COVID-19 Conversations From A Provider's Perspective

"If we tried to do it alone, it was not going to work."

Three Virginia health system executives participated in a virtual discussion about COVID-19 from a provider’s perspective. The hour-long program was part of the 16th Annual Virginia Health Care Practitioners’ Roundtable sponsored by the Virginia Bar Association’s Health Law Section Oct. 22. Here is one summarized excerpt from that conversation.

Panelists:
   J. Corey Feist, CEO, University of Virginia Physicians Group
   Paul Neimeyer, Chief General Counsel, VCU Health System
   Lou Patalano, Chief Legal Officer, Sentara Healthcare
Moderator:
   Jonathan M. Joseph, Christian & Barton

[Jon Joseph] Paul, have you noticed a different kind of issue coming across your desk involving the front-line workers since the pandemic?

[Paul Neimeyer] I think originally there was a coping mindset in that rules no longer apply as we need to save lives. My position is absolutely we need to save lives, and let's think about the right way to do it. But I think the biggest part is how to best support the front lines. Physician burnout was a concern pre-COVID, but now we're looking at a global burnout of medical staff, nursing staff, and administrative staff. Our overall theme is to support our team versus making life harder. We need to provide support because the team is getting challenges at work, and they're getting challenges at home, such as virtual schooling and child care plans.

[Jon] Virginia was on the forefront of employment protections put out by the Department of Labor and Industry. Were you getting questions about these new rules?

[Paul] Yes and I had two attorneys monitor various websites every day to stay up-to-date on guidance changes. HR and the legal department were hand-in-hand for a hundred different issues, and the summer I think, was the hottest period.

[Jon] Lou, do you think any of the changes that you've made since the pandemic began will be permanent after it's over?

[Lou Patalano] I'll answer that question from a health system perspective and from a department perspective. From the health system perspective, I think telehealth is here to stay. Patients find it easy and convenient and there will be strong adoption. So our system will have to figure out what that means for staffing and scheduling.

From a department perspective, I think work-from-home is a reality. I have always been willing to have folks work from home, but it is difficult to monitor metrics and build relationships. A lot can get done with hallway conversations. I also want to build on Paul's point about partnering with our employees and front-line employees. The Virginia DOLI guidance was an opportunity to partner with HR and build a relationship of trust during the pandemic.

[Jon] Corey what was your perspective on changes that you've implemented?

[Corey Feist] From a clinical perspective, telemedicine in a schedule is a real challenge. When everyone was home, it was much easier because that was the only way. It's hard for a clinician to move between seeing a patient in a room and then going into a telemedicine consult and trying to figure out operationally how to do that. I think telemedicine is here to stay, it’s just determining how to make it work and have the service reimbursed. When I review our accounts receivable and our outstanding bills, frankly, it's the telemedicine cluster that is growing. That's one area we've got to bring more clarity to so that we can really use it efficiently.

I too think remote work is here to stay in some capacity. The questions will be how to decide who is a required work-from-home person versus who must come to the office, and navigating when we return to the office. Safety is a factor and let me just say, I think issues around child care are enormous. We have practices in rural areas, so we have individuals who have to be in a clinical environment and they have to be home. And frankly, we've lost people because they've decided they have to be home with school-age kids. So I think we've got some real employment challenges, but we've got to figure out how we work administratively and efficiently from a remote perspective and leverage it. We actually can draw from a larger geography for certain hard-to-recruit positions. So it's this interesting balance between those positions that have to be physical and those that can be remote. How do you get those staffed, how do we do that going forward, and how do we leverage the people working remotely?

[Jon] Paul, have you noticed an overall increase in staff attrition?

[Paul] No, I don't think we've seen a big turnover. I think one key was pre-COVID we had already started down the road of reaching out as physician burnout was on our radar. These efforts definitely got jumpstarted when COVID hit. I think the support mechanisms that we put in place have helped also. We circulated information about establishing temporary day care to connect staff members with the local YMCA that was offering it. Even if staff didn't take advantage of the efforts, they knew we cared and were supportive.

We took the position that our goal was not to furlough, and the message bode well in terms of support of the health system. I think the overall decision was that the dollars saved were really not worth it as people could be used in other areas. So the message was we're here for you, we're supporting you, we need you, and you are all essential. The goal is to keep you. You might be working a little bit differently, and you might be working a little bit more, but you matter. Like some other health systems, we gave appreciation bonuses to director levels and below, and physician staff. Not a lot of dollars, but I think it demonstrated a credible appreciation for people who were working really hard. So I think those things helped overcome some of the issues they were dealing with at home and helped retention.

[Jon] At one point there were plans to expand the number of beds into the convention center. Did you have contingency plans for that scenario?

[Paul] Yes there were contingency plans, which was a collaboration between all of the Richmond-area health systems. Competitor gloves were off as collectively we needed to make sure we all staffed and supported the plan so health care would be provided. Because in the end, if we tried to do it alone, it was not going to work.

Other conversations in this series:


This summary has been edited for clarity and length. It has been provided as an informational service and does not constitute legal counsel or advice, which can only be rendered in the context of specific factual situations. If a legal issue should arise, please contact an attorney listed or retain the assistance of other competent legal counsel. Case results depend on a variety of factors unique to each case and results do not guarantee or predict a similar result in any future case undertaken.

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