How will you handle possible stop to elective surgery?

[dabears505]

Just wondering if any of you guys have thought about how your group will go about things if hospital forces stoppage of elective cases.

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[Peterluger]

At this point it seems that what’s probably equally likely is patients voluntarily not showing up for elective surgery. I mean at this point, is it even wise for patients to show up at a hospital unless actually necessary?

 

[deleted171991]

Expect all hospitals stop doing elective surgeries and cut down on outpatient clinics in the next 7-10 days.

 

[nimbus]

Netflix and chill

 

[deleted126335]

Simple:

If an employee, try real hard to collect my paycheck and resist burning vacation or taking unpaid time off. Submit any CME or other reimbursed expenses ASAP in case my employer goes under in the future.

If an owner try real hard not to write those paychecks so I don't go under.

 

[deleted171991]

Physicians should expect that they will be needed to man the front lines. You may not do elective surgeries, but you may have to help with a lot of ICU-type work, not just intubations. The average place may not have enough intensivists to cover all the cases alone.

 

[Mman]

we have been contemplating what it would look like if the hospital needed to turn operating rooms into ICUs

 

[kmurp]

I expect that much of our elective schedule will be cancelled. Currently, our surgery center is closed, most electives cancelled and the entire ortho dept is on home quarantine. one third of my dept on home quarantine.

 

[dhb]

Physicians should expect that they will be needed to man the front lines. You may not do elective surgeries, but you may have to help with a lot of ICU-type work, not just intubations. The average place may not have enough intensivists to cover all the cases alone.

How are you going to get paid to do this?
Can you be forced as an independant contractor to do this?

 

[dannyboy1]

How are you going to get paid to do this?
Can you be forced as an independant contractor to do this?

Wondering about this as well. I work for the AMC, not the hospital. If we are forced to take PTO or go on unpaid leave who pays us to “man the front lines”?

 

[marr65]

How are you going to get paid to do this?
Can you be forced as an independant contractor to do this?

Possibly might not be paid but your hospital bylaws might require you to help in this circumstance.

 

[deleted171991]

How are you going to get paid to do this?
Can you be forced as an independant contractor to do this?

You bill for the encounter, as private physicians do.

Of course you can be "forced", especially if a full-time physician. I would expect any physician who refuses to help during a period of major catastrophe ("not my job") to lose his/her medical license.

It also may be the time to say thanks to the wisdom of American lawmakers, who have included the agreement to "perform work of national importance under civilian direction when required by the law" in the oath of every naturalized citizen.

 

[dannyboy1]

Possibly might not be paid but your hospital bylaws might require you to help in this circumstance.

Lol. I have credentials at a few hospitals? Who gets dibs? Pretty sure they cannot force me to work without pay. Nevermind the fact that most of us are not ICU docs or credentialed by our hospitals to perform ICU care ....

 

[VA Hopeful Dr]

Lol. I have credentials at a few hospitals? Who gets dibs? Pretty sure they cannot force me to work without pay. Nevermind the fact that most of us are not ICU docs or credentialed by our hospitals to perform ICU care ....

That may be true but I would trust y'all in an ICU before the OBs, ortho, path, derm, psych, ophtho, you get the idea.

I would also hope the average anesthesiologist would be better at ICU care than even us FPs as well.

 

[deleted171991]

Lol. I have credentials at a few hospitals? Who gets dibs? Pretty sure they cannot force me to work without pay. Nevermind the fact that most of us are not ICU docs or credentialed by our hospitals to perform ICU care ....

Are you a naturalized citizen? If yes, then they can (your state/country, not your hospital).

And, regardless, if you're in this profession for the money, the public doesn't want you to have a medical license. So think twice before saying No; it may bite you later.

Not to mention the Hippocratic Oath and other "minor" ethical issues...

 

[GravelRider]

I keep 6 months of emergency funds. Doesn’t anyone else see a problem that our hospitals run on such razor-thin margins that we are wondering if a stoppage in elective surgeries would cause such economic calamity for these hospitals within days to weeks? Maybe they should have thought about the possibility of mass casualty situations before they built that water fountain in the lobby?

 

[dannyboy1]

Are you an immigrant? If yes, then they can (your state/country, not your hospital).

Born in the USA
Again, not to be that guy but besides for the payment issue there are a whole lot of other problems. ICU care is a specialty that people spend years of fellowship training for. There are standards of care that need to be followed. Is the average anesthesiologist really up to date with prolonged mechanichal ventilation, DVT/GI prophylaxis, therapeutic bronchoscopy, tube feeds, following chest x rays, sedation weaning protocols ect. Hell, i suspect even writing a coherent progress note would be a challenge for many. What would our role be? We are attending physicians. Would we work as glorified ICU nurses? Would the ICU attending be the attending of record? What about liability? Does our malpractice even cover this scenario? The American healthcare system is just not set up for this sort of thing....

 

[Peterluger]

I wonder how these 1099 mf’ers in Los Angeles who get paid per case are gonna be doing a month from now. Not that they were doing particularly well in the first place.

 

[nimbus]

Born in the USA
Again, not to be that guy but besides for the payment issue there are a whole lot of other problems. ICU care is a specialty that people spend years of fellowship training for. There are standards of care that need to be followed. Is the average anesthesiologist really up to date with prolonged mechanichal ventilation, DVT/GI prophylaxis, therapeutic bronchoscopy, tube feeds, following chest x rays, sedation weaning protocols ect. Hell, i suspect even writing a coherent progress note would be a challenge for many. What would our role be? We are attending physicians. Would we work as glorified ICU nurses? Would the ICU attending be the attending of record? What about liability? Does our malpractice even cover this scenario? The American healthcare system is just not set up for this sort of thing....

Nobody is set up for this sort of thing. Reports from Italy said they had orthopedists and pathologists helping in the ICU. Hopefully they had some guidance from intensivists. If we run out of ventilators, we’ll be using anesthesia machines which is a black box for everyone else.

 

[nimbus]

I wonder how these 1099 mf’ers in Los Angeles who get paid per case are gonna be doing a month from now. Not that they were doing particularly well in the first place.

Collecting AR. Income will surely take a hit but collections will taper gradually.

 

[Mman]

Born in the USA
Again, not to be that guy but besides for the payment issue there are a whole lot of other problems. ICU care is a specialty that people spend years of fellowship training for. There are standards of care that need to be followed. Is the average anesthesiologist really up to date with prolonged mechanichal ventilation, DVT/GI prophylaxis, therapeutic bronchoscopy, tube feeds, following chest x rays, sedation weaning protocols ect. Hell, i suspect even writing a coherent progress note would be a challenge for many. What would our role be? We are attending physicians. Would we work as glorified ICU nurses? Would the ICU attending be the attending of record? What about liability? Does our malpractice even cover this scenario? The American healthcare system is just not set up for this sort of thing....

We are all just brainstorming for worst case scenarios at hospitals that will not have enough ICU beds, let alone enough ICU physicians. I'm assuming from a liability point of view you are becoming some sort of good samaritan as long as the hospital documents they do not have the resources for normal levels of care.

You put the sickest of the sick patients in regular ICUs with regular ICU teams and then you expand out where the less critical ones are in makeshift ICUs with weird staffing. I mean there won't be enough ICU nurses or docs to cover everyone. All hands on deck. Anesthesia and ER probably the closest thing compared to many other specialties.

 

[Shimmy8]

We're likely to get emergent critical care privileges at the hospitals we cover. Meetings about all this are happening today.

 

[caligas]

sounds like my (anesthesia) billing office may be about to get a crash course in coding for critical care charges.

 

[deleted171991]

sounds like my (anesthesia) billing office may be about to get a crash course in coding for critical care charges.

Easiest thing in the world (it's time-based), as long as the patient is truly critical: CPT codes 99291 and 99292.

Understanding and coding for critical care services - www.hcpro.com

CMS defines critically ill and injured patients as those who are experiencing one or more vital organ failure(s) and who have a high probability of life threatening deterioration in their condition. Lois E. Mazza, CPC, PCA, helps clarify coding for critical care services and addresses how to...

www.hcpro.com

Report Critical Care - The Hospitalist

Strict guidelines and case detail must support these time-based codes

www.the-hospitalist.org

How To Avoid Medicare Denials for Critical-Care Billing - The Hospitalist

The basic principles of documentation for services provided to critical-care and injured hospital patients

www.the-hospitalist.org

 

[nimbus]

sounds like my (anesthesia) billing office may be about to get a crash course in coding for critical care charges.

Don’t know if insurance company actuaries account for events like this. Even if they don’t go bankrupt, we may not get paid.

 

[Mman]

We're likely to get emergent critical care privileges at the hospitals we cover. Meetings about all this are happening today.

I mean you already have privileges for intubating people, placing lines, managing ventilator, titrating pressors, etc. What most anesthesiologists don't have is admitting privileges although with the sort of weird ICU type settings that may be seen in some places I don't even know what you call it or how it gets handled.

 

[deleted171991]

Don’t know if insurance company actuaries account for events like this. Even if they don’t go bankrupt, we may not get paid.

We'll do it for America, land that we love.

 

[Mman]

Easiest thing in the world (it's time-based), as long as the patient is truly critical: CPT codes 99291 and 99292.

The problem isn't going to be how to bill the problem will be that very few private anesthesia groups will have a negotiated fee with insurance companies for those codes so will likely be collecting very little. We are debating if we would just work for a flat fee from the hospital and let them bill and collect as they can.

 

[deleted171991]

The problem isn't going to be how to bill the problem will be that very few private anesthesia groups will have a negotiated fee with insurance companies for those codes so will likely be collecting very little. We are debating if we would just work for a flat fee from the hospital and let them bill and collect as they can.

I think that's a smart idea (to let the hospital bill).

 

[Arch Guillotti]

Nevermind the fact that most of us are not ICU docs or credentialed by our hospitals to perform ICU care ....

Emergency credentialing can happen in 5 minutes if the hospital wants to do it.

 

[Ronin786]

My 20% OR FTE and hospital employee salary is rejoicing. My 80% ICU FTE is battling down the hatches.

 

[narcotics999]

Get the CRNA to staff the icu. They were icu nurse before. They are more “experienced”, per aana


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[Twiggidy]

Netflix and chill

And I’m going to wear my Xbox out

 

[MirrorTodd]

Forget about what the docs are gonna do...there sure as **** aren't enough nurses to go around. Let alone any with ANY sort of critical care experience. Hell, our nurses can barely handle a routine post cabg pt.

 

[deleted162650]

And I’m going to wear my Xbox out

Your wife’s name starts with X?

 

[Vandalia]

Lol. I have credentials at a few hospitals? Who gets dibs? Pretty sure they cannot force me to work without pay. Nevermind the fact that most of us are not ICU docs or credentialed by our hospitals to perform ICU care ....

No, they cannot force you to work without pay, however, they (the medical "establishment" and the licensing boards) can most definitely make certain that you will never work again. At least as a physician.

Also, credentialing and the like goes out the window. When I did my time in purgatory as a staff officer as an AF physician in the 90's, we developed most of the contingency plans for true national disasters; most involved war scenarios but several included pandemics. This involved the military essentially taking over the direction of the American healthcare system. The necessary legislation was "pre-passed" and was available for the President's signature; I am not a lawyer so I do not know the technical details. This was designed around what could people do with at least a minimal chance of success. Dentist? Congratulations now you are doing anesthesia for minor surgical procedures. Ob-Gyn? Congratulations, now you are doing general abdominal surgery.

So if things get really bad ideas like credentials and "scope of practice" go completely out the window, and there is appropriate legislation ready for the President's signature to make that happen.

 

[okayplayer]

Clinical Issues and Guidance

COVID-19 Clinical Issues and Guidance

www.facs.org

No more elective surgery.

 

[Twiggidy]

Your wife’s name starts with X?

In between GTAV sessions

 

[Twiggidy]

The ’Hub is going to need a backup server

 

[vector2]

Clinical Issues and Guidance

COVID-19 Clinical Issues and Guidance

www.facs.org

No more elective surgery.

The lawsuit is gonna be a nightmare if there is a death from an infection contracted during elective surgery and multiple professional societies had already put out these guidelines.

 

[periopdoc]

There's a couple nurses I've been waiting for some time to bang

 

[dannyboy1]

The lawsuit is gonna be a nightmare if there is a death from an infection contracted during elective surgery and multiple professional societies had already put out these guidelines.

How would you go about proving where the infection originated?

 

[CUBR]

MGH has stopped all elective surgery.

 

[dhb]

I would expect any physician who refuses to help during a period of major catastrophe ("not my job") to lose his/her medical license.

What exactly will i be helping with? Is there a magical cure that i can mix up and save a bunch of people and be a real hero? Or will the disease run it's course independently of my intervention?
I have no desire to babysit a gomer on a vent, i'll leave that to the icu hot shots.

 

[dchz]

I would also know the average anesthesiologist would be better at ICU care than even most specialties.

I spent almost a year in ICUs in residency. Most residents out of my residency are very ICU competent.

We are all just brainstorming for worst case scenarios at hospitals that will not have enough ICU beds, let alone enough ICU physicians. I'm assuming from a liability point of view you are becoming some sort of good samaritan as long as the hospital documents they do not have the resources for normal levels of care.

You put the sickest of the sick patients in regular ICUs with regular ICU teams and then you expand out where the less critical ones are in makeshift ICUs with weird staffing. I mean there won't be enough ICU nurses or docs to cover everyone. All hands on deck. Anesthesia and ER probably the closest thing compared to many other specialties.

Everyone is brain storming, but I don't see enough people mentioning hyperbaric chambers instead of vents. May be we don't get enough exposures to hyperbaric chambers in med school, but it's a legit solution to people with isolated hypoxia as a problem:

That's a pic of it at Penn, I can easily cram 20 pts in there (assure they all have the same strain of the SARS-COV-2). Am i missing something?

 

[deleted162650]

What exactly will i be helping with? Is there a magical cure that i can mix up and save a bunch of people and be a real hero? Or will the disease run it's course independently of my intervention?
I have no desire to babysit a gomer on a vent, i'll leave that to the icu hot shots.

How are things in your neck of the woods anyways?

 

[nimbus]

There's a couple nurses I've been waiting for some time to bang

Nurses are high risk. Be sure to suit up in your PAPR before the festivities commence.

 

[periopdoc]

I'm high risk. Sharing is caring.

 

[deleted171991]

I spent almost a year in ICUs in residency. Most residents out of my residency are very ICU competent.

You almost sound like a CRNA. Go do that fellowship.

I spent 5 months in the ICU, during residency, 3 of them MICU in internship (because I wanted to). I didn't learn sh-t in the SICU, because of all the scutwork. Ten years later, the current residents still don't learn much in the same academic SICU.

Most anesthesiologists spend 4 months in SICUs, with zero MICU exposure (or maybe a month). I wouldn't allow those guys to prescribe even the DVT prophylaxis for a MICU patient. Also, there is a HUGE difference between being in the ICU as a resident and as a fellow.

These will be sick medical patients. Non-intensivists should function as residents or fellows, depending on specialty and experience, definitely NOT as primary physicians (except for really good internists).

 

[BLADEMDA]

I'm expecting this to be a relative non event by May in my neck of the woods as the heat and humidity slow the spread of the virus. Second, I think the lessons learned from Singapore and South Korea will help us keep this contained.

In the grand scheme of things we all can withstand 4 weeks of lost wages or income if needed. I simply don't see the this pandemic getting out of control despite the dire warnings from the experts.

"The C.D.C.’s scenarios were depicted in terms of percentages of the population. Translated into absolute numbers by independent experts using simple models of how viruses spread, the worst-case figures would be staggering if no actions were taken to slow transmission.

Between 160 million and 214 million people in the U.S. could be infected over the course of the epidemic, according to one projection. That could last months or even over a year, with infections concentrated in shorter periods, staggered across time in different communities, experts said. As many as 200,000 to 1.7 million people could die.

And, the calculations based on the C.D.C.’s scenarios suggested, 2.4 million to 21 million people in the U.S. could require hospitalization, potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds. Fewer than a tenth of those are for people who are critically ill."

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