Introduction
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MEDICINE IN THE TIME OF COVID
ust as the 1793 Yellow Fever outbreak in Philadelphia and the Spanish Flu Pandemic changed medicine, public health, and society, the COVID-19 pandemic is changing the practice of medicine. Some of these changes are likely to persist over the long term. This article provides a brief summary of some of the key changes in the laws and behaviors impacting current practice, and some guesses as to which of those changes are likely to persist.
Executive Orders and the Practice of Medicine Current Impact. Since March 19, 20201, Governor Ducey has issued nearly fifty Executive Orders relating to COVID-19. Several of these orders affected the practice of medicine. For example, one of the Orders2 required physicians to delay “non-essential or elective surgery”; a subsequent Order3 directed the Arizona Department of Health Services to establish rules regarding whether and under what circumstances those surgeries could be provided. Long-Term Impact? Although these Executive Orders and similar orders issued by other executives are likely to be the subject of many policy papers and Law Review articles, addressing whether the orders exceeded the executives’ legal authority, there have been few if any challenges to the orders. This may be a consequence of the dire circumstances in which the orders were issued. In any event, it seems likely that the issuance of these orders will have little if any impact on the practice of medicine over the long term.
Regulatory Relief Current Impact. Several federal agencies have relaxed the restrictions their regulations impose on physicians.4 For example, CMS initiated its Patients over Paperwork program, which directed federal agencies to “‘cut the red tape’ to reduce burdensome regulations.”5 Among other things, this program temporarily relaxed: restrictions imposed under the “Stark law”; coverage restrictions imposed under NCDs and LCDs6 relating to items or services used to treat COVID-19 patients; signature and proof of delivery requirements for Part B drugs and durable medical equipment; and, a host of requirements and restrictions relating to telemedicine. The DHHS Office for Civil Rights, which enforces HIPAA, also relaxed rules relating to enforcement (see, e.g., the discussion below regarding telehealth). Long-Term Impact? A permanent relaxation or elimination of these restrictions probably would require cooperation between the two political parties and their appointees. A belief that the necessary cooperation will occur probably requires a triumph of hope over experience. Therefore, with the possible exception of telehealth, described below, long-term changes regarding regulatory relief do not seem likely.
Liability Relief Current Impact. There have been several state and federal initiatives that purport to provide liability protections Fall 2020 | arizonaphysician.com
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