips for compliance. To register , please click here and complete the form at the bottom of the page. Please note that completion of the form will register you for the whole Telemedicine series, so if you are interested in attending more than one webinar, please only submit the form once.

Presenters:  
David Ginsberg, co-founder and president of PrivaPlan Associates, Inc. 
Allen Briskin, Senior Counsel, Pillbury Winthrop Saw Pittman LLP 
Wednesday, April 22, 2020 | 6:00 - 7:00 PM | FREE

This one-hour webinar led by Linda Hawes Clever, MD, MACP, will offer practical, creative, and effective remedies to deal with the crush on personal and professional lives during the COVID-19 pandemic. It will start with some strategies, resources, and suggestions and then quickly evolve to questions and answers, as we listen and see the ingenuity, guts, and devotion with which we are addressing the harrowing challenges we all face as a profession, community, and nation. Participants will discover how to r educe personal stress and learn healthy ways to contend with the impact of COVID-19.

You are encouraged to submit questions in advance to help her address the range of clinician concerns and responses to the crisis. And you can also briefly share any personal tips and practices that are helping you during this difficult time. Please send your questions and comments to ccaufield.renew@gmail.com.
Thursday, April 24, 2020 | 12:30 PM - 1:30 PM | FREE

To register , please click here and complete the form at the bottom of the page. Please note that completion of the form will register you for the whole Telemedicine series, so if you are interested in attending more than one webinar, please only submit the form once.

Panelists:  
Marc Dean, MD 
Uli K. Chettipally, MD 
Richard Thorp, MD
Questions/Concerns?  

Please contact ACCMA at 510-654-5383 or accma@accma.org with any questions or concerns you have. Although we may not currently have an immediate answer to all questions, we want to know the information and resources that you need to continue to provide care for our community during this difficult time.  
 
This information will also be posted online at www.accma.org/COVID-19 and will be updated frequently. Please check the ACCMA website regularly for updates.